Creating a Culture of Joy – some practical ideas!

I am hugely passionate about how we create great cultures in which to live and work. One particular thing I love is building a culture of joy! My friends Rachel Pilling and Dan Wadsworth have come up with a super easy way in which to practically build joy in work, through this simple but excellent idea of 15-30. This is the magic that happens when clinicians and managers work together. Watch it, if you work in the NHS then sign up and get involved and if you work outside the NHS – the idea is entirely replicable in any other part of life. By you going the extra mile now, you could save your friend a marathon….Building joy in work is, according to the IHI, the most important foundation on which to build a safe, sustainable and excellent health and care system. With staff morale as low as it is, let’s do what we can to promote joy in the daily grind. Here are Dan and Rachel explaining more in their excellent TEDxNHS talk – well worth your time!:

 

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Living with Trauma – The Realities of PTSD

I’ve written a number of times on this blog about the impact of Adverse Childhood Experiences. However, trauma can happen to us at any stage of our lives and its impact can be absolutely terrifying and profound. Here, my friend Charlie Webster (who some of you will recognise from various sports commentary with the BBC) tells her story to shed light on the realities of PTSD and what can help. I’m grateful for her bravery:

 

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How Does Change Happen?

How does change happen? This has become an incredibly important question to me over the last few years, and I am still on a big learning journey in discovering some answers. There is so much that needs to change – so much that is currently going on in our communities that simply doesn’t work for people. So I keep asking – how does change happen?

 

I recently read a book called ‘The Moral Imagination’ by the great peace-builder and activist, John Paul Lederach. In it, he talks about the concept of ‘critical yeast’. Yeast is itself changed in a new environment (surrounded by flour) and then begins to bring about phenomenal change around it. You don’t continue to see the yeast, but you surely get to see it’s effect!

 

For me, change begins with listening, and by that I mean deep, generative listening to those who we could think of as ‘critical yeast’. The kind of listening in which you can no longer continue to see things the way you did previously. As you listen in this way and find your self changed, you can longer continue with things as they are – you realise that things around you need to change also.

 

It’s one of the reasons why I am absolutely committed to putting myself into uncomfortable surroundings or situations which challenge my neatly held world views and beliefs. I try and make sure I take the lanyard off my neck, step out of the clinical settings I know and the board rooms I sit in and spend time in and with the communities we serve. I really believe it is vital for all leaders, especially those in senior positions to regularly take time away from the boardroom and really sit with the communities they are paid to serve. If you don’t have your finger on the pulse of the pain people are experiencing, then it’s all too easy to make decisions on behalf of them which utterly lack compassion or kindness.

 

So, together with my good friend, Yak Patel, who is the CEO of the Lancaster CVFS (Community Voluntary Faith Sector) and a man of real humility who holds our communities in his heart, we went to be with some people doing amazing things across our district. Yak is great at holding me to account and ensuring that I put my money where my mouth is!

 

We started on The Ridge, the largest council estate in Lancaster. There we spent time with Lisa, who we know through ‘the art of connecting communities’. She runs the community centre, and we wanted to listen to the experiences of people living on The Ridge and understand some of what they are facing. Simple things, like a cut on their bus service (as timetables massively favour the University) is leaving people isolated and cut-off, especially elderly citizens at weekends.

 

I asked Lisa what she thought about the growing rhetoric that the problems communities like ‘The Ridge’ are facing are not to do with ‘resources’ – she rolled her eyes and retorted – “easy for people to say that, but over the summer, I couldn’t pay myself a salary for 2 months, so that I could ensure that the youth provision needed through the holidays could actually run – the funding for those kind of activities has been cut so much, it’s a joke….” Lisa, like so many other big-hearted and socially-conscious community workers, had to work 80-90 hours a week, holding down a second job, simply to be able to pay her own bills – similar to what happened at Christmas, when she worked long hours to make sure that 75 children on the estate actually had something to eat and a present to open on Christmas Day. People of good heart are feeling overwhelmed, unsupported and burnt out. I asked Lisa what she would love to happen – she wants to bring the community together, to talk about what’s strong, not what’s wrong, ask the community what it is they actually want and need, rather than assuming the providers of public services somehow magically know (!) and focus on what The Ridge could become – for the community, by the community.

 

On The Marsh, we met Debz. Debz also came to ‘the art of connecting communities’ last year. You might describe Debz as a ‘salt of the earth’ person. Down to earth, she has seen it all. I asked her what the biggest problem is for her community…..”drugs…..the place is overrun with drugs – and people are on the ropes”. The food club was happening, thanks to fareshare, when we arrived (although huge trays of strawberries were already completely mouldy)….and there were queues down the street….she shared with us some of the complexities involved for young people and the situations they find themselves in – multi-generational trauma….but what she struggles with most is that those who are supposed to care, don’t seem to want to understand. She told us of difficult encounters with the local GPs, the local hospital, social services (one family had had over 24 social workers – what’s the point in that, she asks?), police, schools and city council….although she has noticed some attitudes begin to change (perhaps because of the poverty truth commission).

 

She feels that people on ‘The Marsh’ are judged, looked down on and it’s reputation is very hard to break. But she also knows that people who live there want things to change and they want to be part of the change. That can be really tough, with the threat of violence and the very real involvement of gangs from Liverpool and Manchester, bringing intimidation. “Why would people not do drugs and get involved in selling them? It pays better than any work available”, she shrugs.  She believes the community can find some more hopeful dreams and she talks about the difference a new church in the community centre are making (a conglomeration of a few different congregations working together)….She wants to bring the community together to talk about what they want to see change, but especially how they can be part of that change….however, she doesn’t think it can happen through some kind of new found motivation alone – it’s going to take real investment. She tells me that if we want to stop seeing men dying in their 20s, from drugs, violence and suicide – we need to think altogether differently about how we work together with communities. Yak nods in agreement – he used to have Debz’s job, before he became CEO of the CVS. He tells me how many funerals of young men he has been to from this community. I feel deeply sad.

 

Then we’re on to Poulton (which has the worst health outcomes in North Lancashire), to meet our friend Joanne, who runs Home Start for Lancaster and Morecambe. What an amazing lady! And such a great charity! We sit with Joanne and one of her trustees, Sheila (who used to work in children’s services at Lancashire County Council, before she saw the decimation of her team and the unacceptable levels of stress she and her team were having to work under, which she deemed to be totally unsafe). The work they are doing for young families is extraordinary. Most of their referrals come from Health Visitors, but they are now full, and simply can’t take any more referrals unless more volunteers arrive. What I love about Joanne and her team is the collaborative-coaching approach they take. As they have worked alongside families, and discovered what they want and need, they have seen co-produced groups around issues like Domestic Violence and Autism support. What Joanne is most proud of is that they have created a culture in which you can walk into a room and no one knows who is a ‘client’, who is a volunteer and who is a member of staff – brilliant! “A community of mutuality” – she beams! Humility is the order of the day and it leads to real relationships that bring real change. As services have been cut and fragmented, increasing pressure has fallen onto the charity sector to hold things together – but resources have not followed. Despite great connections across the sector, the pressures are mounting, the cracks are showing and the risks are increasing.

 

I have no idea how much money Lisa, Debz and Joanne must be saving the public services every year, in terms of health and social care….but I do believe we could be making some far better and wiser investments with the ‘public purse’. We should be putting a whole lot more faith in community centres and workers, like them. If we do so, we will find it much easier to tackle deep-seated health and social ineqaulities right in the heart of our communities, taking an asset-based approach, being brave enough to redesign around relationships rather than transactions (as my good friend Hilary Cottam says in Radical Help) and find that communities really do want to be a part of transforming their own futures. Just like in Wigan, there needs to be a New Deal between communities and the public services to ensure that there is mutual vision and accountability for the resources that are available. What are we brave enough to stop doing, so that we can learn to do what is altogether better? Are we able to change? Not if we remain in our silos and ivory towers and continue to tell ourselves the same old stories. But might we dare to step outside the fortresses of what we know and learn to deeply listen? If we can do so, we cannot help but be changed….and as we begin to change….well…..then change begins to happen!

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Do We Believe in Rehabilitation?

The NHS spends a huge amount of money every year, along with local government to help people who have struggled in addiction to find rehabilitation and recovery. Much of it is ineffective (but that is a conversation for another time). However, what’s worse is that once people do recover, and find a new life, we don’t actually let them make a clean start – here my friend, Kate Morrissey bravely tells her story:

 

 

 

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The Resilience Myth

My friend, Dr Sammy Batt-Rawden knows only too well the dangers of just keeping her chin up and carrying on. In this beautiful, but heart-wrenching TEDx talk, she tells her story.

 

Staff in the NHS (and indeed all our public services) are working against a tide of a huge rise in public demand, funding constraints and dangerously low staffing levels for what is required. The old edict to ‘keep calm and carry on’ simply misses the point. There isn’t a culture of shirking responsibility in the NHS. People are going way above and beyond every day, and it is taking it’s very real toll. Yes, we need to increasingly develop cultures of joy and kindness in how we work, but there must be determined change by leaders in the Government to ensure that the buck is not passed when it comes to who is responsible for ensuring the wellbeing of our clinical teams across the UK. Teams are already doing much to take care of each other and themselves, and yet staff surveys across the UK show that absenteeism is increasing, along with burnout and morale continues to decline. Do the maths!

 

Listen to Sammy’s story and let’s change the tone of the conversation so that we can work on practical solutions together. Those solutions will include everyone. Part of the solution lies with learning to work radically differently with our communities. Some of it lies within our choices of how we use the health service. There is of course work to do in how we care for people who work across the NHS and set good working patterns. But there is still much work to be done by those in power to think more carefully about where and how budgets are spent. The new spending plan for the NHS pays very little attention to safe staffing levels or staff development – it needs much more care and attention.

 

I’m so grateful to Sammy for changing the nature of this increasingly important conversation:

 

 

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Humility Goes a Long Way in Building Great Teams

I am a massive advocate of a Culture of Joy! I really enjoyed listening to the lovely Yusuf Yousef at TEDxNHS 2019 and his incredible ability to build relationships, cross barriers and connect people together. This is exactly what we need more of in the NHS and across our public services.

Simple, but brilliantly effective! There is so much inspirational practice everyday in the NHS – but if you don’t have humility, you will miss most of it!

 

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I Am a Medical Feminist

One of my fellow speakers at TEDxNHS2019 was the amazing Dr Sarah Hillman. We both graduated medical school in the same year, and have both become GPs, but Sarah has taken a more academic route. I was blown away by the power of what she has to say and believe every doctor and medical student should engage with this and consider the implications for what we think we know about medicine. We are currently doing a significant disservice to half of our population and we need to take what she is saying very seriously.

 

The politics of love and kindness insists that we must instate women fully. This has never been done. Here is a stark reminder of the job we have to do and the consequences of not taking this seriously. Get a cup of tea, listen and become a medical feminist too!

 

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My TEDxNHS Talk

Last year, I was invited to submit a proposal for a TEDxNHS talk. TEDx are independently organised TED events, and it turns out that TEDxNHS is the biggest of these in the world. I submitted two ideas – one around how we can work radically differently with our communities and one around how we create great working cultures in the NHS – both huge passions of mine. I was well excited to get through the process of selection, but was not at all prepared for the work ahead of me!

 

I do quite a bit of public speaking and really feel alive when I get to communicate things that I’m passionate about. I had no idea how different it is to prepare for a TED talk though! I read Chris Anderson’s book over the summer, and had several anxiety-related dreams . I genuinely thought I was never going to be ready! I couldn’t even really decide what I was going to talk about, let alone get it into an engaging piece of prose, whilst sticking to the all important 18 minute timeframe. Thanks to my amazing coach, Zara Brookes (can’t tell you how grateful I am!) and the kindness of Charlotte Hall and Shane Costigan, with hours of patience and encouragement from my lovely wife, Kat, I finally got it ready – an amalgamation of my passions. I hugely enjoyed the discipline and the focus involved in preparation, and when I got onto the stage at Indigo at the O2 Arena in London, this is what happened – hope you enjoy it:

 

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The Art of Connecting Communities – Day 3

 

So….as has become our custom in Morecambe Bay, we tend to deliver the ‘Art of Hosting/Art of Connecting’ trainings over 3 days, but we have a bit of a break after the 2nd day and then invite people back a few weeks later, partly to let us know what they’ve tried out in the mean time, but also so we can invite our wider community of practice back into the fray!

 

Or 3rd day of ‘The Art of Connecting Communities’ focussed in on how our connections create new possibilities. As a team we felt like we needed to ground a bit more of the undergirding theory that gives depth to this way of working, as well as remembering some of the great practices involved. We checked in, this time using triads, to help us get a bit deeper straight away and then we headed into a 90 minute immersive and reflective piece of learning on the four-fold practice. We drew out a quadrant on the floor to represent the four different ways of thinking about ‘hosting’ and then used circle practice in each quadrant to really reflect together on what it means to: host yourself, be hosted, host others and host together.

 

In each of the quadrants we put a question for the circle to explore. Learning to host and host well is a shift in practice for many of us. But it is a leadership style that is open to all and gives each person a deep sense of value and confidence.

In the ‘host yourself’ quadrant we asked: How do you host yourself well in the midst of chaos? There were some really creative insights. Some which stood out were: Breathe! Be Patient. Just be. Take care of yourself. Accept Chaos.

In the ‘be hosted’ quadrant we asked: When were you last hosted well? Our key agreements were that humour really helps, along with knowing the space is safe, there is no hierarchy, lots of voices are recognised and given space and lived experience is given space to come to the fore.

In the ‘host others’ quadrant we asked: What are your strengths in hosting others? It would be fair to say that this is the question that people struggled the most at. we are so used to knowing what we don’t do well, that we felt a bit of ‘Appreciative Inquiry’ was needed. We all realised that we have strengths to bring to hosting and it’s ok to play to our strengths. It allows us to use empathy and bee aware of the needs of others as well as using humility.

In the ‘host with others’ quadrant we asked: Why host with others? There are, of course, tonnes of reasons, but the ones which stood out for us were: it’s more fun, we learn from each other’s, we support each other, we play to each other’s strengths, we value our diversity and we make better connections.

 

We then had a ‘knowledge cafe’, which enables some quick space for learning about things people might want to go a bit deeper on. It’s adult-led learning! We had 3 rounds of 15 minutes in which people could choose to go to 3 of 4 options around core theory for the ‘art of hosting’:

Theory U

Working with Powerful Questions

The 8 Breaths

Harvesting

 

After lunch we then had an OPERA! No – we did not all start singing (although much more the shame in my view!). Opera is an excellent way of helping to converge a conversation around consensus and decision making. It’s a beautifully relational and democratic process in which a group of people can make collective sense of the options available to them and what they feel really need to be the priorities.

 

We used OPERA to explore a question around saving money in the NHS locally. Basically what happens is this:

 

First you have to ask a good question! Ours was “What ideas do you have about how the NHS can save £120million pounds over the next 3-5 years (with some context given of the issues involved)?

Then everyone works silently on their own to come up with the OWN ideas. After this, they work in PAIRS to agree on their top four ideas. Then they EXPLAIN their ideas to the rest of the group. The group, having heard all the ideas, then RANK them in order before ARRANGING them into groups for action planning. It is quite remarkable to watch this process in action and to see participatory democracy really work in practice! I LOVE IT! There were some really great ideas and it was amazing to see what the group had appetite for and what they resisted or didn’t think would make enough difference. It’s a hugely helpful process that we will use again and again!

 

To finish our day, we had a ‘dream world cafe’. George Monbiot states that the only way to replace the current narrative we are living in, is not through more data, or compelling facts and figures. The only way ahead for us is to tell a better story – one that we want to live in together – one that awakens our imagination. The problem is that we have forgotten how to tell each other good stories. So, we spent some time doing just that – telling a better story of Morecambe Bay and awakening our imaginations to future possibilities. We asked ourselves: Imagine we are better connected? What new possibilities can we now envision for Morecambe Bay?

 

Imagine if we kept on doing this – what kind of stories might we tell and begin to live in? Here is a summary of what we came up with (not bad for 45 minutes!) – the last sketch is particularly moving:

 

 

 

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The NHS as an Anchor Institution

The Preston Model of economics has set many heads turning and tongues wagging! If you don’t know the story, it is well worth reading about, as it offers much hope for the future. Alternatively, you can hear Cllr Matthew Brown talking about it here.

 

If the NHS really took on board what it means to be an anchor institution, as the largest employer in the UK, it could have a seismic effect on the economy, the environment, the health and wellbeing of the people and social justice. It is well within the gift and grasp of the NHS for this to become a reality, both locally and nationally and would involve some basic and fairly straightforward changes (and some more slightly complex ones!) Here is a starter for 10:

 

1) Pay everyone in the NHS a living wage

2) Reinvest the NHS pension pot, taking it out of global corporations or off shore tax havens and instead putting it into local infrastructure and regeneration schemes

3) Ensure the physical and mental health and wellbeing of all staff, through developing the 5 ways to wellbeing in the work place and leading by example by ensuring healthy food options for patients and staff. This could also include all staff having 1/2 day per month to volunteer with local charities, communities and schools around health and wellbeing initiatives

4) Create positive discrimination to employ people and offer apprenticeships/training opportunities to people from more economically deprived neighbourhoods (as per Oldham) to help generate more economic wellbeing

5) Only procure from local/regional companies, again to improve local investment and ensure these companies also have a good health and wellbeing strategy for their own staff

6) Take responsibility for developing a green strategy

7) Join with other large local employers to develop this wider strategy and economic development plan, e.g around green transport, job creation and supporting worker cooperatives – this needs to include local councils and universities

8) Be part of the new local bank/credit unions being set up so that new banking systems are more accountable

9) Work with local schools which are struggling, and create healthy school partnerships which both secure the wellbeing of future generations and can create a more committed and secure workforce through new training schemes

10) Support the community voluntary and faith sector with both practical resource and infrastructure support through the primary care networks and integrated partnerships

 

This is by no means an exhaustive list, just a few examples. Imagine, though, what a huge difference it would make if NHS England, every Integrated Care System, each Integrated Care Partnership and every Primary Care Network adopted this kind of plan. We might focus less on the effects of poverty on health and more on what we can do to make a difference to it, because we would be a part of generating wealth and improving health! This takes the NHS into the doughnut and creates an economy of wellbeing – why wouldn’t we do this?! It’s easy to understand and not too hard to implement!

 

 

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