a-new-year-challenge!

A new culture for a new year?

“We cannot always build the future for our youth, but we can build our youth for the future”

Readers of my last blog post will understand why I have taken time out to reflect on events, and on the personal impact these have had. During these weeks I have been lucky enough to spend time with the next generation of managers and clinical leaders – time which has been both energising and thought-provoking

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In December I spoke at a Leadership Academy workshop where Graduate Management trainees were discussing, coincidentally, the emotional impact of healthcare management. An enlightened choice of topic, and one I believe is important given my own experiences

I find Graduate Management trainees to be an impressive bunch – they remind me of medical students, with whom they share a strong passion for a vocational career in which they can contribute positively to society

I shared my experiences of managing as both a clinician and CEO. We examined the challenge of balancing ‘hard’ responsibilities, such as financial balance or target achievement, with the so-called ‘softer’ ones of ensuring that service delivery incorporates compassion, kindness, and maintenance of dignity

Drawing on the work of Yvonne Sawbridge at Birmingham University we discussed the concept of ‘the emotional labour of managing’. We debated whether a manager who is emotionally aware, accessible and strongly attuned to patient and staff concerns, might be more vulnerable in the role than their less sensitive counterparts?

We reflected too on the harsh views the public have of managers, and the personal impact caused by campaigning politicians who seek to win public favour by promising to cut their numbers. Why is this, and how could this perception be changed?

I also spoke at two learning events for junior doctors. At one of these I met my long time Twitter friend Partha Kar, an established consultant but very much an up and coming leader. (He has already published his New Year reflections here). In both groups there was enthusiasm for improving the NHS, and a willingness to contribute, that was palpable

Young Diabetologists with Partha Kar, and Donna, Vijaya and Matthew from Kings Fund

Look too at the comments on this blog from countless managers undertaking the excellent Elizabeth Garrett Anderson programme. These are managers with experience who are being developed towards senior leadership roles – they too demonstrate emotional intelligence and a strong focus on the patient

I came away from all these sessions feeling positive about the future, but my optimism was tempered. On each occasion, there was a sense in the room that they were powerless to influence the way the service is run and delivered. They knew that life can be uncomfortable for leaders who struggle to align with the culture of target chasing and harsh performance management, and they worried that it was ‘not for them’ because their values and approach did not fit with what they felt was expected. These reservations are also very evident in the comments on the EGA blog

Roy Lilley commented eloquently on this in his powerful end of year article. He talked of ‘management-by-intimidation’ and ‘institutionalised bullying’, and he supported his views with what he hears from his many readers, and with research evidence

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I worry that we have a coming generation of clinicians and managers with a strong commitment to becoming senior leaders, and a preferred style and approach that is very much in tune with the thinking of both staff and public, but who are deterred by the prevailing culture?

It is, of course, this cohort who will determine the future standards of care and service to our patients and communities, so all those in senior positions have a responsibility to nurture and support them

The next generation ‘get’ the future, and can show us the way if we care to take notice. They instinctively understand that the ‘social era’ has arrived, meaning that connections and common purpose are more important than institutional isolation and vested interests, and that collaboration and co-creation will produce a better outcome than hierarchy and central direction

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My New Year challenge to all those with influence is to heed the words of Roosevelt at the top of this article, and start building a new culture in the NHS through our up and coming leaders

Listen to them, and embrace their views and their values. Understand that a culture of dictat, inspection, penalties and blame demonstrates a lack of trust and belief in those charged with delivering services to patients, because it only makes sense as an approach if all performance shortfalls are caused by incompetent leadership

Instead, recognise that the most difficult challenges we face, such as the ‘winter crisis’, are highly complex and not anyone’s fault, and move towards a collective, problem-solving, approach in which support, empowerment and trust are watchwords

In closing…heartfelt thanks to the hundreds of people who sent me messages of support and encouragement in recent weeks. They were very much appreciated, and they have provided the basis of the challenge in this article

Some updates:

I will be continuing to write on this blog, and indeed to invite more guest writers, during 2015. It will have a new look soon, but keep the same web address

My Consulting site is under development, and will be separate

The , run by my daughter and myself, is continuing, and will also be refreshed for 2015. Please do continue to let Emily know if you write a blog, or have seen a blog, that we can include

Thank you for your support, and very best wishes for 2015!

Paul Malyan

Hi Mark,

I am also a participant on the EGA programme and completed my first residential last week. I find it an interesting view that people feel powerless to influence service design. I think that both individuals and teams can achieve a great deal, however we as a health service need to get much better at managing the expectations of the workforce, patients and carers.

It seems that many frustrations arise as people struggle to deliver a service where resources do not match demand. This would push even the most determined person to a frustrated and potentially jaded state over service provision. Managing expectations through good use of emotional intelligence and reasoning may not resolve resource gaps, however it will clarify what can be done and when and make potential conflict situations far less likely, therefore fostering goodwill and positive working.

A factor that really resonated with me was to act on our own trigger points, be aware of expectations and manage these in light of the information and resources available. We can build on optimism through realism – small incremental changes supported by emotionally intelligent actions to improve our healthcare service for all.

MarkN

Thanks Paul. I guess the total resource is not going to change much, given the economic situation and competing demands. I would agree that it looks insufficient currently, but the big question is whether this will remain the case if care models and working practices were to change significantly? Certainly we cannot afford the current model, which anyway cannot cope with the rising demand.

Dave Hammond

Hi Mark

A thought provoking post, thanks.

I’m currently on the EGA programme and fortunate to be studying alongside those emotionally-intelligent managers you mention, as well as working with more of them in my own trust.

I observe people doing their best to square the circle and manage the conflicting demands of time, cost, quality and people. Those who seem best at it are those who take an optimistic view and don’t see high quality as a product only of high cost. However, at some point, there must be a floor below which cutting costs in a given system makes high quality hard or impossible to deliver, and at which setting targets no longer supports better performance.

I wholeheartedly agree that a patient-centred, values-based approach is a core component of the future we want but can be undermined by systems that don’t support this. A focus on individual organisations, targets and penalties is less productive than a holistic approach that is geared to making whole systems operate most effectively.

There is clearly work to be done at all levels, and massive interdependency. The FYFV recognises that optimising the operation of health economies is necessary for the ongoing provision of safe, high quality and compassionate care to individual patients. And there are the ongoing challenges of allocating resources, improving lines of management and communication (within and between organisations), motivating people and aligning incentives to the outcomes we really want: happier, healthier, longer lives.

I appreciate there is nothing new or radical in the above but, to end on an optimistic note, the prevailing culture can only be a product of the people involved. This suggests, I hope, that the culture we are creating together can move us in the direction you describe.

Thanks Dave, good comments. The prevailing culture is indeed a product of us all, and if the comments here from those on the EGA programme are representative of our developing leadership then I’m sure it will change. At the same time, I expect the system levers and incentives to shift too, because they aren’t fully aligned around the need at present I agree