5. Teaming for Everyone?
This is the fifth in a series of blog posts sharing learning and insights from work to develop a culture of Aim High, Feel Safe, Team Up, Fail Well, Learn Fast.
Following several unsuccessful attempts, my searches for funding unexpected got a result the week before Christmas. We were granted a small chunk of external funding to enable widening out some of the Teaming development work - with the inevitable strings attached, of course! To benefit from the funding, we had to plan, engage, design, deliver and complete this phase of development work between the beginning of January and the end of March; the most intense period of the year clinically, due to annual winter pressures and extreme English weather. We looked at each other in head-shaking bemusement and said yes, we would find a way. Some external cash for developmental work is not to be sniffed at in the NHS!
Whilst the work with the Leadership Trio and the Clinical & Ops Management Group was proving impactful, we wanted to engage a far wider range of staff in developing the culture of Aim High, Feel Safe, Team Up, Fail Well, Learn Fast. It seemed vitally important to help staff to recognise that creating a ‘teaming’ culture was theirs to shape. Even though these services operate within a larger organisational context, the specialist hospital has a degree of autonomy. So whilst some factors influencing the culture were beyond the control of staff, there were many aspects of ‘how we work together and treat each other’ which staff co-create together, whether they are aware of it or not.
We decided that the language of ‘teaming’ might be viewed as jargon among staff, so we simply called this work Working Together. In addition, we identified that the nurse leadership team, therapy leadership team, the consultant body and the admin management team were key in modelling and enabling the individual and collective attitudes and behaviours of Aim High, Feel Safe, Team Up, Fail Well, Learn Fast. So we invested some dedicated time with these groups, too.
In the short to medium term, the aims of the work were to see evidence of:
More willingness to ask for, give and offer help among colleagues
Colleagues working across professional boundaries and across teams more flexibly
Enhanced mutual empathy, listening and appreciating each other’s pressures
Reports of feeling ‘we are in this together’ around the shared purpose of quality care
Less daily narrative couched as ‘us vs them’, silos, separation and divisions
Reflection about the quality of teamwork in our day-to-day interactions
In the longer term, to see evidence of:
Better staff engagement scores
Evidence of senior clinical colleagues taking up formal clinical leadership roles
Examples of openness to consider the possibilities of new and different roles to deliver services of the future, even where these impact on existing areas of expertise.
An increase in the clinical ownership of services and quality, with examples of clinicians taking a lead on developments.
We held eight multi-disciplinary 3-hour sessions, to which all staff were invited, working in groups of upto 25. Around one in every three people working in the hospital took part.
The interactive and experiential work in these sessions focused on recognising the part we all play in creating our internal, organisational norms of behaving - both positive and negative. Outputs included colleagues identifying what they need to do- individually and collectively - to foster a more mutually supportive, compassionate way of interacting and relating. Personal commitments were made between individuals in peer-to-peer groups to adopt mindsets and behaviours which would jointly influence the development of Aim High, Feel Safe, Team Up, Fail Well, Learn Fast becoming an everyday norm.
The work with the nursing, therapy, admin and medical leadership teams focused on leading collectively, and how our behaviour as leaders creates the cultural conditions for our colleagues. In particular, intensive work was done on practical, everyday leadership behaviours, actions and relational work which enable all our colleagues to Aim High, Feel Safe, Team Up, Fail Well and Learn Fast.
Key Learning Points
As in many organisations, whilst a ‘no blame’ culture is espoused, this is not always how it feels on a day-to-day basis for many people.
The work we did enabled a dialogue between a wide range of colleagues about the everyday realities when we do not Feel Safe at work, and what we can do - individually and collectively - to create a climate at work which feels less blame-based and more learningful, teamly and compassionate.
During the in-depth work we did, it transpired that these issues of psychological safety and teaming had never been explored and discussed before.
The process of giving staff time and space to explore these issues helped to develop higher levels of trust, mutual understanding and authentic dialogue.
A key benefit reported by staff were the insights and learning they gained through dialogue in multi-professional and multi-level groups, with colleagues who are interdependent to provide safe, high quality care. This type of multi-way conversation had never been experienced by most staff in their whole career. It helped with breaking down hierarchical and professional boundaries, and laid some promising foundations for a psychologically safer climate.
In order to engage a wider range of staff in honest dialogue about all these issues, it seems important for colleagues within the hospital to facilitate conversations about this with groups of their colleagues as part of their everyday leadership and team-based work.
A small number of team leaders decided to experiment (modelling Fail Well, Learn Fast!) in this work with their own teams, facilitating discussions based on the approach we had developed. They found this to be a not-altogether-easy, but a positive experience, with colleagues sharing their thoughts, feelings and ideas much more openly than before.
The majority of team leaders said that they did not feel confident to lead these kind of discussions without further support. This was echoed by the most senior leaders in the organisation. Facilitating developmental work of this nature in a group setting, and enabling dialogue amongst staff about issues of patient safety linked to psychological safety were beyond the experience or self-reported skillsets of most people leading these services.
Qualitative data provides some direct examples of how behaviours and attitudes shifted following the Working Together sessions, which map onto many of the original aspirations for the work. Please feel free to contact me for further details.
Whilst a Phase 3 of the work currently seems unlikely due to lack of funding, the need for and focus of further work seems clear. Most important would be to involve the remaining staff not previously engaged in the approach, whilst concurrently building further internal capacity and confidence to facilitate the culture development work on an on-going basis.
So, we have jointly learnt deeply and extensively through this work. As always, we are left with a ‘So What?’ in our minds. Did it make any difference? What’s next? What do we still need to learn more about? For what it’s worth, some of my reflections on these questions are in the final blog post of this series: Practical Teaming: So What and What Next?
Image by Hans Braxmeier