Glenn Carter, Speech and Language Therapy Coordinator, NHS Forth Valley @Glennetal
Culture
I love working in the public sector and the reason for this is simple: I come to work to fulfil a core purpose of improving the lives of children and young people whom we serve. For me, that is where the joy is. To that end, Children’s Speech and Language Therapy has recently undergone a radical transformation that will allow us to meet the needs of the most vulnerable people in our community living in poverty. This shift is the culmination of a broader transformation driven by ‘Ready to Act’ over the last 4 years (Scottish Government, 2016). But how do we support staff to engage in radical transformation that is required in order to meet the complex needs of the population, particularly within the context of increasing workload and potentially reducing resource? How do we support staff to stay engaged with their primary purpose and compassionately connect with others?
This is the fundamental challenge that the public sector faces and I believe a very significant part of the answer is to be found within one word: ‘culture.’ Culture is hard to define but put in its simplest terms, it is the personality of a group of staff or an organisation. It is ‘how we do things around here.’ You feel, sense and experience culture. Much of what culture is remains invisible and below the surface and yet it is hugely powerful in its impact. The culture of a group of people is driven by a shared set of values, assumptions and beliefs.
The research is clear on what you will observe from people when they are functioning within a healthy work culture (see visual of the cloud). You will see staff who are flourishing, have energy, job satisfaction, intrinsic motivation, are happy and are growing personally and professionally. This is how I would define joy in work.
This is hugely important in itself but when you consider the fundamental link between this and the benefit for the people we serve (visualised within the tree), its importance becomes undeniable.
The people we serve require us to function within a healthy culture. It’s not a ‘nice to have’, it is a fundamental requirement for staff if they are going to deliver quality, safe, compassionate care and engage in creative, innovative and transformative work.
How do you Transform Culture?
Within the Allied Health Professions in NHS Forth Valley we have been on an improvement journey to promote a healthy culture. We started this journey in Children’s Speech and Language Therapy 18 months ago and through the use of quality improvement it has been a joy to measure and see changes in culture.
We have achieved this in two main ways
- Leadership development
- Using the IHI framework for joy in work
I believe both approaches are essential if you are serious about improving culture. Our model for leadership would require a different blog entry altogether, suffice to say, we have been focusing on three key principles of: prioritising relationship, giving power away and facilitating effective action. Compassionate leadership and culture are inextricably linked. As Edgar Schein (1986) wrote: ‘the only thing of real importance that leaders do is to create and manage culture.’
In regard to making use of the IHI framework, we started very simply by having a 1:1 conversation with all staff asking them ‘what makes for a good day’ and ‘what makes for a bad day.’ This simple act of truly listening to staff appeared to shift the culture almost immediately. The information from those conversations was themed and then went back out to staff to prioritise.
We then developed a joy at work questionnaire based primarily on the IHI framework, but we supplemented it with some other principles developed from our reading on leadership. This questionnaire gave us excellent data about how staff felt about work and it was themed using the IHI framework e.g. Wellbeing and Resilience, Psychological Safety, Meaning and Purpose etc.
We established a cross-banding improvement group to oversee this work and ensured that we spent time understanding our unique context. This process has allowed us to understand the system and in partnership with the wider staff group we have identified what to work on first. We now send out a condensed joy at work questionnaire each month which allows the improvement group to track change over time.
The run chart demonstrates data over time regarding one of the eleven questions we ask each month.
I believe the key to success of this approach is found in the fact that although the process was initiated by leaders, it was driven by the wider staff group. This is not a ‘them’ and ‘us’ initiative. It is an ‘us’ initiative.
Conclusion
To return to my original point about what brings me joy, it’s about improving outcomes for staff and for the people we serve. Two sides of the same coin. Our recent review and transformation of the service has been radical and challenging. I would suggest, and there is evidence in the literature to support this, that this level of transformation would not have been possible unless the staff group were functioning within a healthy culture where they feel psychologically safe to make mistakes, where they know their team leader cares for them as a person and where they are treated with dignity and respect. Transform culture, transform services and then you will see improved outcomes for the people we serve. In that order.
AHPs across health and social care. 