Creating a Culture of Joy in the NHS

A Culture of Joy is the biggest determinant of safe and high quality healthcare! That is such a phenomenal statement that it is worth reading over and over again, making it into a poster, sticking it on your wall and meditating on it morning and night. It feels to be simultaneously absolutely true and somehow beyond belief. I’ve previously blogged here about the need for a culture of kindness in the NHS, and I hold to that – kindness certainly doesn’t exclude joy (!), but a Culture of Joy….. I don’t know, in a day in which 50% of our staff admit to feeling burnt out, can we honestly say we have developed this throughout our health system in the UK? So, what does it take to build this? How do we have a joyful workplace? If it is really the single largest factor affecting patient safety, which research from The Mayo Clinic, The IHI and The Quality Forum tell us it is, then we better sit up, pay attention and do something about it!

 

There are 3 key ingredients to creating a culture of Joy.  The first (and this is in no sense a hierarchical order!) is leadership, the second is how
teams actually function together and the third is personal responsibility. You will see the words incorporated from the ‘culture circle’ in bold!

 

Good Leadership: Here’s a fascinating fact, I learnt from Stephen Swensen, of The Mayo Clinic – The bigger the signature of a CEO, the worse the outcomes for patients, staff and the finances of the organisation!! CEOs are responsible for setting the structures in place that allow healthy cultures to develop. Leaders create a culture of joy by having humility and developing 5 key behaviours:

 

  1. Appreciation – good leaders build joy in their teams by saying ‘Thank You’ – it is one of the things the team at my surgery consistently tells us, as partners. Of course we are grateful, but we don’t say it enough. Every member of a team knowing that they have value is so vital. I remember, as a house officer on a medical ward watching a lady called Jean, cleaning the ward and saying hello to all the patients. I went up to her and said, “Jean, I just want to thank you for everything you do on this ward, every day. The way you keep this place clean helps fight off infections and keeps people well; and the smile and kindness you bring is really comforting to people who are scared or hurting.” To my great surprise, she burst out crying. I asked her what was wrong and she told me that she had worked on this ward for 25 years and no-one had ever said ‘Thank You’ to her. My favourite hashtag on twitter is trybeinggrateful – it costs so little.
  2. Transparency – good leaders communicate openly with their teams. They don’t do ‘special huddles’ in which they invite a few ‘high level’ people to know their secrets. No. They communicate with honesty and openness and this builds trust. And with trust they are able to negotiate difficult situations and requests of their teams, because there is a belief that everyone is in it together.
  3. Ideas – They look to their teams for ideas. One of the things I loved learning about recently is that the CEO of Toyota in Derby, deliberately does not park his car in the special ‘CEO parking space’ right next to the building. Instead, he parks it at the far end of the factory, so that the walk to his office takes him through every department, (a good 30 minutes of his time), so he he can say “hi” to his staff, connect with them and ensure that he is hearing about their ideas for innovation and improvement. Toyota takes 2.5 million suggestions from its staff every year. This simply doesn’t happen enough in the NHS, and I wonder how many CEOs take time at the start of the day, to walk the corridors, listen to patient stories, understand the pressures in the ED, hear the heartbeat of the wards and get a sense of the ideas brewing in some of the most compassionate, caring and intelligent staff of any organisation in the UK. If we are to transform the NHS into a system that is truly safe, sustainable and excellent, we must listen more to the ideas of our teams and in doing so, we will cut waste, undo the reems of red tape and instead find we are working far more effectively and efficiently. To embed this into the culture, there must be psychological safety – that means that no question is too stupid, no idea is too dumb and it is safe to bring to attention concerns a person may have, without a fear of retribution. One great question for leaders to ask is, “what are the pebbles in your shoes?’ – in other words, what matters to you? Or what are the barriers for you here? What’s getting in the way? Great CEOs do not have great answers, they are willing to work with complexity and have great questions!
  4. Career Mentorship – every person needs to be able to keep learning and develop in their role. We all need mentors or coaches at different stages in our careers, and ensuring these structures are in place to support staff as the complexity and pressure we deal with increase, is vital in building joy. People who are developing in their role are naturally safer in their role.
  5. Inclusiveness – To a good leader, it doesn’t matter who you are, what you look like, what you believe, what your sexual orientation or status might be. You need to know that you are welcome and you are loved just as you are. Inclusive teams that do not scapegoat, do not sideline and do not bully are joyful teams. Joyful teams celebrate difference and thrive off it.

 

Joyful Teams:  It’s really important to understand that joy does not mean false happiness. It does not mean that we walk around with fake smiles on our faces all the time and pretend that everything is ok. Joy is much deeper than that. We deal with very sad and difficult things in our workplaces every single day. We break bad news, we hold people as they take their final breaths, we watch people make terrible life choices, we see and carry the hurt of those who suffer loss and each of us has our own burdens we carry from the lives we live outside of work. Joyful teams do not pretend like that stuff isn’t happening every day – quite the opposite. Joyful teams develop three key qualities:

  1. Camaraderie. The high school musical song – ‘We’re all in this together’ is a great theme tune for NHS teams. People need to know that they belong, that they are loved and that people care about them. On good days, we celebrate together, on bad days, we pull together. Joyful teams develop encouragement, support and kindness in how they treat each other.
  2. Purpose. Joyful teams have a real sense of shared vision and purpose. They know what they are there to do and each person knows that they are valued in that team. The posh term for this is a sense of corporate agency. This is our job to do, we are responsible for what happens here and we want to do our work with excellence. 
  3. Trust. It is really important that individuals feel trusted to do their job without feeling like they are always being watched or criticised or that they have to give an account for every action. When people feel trusted, they actually work more effectively and produce better outcomes.

 

Personal Responsibility: in order to create a culture of joy, it is not just the responsibility of the CEO or team leader, nor the atmosphere created by the team as a whole – we each have a responsibility to steward and hold to this culture. And that means taking care of our own needs. We need to be active, eat well, take notice, be mindful, sleep well, forgive those who hurt us and have good friendships. Making sure that we ‘host ourselves’ well, ensures that we play our part in building the culture of joy that is so vital to the providing care that is of the highest quality and safety. There is a personal accountability to ourselves and to those we work with to ensure this is so. There is also personal agency that rises to the challenge that each one of us can set a new trend and make a significant difference to the culture in which we work.

 

In the midst of all we are currently facing in the NHS, for the sake of our patients and their families, it is vital that we build cultures of joy now and cultivate them for the future.

 

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Making Healthy Choices for the New Year!

So……a new year…..some new resolutions? How about some health resolutions? Given the health crisis we are facing, if you could change one thing over the next 6 months, what would that be? And if you did change something, how would you know it was being beneficial? What would you notice? What would others notice? How would you know you were progressing up your ‘ladder of success’?!

 

Come on, now! You can do it! What would you like to focus on? Would it be exercise? What would be realistic for you? Walking for 10 minutes three times a day at a pace that gets you out of breath? What about taking a leaf out of the books of children all over the UK in running a mile a day – it only takes about 15 minutes?! Or how about seriously reducing your sugar intake or the amount of alcohol you drink? What is your focus going to be?

 

Think in a solutions focused way! You don’t have to make unrealistic goals or promises you are going to break next week. Be honest with yourself. Think about what the barriers and pitfalls might be and get prepared for them. Your inner chimp has had too much control and it’s time you lived out your values this year. (Read the Chimp Paradox by Steve Peters). What is your number one health value? Feed that value to your mind every day as you wake up and when you go to sleep, so that you can re-program your brain and get living in line with what is important to you! Two of my values for this year are that I value being active and I value feeding my body with things that benefit my health.

 

So, let me give you an example of how you can work this up on your own, to have goals that you can achieve. Firstly, choose the thing you want to change. So, I might say, I want to do 3 lots of 10 minutes of exercise every day. Does this feel achievable? Yes – I think so, but I won’t beat myself up on days where work is crazy or the kids are sick. But I am going to make a determined effort to ensure work does not stop me being healthy. OK, so what will I notice if I am doing more exercise? I’m going to challenge myself to make a list of 10 benefits:

 

1) I will be able to fit back into my favourite jeans.

2) I will feel less breathless when climbing stairs – now I challenge myself and instead of using a negative (I will feel less), I try and phrase it in a positive way – I will have more energy when I climb stairs.

3) I will have more focus in my work because I will have cleared my head with a midday walk

4) I will be more fit

5) I will be looking in better shape

6) I will have more energy to play football and other sport with my kids

7) I will feel more alive and active and I will know this because I will be breathing more easily

8) I will enjoy walking with other people and talking with them

9) I will be sleeping better

10) I will have less back ache, as I will be losing weight

 

Ok – so what will other people notice?

 

  1. My wife will notice I have more energy and zest for life
  2. My kids will notice I am playing more actively with them
  3. My patients will notice that I practice what I preach
  4. My colleagues will notice that I am more present in conversation because my head is more clear
  5. My friends will notice that I’m taking my health seriously
  6. My wife will notice I’m in better shape
  7. My wife will notice I’m snoring less and waking up more refreshed
  8. My kids will notice we start going for more walks after dinner and at weekends
  9. My family will notice we are spending more time together being active, no matter what the weather
  10. My friends will notice I am more relaxed and happy

 

And the next step is really simple. All I have to do is simply recognise ANY time ANY of those things happen and it will encourage me on my journey of change. The secret is this: We have to imagine another way of being, paint as much colour onto that canvas as possible and slowly watch that picture emerge in our lives as we take hold of the future we actually want. It’s not the power of positive thinking. It’s the power of acting in line with positive choices we are making. Come on! Let 2017 be the year when you made a choice and acted in line with it! Put your chimp in it’s cage, stop making your excuses and be a more healthy you!

 

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Wake Up to Our Health Crisis

Tweet It’s all over our news today – our health is in a real mess, and this is our wake-up call moment – we really do need to take it seriously. It’s all very well us protesting about the under-funding and under-recruitment in our NHS (and we are right to do so), but we can [Continue Reading …]

Is Our Work Killing Us?

Tweet So a huge study from Norway tells us that being inactive at work and sitting at our desks for too long is as dangerous to our health as smoking and is a major cause of early death.   Hour’s activity ‘offsets sedentary day’ http://www.bbc.co.uk/news/health-36895789   Here is my response:       Share This: