Day 2 Programme for Senior Managers and Leaders Gareth Evans, Senior Organisational Development Officer Pamela Roberts, Senior Organisational Development Officer 1

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Aims & Objectives – Day 2 Aim:  To provide you with a set of techniques, tools, models and frameworks for influencing behaviour, team working, mental models, productivity, staff morale and well-being, team culture and ‘whole systems’ working Objectives:  Practice applying additional tools and techniques  Introduce Systems Diagrams for mapping out  Introduce Systems Archetypes – typical patterns that occur in services  Complete Engaging Leadership Self Assessment Exercise & review between- session tasks on Self & Other Awareness  Explore the principles of effective team working:  Looking at benefits and Operating Principles  And creating a ‘Community Map’ for your team  Build on your Community Map and undertake a Team Influence Audit and identify areas where you can extend and increase influence  Get agreement to review course use-ability with you 3 months post completion (invite you along to a focus group to explore your use of the tools back in work) 3

Applying Additional Tools 1  In this next section we are going to introduce you to something called ‘Systems Diagrams’ and ‘feedback loops’  Thinking and talking about the ways in which things interconnect and join up to influence each other can get complicated and abstract quite quickly  To get around this Systems Thinkers use a number of visual aids to help map out these complexities in ways that are easier to understand  This next section introduces you to two types of feedback loops that occur in systems – reinforcing and balancing loops – and how to create simple systems diagrams using these ideas to help you map out visually how your system is being structured by the ways in which its parts interact. 4

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Applying Additional Tools 1 cont  Reinforcing Loops (Vicious & Virtuous Circles)  These are change-oriented loops where a change in one variable leads to a similar type of change in another variable  In this type of loop both variables either increase or decrease in relation to each other. This type of loop pattern can often happen quickly – as when small arguments quickly escalate into big fights; or when one person laughing triggers the same response in the other person and this reinforces itself so that both people are quickly in tears laughing 6 Person A laughs Person B laughs R

 Balancing Loops (The more things change the more they stay the same)  These are stability-seeking loops where an increase in one variable in time leads to a decrease in another or vice versa (as the system seeks to bring itself back into balance) In this type of loop variables tend to move in opposite ways to each other. This type of loop pattern tends to occur more slowly (delays) – as when mediation is put into place to reduce increasing workplace conflict, or when we integrate newly gained learnings to decrease gaps in existing practice 7 Workplace Conflict Mediation B

Practising with Feedback Loops  In your groups work through the vignettes together and decide whether the situation is one of reinforcing or balancing feedback.  Then have a go at mapping out a simple systems diagram that captures the key variables and the type of feedback loop between them  Also consider any situations in your own work areas that fit with the ideas of reinforcing and balancing feedback  We will then discuss what you came up with and have a go together at mapping out any feedback loops you spotted in your own work area systems 8

System Archetypes (AAT 4)  System Archetypes are ‘common patterns’ that systems often cycle through – they are the ‘deja vu’ experience we often get in our teams and services (Haven’t we been here before???)  All the tools of systems thinking are designed to help us recognise these archetypes and be able to respond creatively (systemically) to them – to help us get off the merry-go-round and do something different  There are 8 common archetypes that have been identified which you can study in your own time with the following handout  To help us see the value in working with these common patterns we will explore two that tend to happen in the NHS on a frequent basis – see if you recognise them in your own work area...  The first is known as ‘Limits to Growth’ (Why do things go back to how they were?)  And the second is ‘Shifting the Burden’ (Quick-fixing the ‘symptom’ not the cause) V4 Draft Document Only – 19/03/159

Limits to Growth  Let’s take a look at this archetype using the example of ‘increasing PADR compliance’  The learning with this archetype is that ‘something always pushes back’ – limits will eventually make themselves known and subsequently we will see diminishing levels of growth from our efforts over time  When this happens the typical solution is to ‘do more of the same’ as previously, i.e. Keep pushing the growth action just harder and with more effort (and over time become increasingly frustrated as change does not happen as expected)  Learning into Action:  We need to explore our systems ahead of time for potential limiting factors and look at how we plan for, address, work around, reduce, offset, etc,any limits to growth  Look at external issues like limits to resources, political/strategic pressures, impacts of other systems (partners with competing priorities)  Look at internal issues like systemic structures, mental models, engrained habits of practice, potential threats to established hierarchies, norms of power and control V4 Draft Document Only – 19/03/1510

Shifting the Burden  Let’s take a look at this archetype using the example of ‘workload stress’  The learning with this archetype is that in the face of challenge we tend to react without pausing to think – we respond to the symptom and not the cause  We then apply symptomatic solutions as this is what is expected, is easier to implement, helps us avoid addressing fundamental problems that are difficult to deal with, etc  Learning into Action:  As leaders we need to ask ourselves questions of the types of solution we apply to problems and the potential side-effects (unintended consequences) of these over time:  Are we attempting a quick fix, or doing something to alter fundamental structures?  Remember: Quick fixes tend to produce initial gains (and thereby reduce the sense of urgency to look at more fundamental problems and solutions); the side effect of this is that we lose opportunities to think ahead of time and respond, design or transform –we become trapped in cycles of event – react – event – react, etc 11

Do your skills and abilities balance towards achieving an engaging leadership style?

Review and Reflect  What was your experience of completing the between-session task?  How did what we learnt yesterday influence your responses?  In what ways can you apply what you have discovered within team meetings?  Is the link between personal mental models, systemic structures, team trends and patterns and day to day events becoming clearer?  Is anyone prepared to share any insights from the task? 13

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Why team based working in healthcare? 5

Team Based Working Team based working is a philosophy or attitude about the way in which organisations work – where decisions are made by teams of people rather than by individuals and at the closest possible point to the client, patient or service user. Aston Organisation Development Ltd 2014

Benefits of TBW NHS research Reduced hospitalisation and costs Increased effectiveness and innovation Increased well-being of team members Multi-disciplinary teams deliver high quality patient care and implement more innovations Lower patient mortality Reduced error rates Reduced turnover and sickness absence Aston Organisation Development Ltd 2014 Activity

Team working in health care  Amy Edmondson  US 1990s error management  Aston Research  Healthcare team effectiveness  HR and patient mortality  Mental Health team effectiveness  Primary Healthcare team effectiveness  Team working and clinical effectiveness in breast cancer teams  Assessing organisational capacity to deliver Clinical Governance  The NHS Workforce initiative – mental health of the NHS workforce Aston Organisation Development Ltd 2014

Evidence : Research conducted by Professor M West and C. Borill concluded that the higher the percentage of staff working in teams within a hospital, the lower the patient mortality. On average, in hospitals where 60% of staff worked in formal teams, mortality was around 5% lower than would be otherwise expected. Staff working in formal teams also introduced more innovations to improve the quality of patient care, show an improvement in their general well-being and have higher levels of job satisfaction. Aston Organisation Development Ltd 2014

Team working and patient mortality

What is a Team? Typically no more than 12 people who: Have shared objectives in common. Need to work together to achieve these objectives. Have different and defined roles in the team. Have a team identity. Aston Organisation Development Ltd 2014

7 Key Principles of Effective Teams 1. Team Identity 2. Team Objectives 3. Role Clarity 4. Team Decision Making 5. Team Communication 6. Constructive Debate 7. Inter-Team Working Aston Organisation Development Ltd 2014

The Aston Team Performance Inventory Team task design Effort and skills Organisational support Resources Team Processes Objectives Reflexivity Participation Task focus Team conflict Creativity and innovation Individual satisfaction Attachment Team effectiveness Inter-team relationships Team innovation InputsProcessesOutputs Leadership Leading Managing Coaching Fully effective teams:

Aston Organisation Development Ltd 2014 Activity Quick Team Effectiveness Audit Do you work in a team? Be honest, no right or wrong answers! Think objectively, consider all of the team

Operating Principles:  ‘ways of working’ a ‘sense of how they work in the world’ - e.g. “we are the sort of team that.....”  This is about how we behave and how we treat each other, for example, do we trust each other, are we open and honest? Aston Organisation Development Ltd 2014

Operating principles: Remember a time when you worked in a successful team – one that you enjoyed being part of and that achieved its goals What made this team so successful? Think about processes and behaviours Write one feature on each post-it 29 Activity Aston Organisation Development Ltd 2014

Home team: The team whose objectives determine the way you work in all the other teams you are involved with. Team community: A number of teams that need to work together to achieve a higher goal e.g. a patient pathway. 18 Aston Organisation Development Ltd 2014

Inter-team working Team based working is about whole organisations working in co-operative teams, not just about individual teams working effectively. Team members need to have a common understanding of the team’s position in relation to other teams and organisations that it needs to interact with. Aston Organisation Development Ltd 2014

Pathway Management Team Trust Board CCG G.P.s Portering Ward Management Team Theatres Social Workers Radiology Bereavement Counselling Physio Patient Forum Regulatory Board Business Devt Group Monitor Local Authority OT CQC HR ITIT Estates Carer Networ k Care Homes 26 Example of a Community Map Aston Organisation Development Ltd 2014

 In the middle of a sheet of paper draw a circle that represents your own home team.  Around this circle draw in at relevant distances: − all the teams that your home team regularly works with − any other teams that the team will need to work with in the future − any external teams or organisations that influence the formation of team targets and those that influence the team’s ability to achieve its goals. Develop a Community Map and explore the teams you work with but need to influence more effectively in order to deliver an efficient service Activity

Using your Community Map and the Team Influence Audit, identify which areas you need to be able to increase influence if you are to succeed in achieving your team objectives. Identify your top 5 priority areas and using the ‘building team influence’ questions, develop a plan in order to extend and increase influence in these areas, using the action sheet in your workbooks. Activity

Write a headline about how effective team working in your area has contributed to the organisation successfully achieving its strategic goals. Rules: Less than 10 words Dated one year from today. Say which professional journal or other relevant publication this headline appears in. You must feel proud to see this headline. Small Group Activity

Summary of Main Learning Points  Defined and explored Organisational Development, Systems Thinking & Principles of Effective Team Working  Understood how stepping back and seeing the bigger picture helps us ‘map the system’ and see patterns and deeper influences that shape day to day events  Used a number of frameworks and tools that give us ability to leverage change at a number of levels within teams and service areas  Understood the connection between mental models, systemic structures and culture  Understood how exploring for the system’s implicit purpose reveals ways in which we can influence work place culture to improve dialogue, trust, confidence and openness to learning  Made the link between the various factors in effective team working and improved morale, productivity, staff engagement, staff capability and effective use of resources  Understood that systemic change needs time, has consequences, and that taking time to think helps us respond, design and transform (and not just react) 33

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Feedback, Reflections, Next Steps  Feedback  Please take some time to complete the evaluation form provided and make suggestions for how to improve the workshop for future groups  Reflection and observations about Day 2, and the Wider Programme  What has been the most useful aspects of the programme?  What do you think you can do to continue your learning back in the workplace?  How do you think you can apply some of the tools and techniques back in the workplace?  Next Steps  We are planning a series of CPD ‘master classes’ that build on topics we have discussed and explore related ones such as workforce modernisation, succession planning, talent management, etc – let us know if you are interested in attending any of these  Would anyone be interested in being part of a ‘systems thinking’ practice group with the aim of practicing using systems thinking to develop skills, explore workplace issues and consider possible systemic interventions? 35

Diolch Yn Fawr Thank You V4 Draft Document Only – 19/03/1536