COULD SELF-MANAGEMENT SAVE OUR HEALTH AND CARE SYSTEMS? – INTEGRAL EUROPEAN CONFERENCE PRESENTATION 2018
By Anna Betz and Jane Pightling for Enlivening Edge Magazine Part 1
The role of transformative listening in transforming self and organisations
When both staff and patients have a lot of re-learning to do, we need to develop more advanced skills to listen more deeply to each other, to our own and each others’ values and motivations. We need to learn what it takes to use knowledge wisely to co-create health with individuals and communities.
Liberating creative potential encourages the emergence of new insights and practices which is evidenced by the newly formed Wellbeing Teams in the UK. The healing of our broken health and social care systems will require active support of self-care, facilitation of self-knowledge, and working in a highly relational way.
This work of healing is inseparable from the way we organise our larger systems of health and care.
Courageous and visionary leaders who really care for the system as a whole, and staff who are ready to live their values by working with patients in a way that is empowering, are starting to come together to co-create more dynamic organisational structures. The art of listening is central to this transformative work.
Initiatives such as Making Every Contact Count and Shared Decision Making and Health listen to citizens and support them to feel responsible for their own health, and to make lifestyle choices that will enable them to live the life they aspire to lead. This allows them to discover and keep doing what matters to them.
If we want to succeed in co-creating healthy systems and health-generating communities, we need to listen from a broader, less outcome-fixated perspective, and create together the conditions that become a fertile soil for the emergence of innovative ideas and practices. Professionals will need to redefine relationships with citizens, and to recognise that we can add value only if we co-produce a solution that recognises the citizen’s strengths, and focuses on what matters to them.
Similarly, our organisations need to redefine relationships with our communities. They need to learn to listen without trying to control outcomes, start giving space to communities, and intervene only when invited to help or requested to do things that the community cannot. In this article Anna discussed this aspect in more detail.
Jane lives and works in a community that is encouraging staff and citizens to embrace and participate in this new relationship as partners, spending time and resources listening to communities, and developing creative ways to support and provide what the community requests. This has meant developing learning opportunities and coaching for citizens with long-term conditions, co-facilitated by professionals and people with lived experience. It has involved diverting resources to enable citizens to set up groups and networks that meet their own needs.
For example, very small resources were required to start an outdoor activity group for dads and children wanting to improve their fitness or to provide a community meeting space for older people with mental health issues to talk and provide each other with support.
The setting up of groups and networks included diverting resources to fund a worker to work with homeless people, resisting pressure from the press and local politicians to “remove the problem quickly”. It meant working on the street, listening and waiting until the people themselves decided the time was right to change. It meant supporting the community to come together to develop town centre initiatives to connect existing resources and co-produce and co-implement a plan, securing new resources to provide accommodation and support people back into housing when they are ready.
To change the way we have been conditioned by our political, social and educational system to think about healthcare, organise, and deliver it, clearly requires new ways of understanding, designing, and providing it.
How can we discover an approach that is energising, revitalising, and enriching, one that builds on strengths and assets within and amongst individuals and communities?
It all begins with the quality of our listening and with allowing ourselves to be challenged and transformed by what we sense, hear, and feel called to do and manifest in our lives.
Allowing ourselves to be challenged without behaving defensively is connected to a certain quality of thinking or a mindset that we apply when we approach situations. What if the challenges we meet in our life and work are gifts to help us in discovering what else is possible? How can we learn to relate to our own experiences, to each other and to professionals in a way that is empowering and transformational?
Otto Scharmer calls the shift in mindset that enables us to connect with more of our human potential a shift in evolving human consciousness from habitual ego-system to eco-system awareness. An eco-system awareness is focusing not only on one’s own wellbeing but on the wellbeing of the whole which broadens the mindset and helps us to listen with more openness.
The authors Anna and Jane, along with Helen Sanderson, work in different roles in the health and care sector in the UK. We look forward to sharing with you at the Integral European Conference in May some of our experiences and practices, and we invite you to co-sense and co-discover with us where this journey could take us all.
If you are curious about the part you can play in re-inventing health and social care, why not register for the IEC2018 conference and join our two workshops on Friday 25th May? When you register to join the conference following this link don’t forget to mention that you are interested in the Teal Organizations Track.
Join the conversation and help to discover through deep listening what in Christiane Seuhs-Schoeller’s words our “superpowers” are. According to Ria Baeck “most people don’t know and are not aware of what their unique gift to the world is. It is just inside them, totally normal and easy to access.” She has tried to write it in these words: http://www.collectivepresencing.org/6-2-from-authentic-self-to-souls-calling/
To continue the conversation and engage in action together join us at the conference following this linkand remember to mention that you are interested in the Teal Org Track.
Part 2 of this article will be published soon.
Anna’s background is in Health and Social Care with training in Herbal Medicine, Socialwork, Mindfulness Practice, Transparent Communication, and Systemic Family Therapy. She practices a pro-active evolutionary approach to Health and Wellbeing and leads on projects in the UK National Health Service using Mindfulness and diet for people suffering from chronic inflammatory diseases like diabetes and dementia. Her passion for building thriving and sustainable communities inspired her to co-found the HealthCommonsHub. She feels at home in places where individual, communal, organisational, and social evolution meet, and where people support each other in becoming whole and feel enlivened.
The Sustainability and Transformation Planning process challenges health and social care to achieve two huge tasks. Redesign and build a new system around the needs of people and communities and do it in a financially sustainable way. To add to the complexity STPs are caught in tensions between central government and local control, long term aspirations and short term crisis and the recognition of the potential to realise huge change against the scepticism that this is just another way to cut budgets and services. It’s not only the outcomes and environment that are challenging. To succeed the system and the people in it must begin to work in a whole new way. Local leaders have been given joint responsibility to deliver. This demands a refocus from the internal hierarchies and individual organisations to spanning boundaries and building authentic relationships and networks across the landscape. Changing demographics and demands; depleted financial and staff resources; new technology; changing patient, staff and community expectations and redefining of illness, health and well-being all combine to create a complex, unpredictable and sometimes volatile environment for this work.
To work well as systems leaders, thinking beyond the usual focus of one organisation and instead holding what benefits the whole system requires relationships built on trust, shared values and the ability to appreciate contributions from all parts of the system. It also requires a huge change of perspective. We need to move from organisation based discussions focused on acute hospital ward closures to apply generative listening to the people and community who need the services and the staff who are passionate about and committed to providing it.
It is because leaders are now fully appreciating the situation and achieving the confidence to hold the space and step back that Communities of Practice are becoming a popular way of working. Communities of Practice work first to bring people together around a shared interest or domain. This can be a professional or academic interest and can also be about personal or lived experience. Bringing different expert experiences and tacit knowledge together and enabling people to develop shared stories, collective sense making and shared values develops a group identity and relationships where deep learning and new knowledge and practice can be developed. Communities can bring people together across traditional boundaries, encourage groups to identify their most burning questions and facilitate them to co-create new knowledge and practice in response to the most complex challenges. Staff involved in this way of working have reported a reconnection with motivations and values that they felt had been lost in their work. Patients, service users and carers spoke about being heard and valued as their experiences were validated and aspirations recognised. Perhaps most importantly Communities are generating innovative, sustainable solutions to sticky problems and creating real value for themselves, their organisations and communities.
Proof perhaps that “None of us is as smart as all of us”.
I never imagined that I would be able to provide visuals like this. I was under the impression that you needed to be good at art and drawing. It was a liberating experience to find out that actually it helps not to be too confident and experienced at drawing. This allows us to keep it simple and concentrate on what it is exactly we are trying to communicate, not the drawing itself. With some expert guidance I found I really enjoyed it. There's great pleasure in seeing a project or piece of work communicate its value in such a powerful way. It's been incredibly useful. Many people have a preference for visual communications and in situations where it's vital that everyone can participate, it helps provide inclusive communication. It's also been very popular with groups I didn't expect to like it so much. Busy managers and clinicians appreciate how much can be efficiently communicated in a visual. Thank you Cara and Graphic Change I look forward to learning more.
First published Dec 2015
Organizations Making the Shift : Can the UK’s National Health Service (NHS) Not Be a Teal Organisation?
I remember at a meeting, talking to someone working to establish a Teal organisation who told me that the NHS could never be Teal. The NHS is a long way from Teal, for sure. The NHS as a governmental entity is formed of many different organisations. Right now it’s probably more of a rainbow than any particular colour, in terms of the developmental stages of its units. Even so, the NHS and the services it incorporates have made many big changes previously. For example, I was part of the alliance between health and social care staff, families, and service users that worked to move mental health care out of the asylums and into communities. I have worked with some amazing people and I have seen them do incredible things. Maybe they can evolve a Teal NHS; I think so, and this is why.
The Current NHS
Customarily, particular NHS services have been keen to police and protect their own borders, responsibilities, and resources. In the worst cases, people are bounced between different services, and struggle to find their way in a complex web of providers and eligibility criteria. Sometimes they fall in-between services and their needs go unmet or they just give up. For example, when I was pregnant I had pregnancy-related carpal tunnel and needed a wrist splint. I was told by the physiotherapist I saw at my local primary care clinic that she couldn’t provide it to me, as her budget didn’t cover pregnant women. She advised I should travel into the city to the acute hospital maternity unit and see the physio there. I gave up and bought one via the internet.
Institutional Context of the Co-Creation Network of Communities of Practice
I have been working for the past year with a group of NHS clinicians, academics, service users, and staff from charitable and private industry to establish what we call the Co-Creation Network which encompasses a variety of “Communities of Practice” committed to making improvements in the health and social care system.
The Teal characteristic of evolutionary purpose is evident in that these Communities are about making improvements partly by breaking down the traditional boundaries of health and social care services, and encouraging/implementing a community-encompassing approach.
The Network is sponsored by two regional NHS bodies: Yorkshire & Humber Leadership Academy and Yorkshire & Humber Academic Health Science Network. Both regional bodies recognise that the challenges faced by the health and social care system require something very different. Both bodies have struggled to hold the space for this Network and the different approach it takes, against the usual system demands for performance management to justify any investment and direct activity.
Communities of Practice are a voluntary, not delegated endeavour. Some participants are given leave to attend meetings and events in worktime, but most CoP activity is done in members’ own time. Thus, membership in a Community of Practice requires great passion and personal motivation.
How the Communities of Practice Operate
Each CoP is people working together to co-create new knowledge and practice in an aspect of their own field. Communities are varied, focusing on whatever their members see as important. For example, Communities of Practice have been established to consider Sepsis, Medication Safety, and Creating Caring Cultures.
The Sepsis CoP is working on awareness-raising techniques to address an issue that people have not been well aware of previously. The NHS system has given them implicit permission by tasking staff or organisations to reduce sepsis incidents, but has not given directives on how to do this. So the CoP has the freedom to develop and implement some “How’s.”
You might be wondering, how do new “ways” get authorized to be implemented and put into practice in various settings? In some cases, the system has not given permission (versus the implied permission re Sepsis concerns) and the CoP may be challenging received wisdom and practice. Some CoP’s have been formed with the express intention of doing such challenging, as they strongly believe that current practice is not good enough. CoP’s looking at changing the traditional relationship between professionals and patients are often in this position. Part of their learning is how to identify and influence key stakeholders to co-create a new approach.
The Communities of Practice are courageously pursuing new knowledge and new practices that they believe can bring real value to the services they provide.
In an acute hospital, a Community of Practice has introduced mindfulness practices for staff and elderly patients. It is reporting a real cultural shift in the ward environment, and a huge impact on patient safety, with fall rates hugely reduced.
This Community is now turning its attention to how it might extend this ethos of care out into the community to involve everyone who might provide support to their patients.
A Community of Practice was formed by a group of staff developing a new role in primary care to connect services and provide better care for older people with complex health needs. In the UK, locally-based clinics provide access to doctors, nurses and health care support staff as the first point of contact − and principal point of continuing-care contact − for services dealing with ongoing health conditions. It was noted that an older person with several long term conditions such as heart disease, diabetes, and dementia would be in contact with their local primary care doctor and nurses, but would also have links with a huge variety of other health and care organisations including specialist medical services provided at outpatient clinics in acute hospitals, specialist community-based teams such as mental health and dementia care, specialist home care services from a physiotherapist or occupational therapist, nursing visits from charities, as well as support and care workers from not-for-profit care companies. This Community of Practice is noticing early signs of expected success in reduced admissions to hospital for this patient group as all those services work better together to keep the person safe and well at home.
There is also a vast array of other benefits from this CoP’s connecting of services. They include improved understanding and appreciation between different government-provided health and social care services, good relationships between different locally-based clinics, authentic connections between statutory (government-provided) services and community assets and resources, and a commitment from all elements of the whole system to improve the support provided to these elderly members of their local community.
Next-Stage Challenges Faced and Dealt with in CoP’s
I believe my experience provides one bit of clear evidence that the three Teal principles of self-management, evolutionary purpose, and wholeness have been readily adopted as core principles by some NHS staff and those working with them. I am sure there are other examples too. The Communities of Practice established as part of the Co-Creation Network adopted these principles despite the fact that they were challenging and difficult at first.
Communities of Practice are self-managing by definition. They set their own agenda, organise themselves, and also decide what learning they will pursue and how they will use this knowledge.
This was a shock to many NHS staff involved, and it was difficult not to seek permission and direction from elsewhere. Many of us experienced confusion at first. “What is it we are supposed to do?”
Communities moved swiftly from confusion to feelings of liberation and then action. Members gained confidence, established relationships, defined their shared agenda, and organised meetings and “learning expeditions” — our title for the work to answer the questions we have set ourselves.
One of the most unifying and important aspects of the Co-Creation Network is the way it supports wholeness. The Network adopted mindfulness practices to help stressed, overstretched members be fully present in their Communities of Practice.
The opportunity to make authentic connections and pursue work that they identified themselves as important was cathartic. I think it may have even persuaded some members, who were disillusioned and damaged by their working environments, to stay within the NHS and work towards change.
“This work gave me space to connect with that passion again and start to explore what could be possible. Through learning about CoP’s I could see that I wouldn’t make it to the top (of the mountain) on my own, but I could take others with me and we could support each other on our difficult journey. And that the journey itself would make us stronger, through sharing and learning together.” Community of Practice Member
Perhaps most inspirational is the evolutionary purpose evident in the Network and its Communities of Practice. Free to pursue their own agendas, Communities of Practice have been established to consider pharmacy, mental health and childbirth, work with older people, the role of mindfulness in healthcare, Innovation, Musculoskeletal Practice, and many other areas. However, it’s not the rich variety of learning and practice being developed that I find so significant; it’s the way this is being done, described in this article. Like for Buurtzorg in the Netherlands, the results can already be termed “outrageous”. (Laloux, 2014 Reinventing Organisations, Chapter 2.2 Outrageous Results paragraph 1)
“There was an absence or at least a much reduced sense of fear about “doing it wrong;” this felt different from much of my previous experience of the NHS.” Community of Practice Consultant
Reinventing the NHS as Teal
Contrary to my own typical experience of “falling through the cracks” of the system, now more new Communities of Practice are focusing on working across traditional service boundaries, and often exploring a geographically-defined approach which reflects the community or neighbourhood experience of the people accessing their services. These Communities of Practice seem to have found a real evolutionary purpose.
They are working towards breaking down traditional NHS boundaries and developing new ways of supporting health and well-being in an environment where it is clear that health and social care needs to radically reinvent itself.
Maybe the person I met was right after all. The NHS as it is now cannot be a Teal organisation. But the NHS that will be, must evolve to become a Teal organisation.
previously published Enlivening Edge 27th October 2015 http://www.enliveningedge.org/organizations/uks-national-health-service-nhs-cannot-teal-organisation/#more-1448
I had an unexpected childhood. In the early 1970s my father left his respectable and secure job in a nationalised industry and headed off to university. It wasn’t until I was going through some of his books after he died and came across a passage he had marked about education for education's sake, that I began to appreciate why he had taken this decision. As a student at Ruskin College Oxford, Ruskin’s concept of education as “leading human souls to what is best, and making what is best out of them.” was a core aspect of his motivation to become an educator. In the 1970s it was not done to leave a good job and pursue an uncertain future, especially if you were already in your thirties with a young family to support. I will never know what made him realise that the steady job would not be steady for much longer or what gave him the courage to pursue what was really important to him. I do know that it delivered financial stability and despite its challenges, I think it delivered real job satisfaction too.
My father’s actions were unusual at the time but now his story seems much more familiar. There are a number of recent pieces of US and UK research recording how most of us will have a number of jobs with an increasing number of employers during our working lives. The Association of Accounting Technicians research in 2015 interviewed 2000 people and found that 46% would change their career completely after finding their current path wasn’t for them. It is much written about that millennials and younger people in the workforce expect much more than a wage packet as fair recompense for their labour. Our relationship with work is more complex and sophisticated than it used to be. Whilst income is important; job satisfaction, well-being, work-life balance, development opportunities and working for an employer that demonstrates social responsibility and where we feel proud to be part of the organisation are also key.
It is now recognised that being able to align our personal values and motivations to that of our business or employer is vital to productivity. When we are not fully engaged with our jobs, when we are not convinced our job is worth doing, when we don’t feel we are making the best of our talents, or being enabled to do the best job we can, we are less efficient and the quality of our work suffers. The CMI Quality of Working Life Report 2016 found motivation was becoming an increasing challenge for managers, 28% reported feeling not very motivated or not motivated at all. Over a third of public sector managers reported feeling demotivated and working at less than 70% productivity.
More now than ever, it’s important to have a clear understanding of what motivates and drives us and how we can align this in our work to do a job worth doing and do it well. The fast changing world of work and business means that we need to accept that the "what" and "how" of our work will change frequently. We must have a deep understanding of the "why" in order to provide the compass to navigate our future career path and deliver satisfaction, well-being and success.
This article was inspired by Lani Morris
Jane Pightling has experience across the public, private and charitable sector. Through her work in the NHS Leadership Academy and her consultancy Evolutionary Connections she developed complex systems leadership capacity, providing training, coaching programmes and establishing networks and communities of practice to sustain learning. She maintains her social work registration and her commitment to person centred and community focused approaches. Jane has a deep interest in the potential offered by new ways of working, designing and building organisations and communities that can best deliver this kind of service. She works mainly with organisations in the health and care sector to develop approaches that design in autonomy, wholeness and purpose.