Stop, look up, and breathe; how to thrive in the NHS environmentby Rita Symons (1 Comment )
How do you break the daily cycle of urgency and find time to look ahead? With so much change in the NHS, you could be finding the day-to-day ‘hamster wheel’ overwhelming. Our guest writer Rita Symons (BSc, MSc, PCert.), writes about the necessity of allowing space to focus, and offers guidance on how to not only survive but thrive in the NHS today.
How many of us have long forgotten the New Year’s resolutions about work life balance and going home on time? In an increasingly pressurised day to day environment in the NHS, how do leaders stay resilient and allow space to focus on the significant challenge of transforming the system?
There is much literature about change in the NHS and why it does and doesn’t happen. We are moving in theory from a leadership paradigm of heroic leadership to one of system leadership. It could be argued the behaviours in the system haven’t caught up and all too often leaders are directed to focus on the urgent, not the important.
It may be relevant to apply theories of human motivation in this context. Ford (1992) identifies four key requirements of complex change, which can be paraphrased:-
• The motivation to get going
• Skills to construct and implement a plan
• The right tools and structures to adapt
• The cooperation of a responsive environment that will facilitate, or at least not excessively impede, progress towards the goal
He concludes that if any element is missing, goal attainment will be limited.
So what could this mean for us in the NHS?
Most senior leaders in health and care are motivated by strong values and a wish to improve patient outcomes. We know from work such as that undertaken by the Nobel Prize winning Kahemann (2011), however, that individuals are naturally risk averse and do not respond best in a high fear environment.
In my own research, I concluded that there is still a focus on the individual organisation not the system and a subsequent misalignment of incentives.
One would hope this will start to change in the next phase of Sustainability and Transformation Plan (STP) development. Jason Helgerson and Juliette Price, in a recent blog for the NHS Confederation discuss the importance of shared measurement in system change. It feels like this is an area which requires more focus.
So, it feels like the stars are not yet aligned with respect to the system we work in and we are not quite in a place where we have an ‘authorising’ environment. What then does this mean for individuals in the system?
Leaders brave enough to step up to lead across systems need to equip themselves with the best tools and the best people. They also need to pay attention to the theory of change.
Kotter and Cohen (2002) cite eight stages of successful change management in organisations. They are:
• push urgency up
• put together a guiding team
• create the vision
• remove barriers to action
• accomplish short term wins
• keep pushing for wave after wave of change
• create a new culture to make it stick’.
This seems obvious but in terms of the environment in the NHS it may be difficult to achieve all these elements.
Reflecting on my own personal experience of leading a change programme across nine organisations, I certainly did not pay enough attention to ‘removing barriers’ and ‘focussing on short term wins’.
From the point of view of individual leaders, clear purpose is a requisite, but this needs to be combined with a real focus on self-care.
Resilience is a much used word, but the importance of maintaining good physical and mental well-being; maintaining family relationships and developing acceptance where appropriate needs dedicated time and effort.
Different tools work for different people, but think about building ten minutes of meditation or mindfulness practice into your day to still the mind, just for a moment.
In my coaching practice, I see many senior leaders and managers on the hamster wheel, unable to focus on the long term goals because they are so busy swirling around in the here and now.
To those people, I would say, stop, look up and breathe. In the current political context this might feel like naïve advice, but step off the hamster wheel and look into the hopeful future.