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

2. 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:  Review between-session tasks on Self Awareness & Staffing Issues  Practice applying additional tools and techniques to yesterday’s case studies and to your own practice examples and issues  Introduce the 7 Steps in Systems Thinking Framework (Extended Iceberg Model) for in-depth analysis, planning and implementation of change and practice using them on an extended case study  Introduce Systems Archetypes – typical patterns that occur in services  Explore the principles of effective team working and practice creating a ‘Community Map’ for your team to understand inter-connections that impact on you  Use Tools and Techniques to illustrate the course content and explore your team issues and challenges  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) 2

3. Review and Reflect  What was your experience of completing the between-session task?  How did what we learnt yesterday influence your responses (and how might these have been different to what you might have thought previously)?  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? https://www.youtube.com/watch?v=kUAf1w_x6y4 3

4. Applying Additional Tools 1  In this next section we are going to introduce you to something called ‘Systems Diagrams’  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  We have already explored two simple examples yesterday – the ‘systems map’ and how it became an ‘influence diagram’ once we started tracking how different parts inside and outside the family influenced each other  This next exercise introduces you to another diagramming tool – the ‘Doom Loop’ 4

5. Applying Additional Tools 1 cont  First take some time to read through the first two pages of your handout – ‘Guidelines for drawing a Doom Loop’ and then ‘Constructing a Doom Loop’  Now in your groups work through the case examples you explored yesterday (Patient Flow & Silo Working) and use the Doom Loop provided to map out the Issue, Causes, Consequences and possible Links  When you have completed this exercise feedback your thoughts and reflections to the wider group 5

6. 7 Steps to Systems Thinking (AAT 2) 6

7. Case Scenario  Take some time to read through the following case scenario on your own at first  Using the ‘7 Steps to Systems Thinking’ handout scan through the case scenario and make some initial notes on the different elements within the case and how they map onto the Iceberg  Get together in your groups and share your initial thoughts and observations  How would you go about influencing change in this situation?  Agree an action plan, based on your use of the Iceberg Model, to resolve the issues you have identified  What might be some unintended consequences of the changes you make? 7

8. Case Scenario Review  Feedback to the whole group on your thoughts about taking things forward  What did you make of the 7 Steps Framework?  We would suggest that the 7 Steps Framework could be used in team meetings as a structure for hosting helpful discussions when you need to adopt new practices, initiatives, etc  What do you think?  Any other suggestions for where the 7 Steps Framework could be used? 8

9. System Archetypes (AAT 3)  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

10. 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

11. 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

12. Principles of Effective Teams (AAT 4) ‘ ‘Real Teams’ demonstrate 3 very basic characteristics. These are the very minimum dimensions of effective team working:  Team has clear objectives  Team works together interdependently to achieve these objectives  Team meets regularly to review objectives and the ways in which the team is working to achieve them 12

13. Benefits of Effective Team Working NHS research (www.astonod.com)  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

14. 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

15. 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 Local Authority OT CQC HR ITIT Estates Carer Networ k Care Homes Teams & Community Maps (AAT 5)

16. Teams & Community Maps cont  Take some time individually to draw a community map for your service area and the teams you have to work with to achieve your purpose and goals:  Use arrows to indicate important relationships within the community  Use different thicknesses of arrows to indicate those relationships that have the most influence on you achieving your purpose (as with Influence Diagrams)  Consider the impact of the following systemic structures on these relationships:  Communication and information sharing  Typical working practices & policies  Issues related to finance and funding  Geography, location and the buildings which you and others work in  What might the unintended consequences be of not paying attention to those relationships that have the most influence on your team?  What impact Mental Models (Yours, your team’s, other teams) might be having on the relationships within your community (e.g. Power, control, status, ideas about who needs to know what vs. who doesn’t need to know, etc)? 16

17. Synthesising Task  In your groups take some time to discuss the tools, frameworks, models and techniques, etc that you already use in your role as a Senior Leader  E.g. Process Mapping, Root Cause Analysis, IQT, PESTLE, SWOT, 5 Whys, 6 Thinking Hats, Force-Field Analysis, Fishbone Diagrams, etc (available in a Resources Link on Pinnacle)  Think about how you could utilise these (as appropriate) within the 7 Steps in Systems Thinking Framework, Iceberg Model or Team-based Working  We would suggest that Step 5 is one useful place, alongside asking the ‘Going Deeper’ Questions (or as part of using the questions)  What else do you already know, do and utilise that can be usefully synthesised with the tools and techniques of systems thinking and the principles of effective team working?  Share your ideas, thoughts and suggestions with the whole group 17

18. 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) 18

19. https://www.youtube.com/watch?v=rDxOyJxgJeA V4 Draft Document Only – 19/03/1519

20. 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? 20

21. Diolch Yn Fawr Thank You V4 Draft Document Only – 19/03/1521