I am sharing my experiences of leadership and the journey of a healthcare entrepreneur. I hope that this will inspire others into following the same journey and create opportunities for all!

The Maslow Foundation aims to ensure social inclusion, using the voice of lived experience to create services that meet their ambitions and I am proud to be Chair of Trustees creating hope, joy and meaning in our lives. Our services include creating safe spaces to ensure meaningful conversations, being able to connect individuals into wider services with a model of trauma stabilisation and connection. We are pleased to be offering housing to those who cause harm from domestic violence and enabling their partners to remain in their local community. This has revealed the challenges with employment and our move to creating an entrepreneurial laboratory and microbusiness support. We are champion the Child Impact Assessment to support mothers who may be sent to prison and their children to inform judges and provide a robust plan for the family. To support the charitable sector I have launched Urban Nest Housing Solutions to access housing with safety at our heart.

Nurture Health and Care Ltd has been co-founded by myself and my team to nurture workforces across the public sector. This is built on a model of Psychological Safety and recognises the need for connection, sense making and action. By creating sense making structures through our supervision model or decision making groups in our investigation team, we can enable people to make sense of risk and uncertainty. We are proud to be offering services to the NHS for investigations and the Prison and Probation Ombudsman/NHS England for clinical reviews. In addition, we are providing sexual offence examiners to sexual assault referral centres, with a unique workforce strategy which includes the accredited Sexual Assault Nurse Examiner programme (SANE) and our inspection ready governance delivery. We use our four ways of knowing to help provide understanding, equality of voice and values based decision making to create new insight for our services. We provide post graduate preceptorship programmes and enjoy the contribution of our Nurse Ambassadors and run a Nurture Ripple and Cultural Architect Programme generating psychological safety to embrace the ambition and creativity of our workforce enabling success.

I am interested in how language can represent culture and be measurable through artificial intelligence and have set up a new organisation, the Centre of Artificial Intelligence Interface (CAII), with the launch of our new website and first product which acts to create different perspectives as a basis of decision making: https://www.3friends.ai/ and looks how ethical AI solutions can contribute to healthcare.

As a Trustee for Survivors In Transition, I continue to support my passion of providing services to those who have experienced sexual violence and am lucky to work alongside Fiona Ellis, who as CEO has created a values based innovative organisation to provide therapeutic interventions.

I am also exploring setting up a microgrant funding system to create financial support, coaching and an incubator of change recognising how passion, entrepreneurialism and the agency of people can support change in our services. I look forward to sharing this journey.

Alexis Hutson (https://www.alexishutson.com/) facilitated the Faculty of Medical Leadership and Management course – Tomorrows Strategic Leader which I attended and highly recommend. She was an excellent resource and identified the concept of ‘Taking a Thought for a Walk’ which I have named this blog after. Simon Bennett (http://www.simonbennettcoaching.com/) is my personal coach and I advocate this support, It enables us to explore the journey that we are all undertaking in a psychologically safe space.

I believe that without aiming for the impossible, miracles cannot happen and through authentic leadership, we can enable every person to be able to reach their own potential.

When evaluating success, if our focus shifts from rules based compliance and competition to a landscape of values based decisions and collaboration, how can we quantify that success?

How can we assess the effectiveness of service models that prioritise thriving over mere expansion, cooperation over competition, and the experience of values over rule-bound compliance?

Values-Based Practice underscores the importance of managing intricate and sometimes opposing values, especially in healthcare scenarios. This approach emphasises the significance of aligning with our core values, fostering individual and organisational collaborations, navigating the uncertainties of risk through the use of values, and cultivating a compassionate and human-centric workspace.

Though concepts like culture audits, trauma-aware strategies, and psychological safety are prevalent, these often don’t mirror real-world settings. Here’s where language could potentially serve as an indicator of cultural alignment and a care system anchored in values.

Despite extensive research, there isn’t a concrete method or tool that measures or categorises language in the evaluation of board reports, patient safety, or educational initiatives. Yet, the advent of artificial intelligence opens the door to scrutinising language based on content, discerning the presence of values, humanistic terms, technical jargon, and gauging language for emotions, biases, or cultural nuances.

Language, as suggested by studies in culture and psychology, is instrumental in cultural dynamics. It is the primary vehicle through which we decipher the thoughts of others and forge a collective understanding of the world. Sociolinguistics delves into the nexus between language and its context, investigating the variability of language use across social settings, and how it mirrors and amplifies societal norms and values. This sentiment is echoed by disciplines like marketing that delve into how language, along with broader cues, can influence consumer behaviour.

Research from diverse fields like linguistics, anthropology, psychology, sociology, and communication converge on the idea that language is not just a reflection but also an enforcer of cultural norms, values, and beliefs. It appears to be an essential benchmark for success in areas like personalised healthcare, value-driven leadership, and broad systemic transformation.

https://oxfordre.com/communication/display/10.1093/acrefore/9780190228613.001.0001/acrefore-9780190228613-e-26

https://journals.sagepub.com/doi/full/10.1177/00220221221114046

In today’s era, an overtly medical and mechanistic approach to care prevails, paralleled by an industrial framework of service provision. This is evident in the terminology we use: “Human Resources”, “Assets”, “Efficiency”, “Systems Analysis”. However, a paradigm shift is needed—one that emphasises relationships, encourages recipriocity, and nurtures a sense of community and belonging.

As our dialogues progress and grow richer, so should our language. It’s high time we moved beyond the mechanistic terminology and embrace words that truly resonate with the vibrancy and hope innate to humanity and utilise technology to measure our success.

For your information, according to Chat GPT this blog contains 21 words reflecting values and humanity, 24 words reflecting business and technical language.

In the current age, where ongoing crises riddle our institutions and dwindling productivity plagues our economy, the quest for swift and sustainable transformation within organisations is more critical than ever. The solution, I propose, is not just about rebuilding trust but about cultivating a mindset that aligns our organisational goals with the natural order of life – a process known in ecology as ‘rewilding’.

Re-envisioning Growth: An Introduction to Rewilding

Amid these complexities, innovative models such as the Donut Model of Economics provide a refreshing alternative to the relentless growth cycle that depletes resources and widens inequality. Simultaneously, successful rewilding projects like the transformation of Patagonia into a national park offer a transformative lens through which we can reimagine our organisational structures.

The Crux of the Challenge: Our Organisational Landscape

Our organisations, much like our natural landscapes, have been stripped of their inherent creativity and freedom to innovate, giving way to rigid rulebooks that fail to meet the complexity of our environments. This results in individuals feeling overwhelmed, stuck, and fearful, giving rise to toxic cultures that manifest in dire consequences like aggression, bullying, and confrontation.

Rewilding Organisations: A New Path

So, what if we could ‘rewild’ our organisations? What if we could reintroduce the dynamism and biodiversity of a natural ecosystem into our rigid organisational structures? In the same way rewilding restores nature in areas altered by human activity, we could strive to extricate our organisations from the confines of capitalism and reintroduce the human element into the conversation.

Rewilding organisations means restoring balance and harmony in spaces distorted by capitalism, industrialism, and resource exploitation. It presents an opportunity to prioritise social and environmental wellbeing as much as, if not more than, economic growth, paving the way for sustainable and harmonious ways of living.

The Principles of Rewilding: From Ecosystems to Organisations

Rewilding as a process is grounded in principles such as identifying a space without imposing boundaries, removing destructive practices, reintroducing native species, monitoring closely, and being patient as recovery takes time. But how does this translate to organisations?

Embrace Natural Dynamics: In rewilding, nature follows its own path. For organisations, this translates into an environment that encourages autonomy and self-organisation, fostering a more dynamic and responsive setup that reduces rule-based and compliance-based practices.

Diversity and Interconnectivity: Just as a healthy ecosystem thrives on biodiversity, organisations benefit from a diverse mix of skills, perspectives, and roles that need to flex and adapt. Siloed thinking needs to be abandoned in favour of prioritising connection.

Resilience and Adaptability: Rewilded ecosystems are resilient and adaptive. In a similar vein, organisations need to build the capacity to adapt to external changes, remaining attentive to how changes impact and adjusting course where necessary.

Succession Planning: In nature, different species dominate at different times as the environment changes. In organisations, succession planning ensures robustness even as personnel change. As our systems evolve, we need to be open to the emergence of significantly different structures.

Long-term Vision: Rewilding requires long-term commitment and patience. As organisations, our first step could be to move away from a narrow focus on productivity and efficiency, towards a long-term vision that serves our community.

By following these principles, we can shift from rules-based to values-based decision-making, creating organisational cultures that reflect a healthy ecosystem. We need to appreciate diversity, cultivate power from paradoxes, establish connections to eradicate silos, and build trust to foster new practices.

Leadership in the Era of Rewilding

Leaders need to create time, be patient, relinquish control, allow things to evolve, and bring others into the decision-making process. Remember, rewilding is a long-term process, potentially spanning years or decades, requiring patience and persistence.

In the grand scheme of things, we should follow the principles of ‘reduce, reuse, recycle’ to wisely manage resources and value humanity equally, enabling people to thrive and foster personal growth.

As we navigate through this shift, we must remember that rewilding is not just about bringing back what we’ve lost, but also about venturing into new, unfamiliar territories. It’s about creating a space where we are not just surviving, but truly thriving.

In reviewing patient safety investigations and analysing the words that they are using, it has led me to consider how rules based decision making has resulted with inflexibility within our systems and created anxiety for practitioners when individuals do not fit algorithms that have been designed for specific diagnosis.

In shifting to principles based decision making, we can consider values, connection, emotions and rights as part of this perspective and it creates a new mechanism of moving forward, often reducing conflict.

Human values provide a powerful framework for decision-making. When we align with our values, life seems to flow. When there is misalignment, things can start to feel difficult. Principles, associated with values, connections and rights therefore can highlight a new way of considering a problem which enables individuals to feel confident and act autonomously when the world feels complex.

These words should then be present in our narrative and our practice and be represented in our patient safety reports, investigations and embedded in our policies and practices.

Currently, health and care organisations run their services through a rule based decision making process and the language is dominated by technicality with transactional labels.

Human rights are based on principles of fairness, respect, equality, dignity and autonomy, and these principles weave their way through our national strategy and policies. Principles should have created a positive decision making toolkit especially where there is risk and uncertainty.

The ratio of ‘checking things’ in the NHS through assessment, audit, scrutiny, supervisory oversight, justification and inspection to ‘doing things’ such as supporting, nurturing, connecting and even intervening feels disproportionate.

If we embrace the Human Rights Act, there are the basic things we all need to stay alive – like food, water, air, shelter, and sleep, and to feel safe and secure. [Article 2: The right to life. Article 3: Prohibition of torture, inhuman and degrading treatment. Article 5: Right to liberty and security.]

Currently, these rights although part of policy, have not translated into actions.

The need for belonging and connection, family and friendships, love and intimacy, dignity and respect and freedom also form the basis of our Human Rights Act but again often do not translate into practice. [Article 3: Prohibition of torture, inhuman and degrading treatment. Article 5: Right to liberty and security. Article 8: The right to respect for private and family life, home and correspondence. Article 9: The right to freedom of thought, conscience and religion. Article 10: The right to freedom of expression. Article 12: The right to marry and found a family.]

Using these legal rights should have created a lens for thinking about the situations we encounter however they became a rule book which trapped us in a never-ending cycle of screening, triage, signposting, assessing, planning, justifying, referring, delivering interventions, reviewing and following processes. We spend our time defending our decisions and being seen to observe policy and processes rather than understanding each situation. We worry about staying within budget, practicing defensively and I would suggest that we are fighting with, not for, those we serve.

The endless words that reflect technical language and transactions which I have taken from our analysis of investigation reports included complaints, providers, inspections, processes, services, transfers, policy, systems, departments, investigation, risk, guidance, governance, measures, referrals and management to name but a few and these words are distancing, dehumanising and created technical recommendations which have not led to improvement.

There was a shocking absence of words that reflected values, connection, emotions or rights, and therefore there is a lack of humanity within the solutions which presumably reflects the nature of oversight. The absence of words like rights, ethics, advocacy, relationships, connection, creativity, and hope were missing despite these being championed in national strategy such as https://www.nhsconfed.org/publications/messenger-review-nhs-leadership#:~:text=The%20report%20rightly%20points%20out%20the%20gaps%20in,pathway%20from%20recruitment%20through%20to%20mid-career%20and%20beyond or https://www.gov.uk/government/publications/the-hewitt-review-an-independent-review-of-integrated-care-systems

Decision Making Strategy: Rules-based versus principles-based regulation – is there a clear front-runner?

A recently published paper, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10016636/ reviewed an analysis of incidents and utilises a qualitative alongside a quantitative analysis of harm in prisons which included the views of those who had been detained in prison and key stakeholders alongside the quantitative measures and eludes to principles being key with a language that reflected values, connection, emotions and rights including: equivalence, context, ethics, experience, dignity, distress, identity, reality and perception.

I noted the move of the RCN to principles as part of their professional development. https://www.rcn.org.uk/Professional-Development/Principles-of-nursing-practice

Our current regulatory approach is rules based. Recent criticism of Ofsted, alongside CQC and HMIP all demonstrate the impact and un-intended consequence of inspections. Analysis of words contained with a CQC inspection report had zero words that were considered to align to values, connection, emotions or rights.

In healthcare, both rules and principles play important roles, although they function differently and serve different purposes.

Rules are specific, concrete instructions or guidelines that are designed to ensure consistent and standardised care, reduce errors, and maintain compliance with legal and clinical standards. For example, hand hygiene rules or dosage rules for a specific medication.

Principles are broader and more flexible that reflect the fundamental values and goals providing a framework for making decisions and taking actions when specific rules cannot meet the different contexts which exist.

Regulators will require a different approach to analyse whether principles have been applied appropriately. This will require a relationship of shared understanding which requires time to build and a landscape where the regulator is also not punished for deviating from rules base practice.

The choice between rules and principles is not absolute and can partly accommodate nuance.

How can we all embrace values based decision making

Overall, transitioning from rules based decision making to one that that prioritises principles will require creativity, coaching, and open-mindedness to enable cultural, managerial, and operational change and by analysing the language we use could provide a road map to demonstrate success in this journey.

Because every situation is different, values-based decision-making can provide the flexibility needed to adapt to a variety of circumstances. However, it can also be challenging because it requires interpreting and applying values to different situations, can lead to different interpretations among different people.

In real-life situations, many organisations and individuals will use a combination of both approaches. The key is finding the right balance. Too much reliance on rules can lead to rigidity and a lack of creativity, while too much emphasis on values can lead to inconsistency and uncertainty. I would propose that through analysis of the words we use can provide insight into this transition.

The use of language in healthcare can significantly influence patient safety in several ways.

We identify communication as a contributing factor to investigation recommendations but I would like to explore if the words by which we describe our world, reveals the culture in which we work.

Robust Standards of Documentation

We are fully aware of the need for accurate and comprehensive documentation in compliance with our professional bodies standards, however reducing complexity to black and white statements of fact leads to the loss of context.

Clear and accurate communication between professionals and our patients is crucial in safety. Misinterpretation or misunderstanding can lead to errors in medication, treatment plans, and other aspects of care but within the words we use, we create labels and our sense making often reveals categorisation which creates those who belong and those who are ‘other’.

Patients need to fully understand their health conditions and the treatment options available to them in order to make informed decisions. However, health is a complex bio-psycho-social interaction which requires time and positive communication strategies to create a personalised plan.

Examples of Language in Safety and Quality

An example, is a lady who complained to a nurse, that she wanted to see a doctor after having surgery earlier in the week and fearing complications.

This led to conflict as the system utilised nurses and no doctor was available.

The clinical team united and labelled the person as ‘trouble’ rather than seeing her as a scared post-operative patient and no-one recognised that there was reasonableness in the request.

No-one identified that the system was flawed and did not meet the needs of the patient rather they preferred to label our patient as a ‘problem’.

A second example is from Sussex Prisoners Families which is part of a shared narrative in relation to a child who witnessed their mother being arrested.

My name is ……………..

This is my story about when the police came to our house and took my mum away (when I was five years old). I don’t remember much. We were all in the living room when there was a big bang on the door. I could hear a lot of people talking. The next thing I remember is my mum being on the floor. I was very scared and was crying a lot. My mum was asking them not to hurt her arm and didn’t want me or my baby brother Bobby to see. I was yelling for my mum and crying more. I remember screaming for my mum as they were fighting with my mum. My mum told me it was okay, and it is a game the police was playing, looking all around the house and pulling things out and making a mess everywhere. I was so scared because I didn’t know what was going on. They took my mum out the house and I didn’t know what was going on. They took my mum out the house and I didn’t know if I was going to see her again.

We rarely have our patients histories shared in a narrative which reveals their true thoughts and feelings, which prevents us from being able to truly understand.

Professional Language

Interprofessional communication is an interesting area as we have generated a business biased language where resources, assets, efficiency and effectiveness all blossom, but paying attention, having compassion, being open and creative is absent.

Cultural differences can be seen in our language. Culturally insensitive language can lead to miscommunication, misunderstanding, and harm but to be able to constantly place ourselves in others shoes, creates a cognitive load that is under appreciated. Once again, those who are different appear outsiders in our systems.

The language we use can have a significant impact on psychological well-being. Through the creation of trauma informed environments, in which we actively listen and try to generate psychologically safe environments is important so that we understand the experiences and reactions of those for whom we care.

If we reviewed our patient safety transcripts, what we would find is business and expert language being promoted and the narrative being lost.

The 20th century, and particularly from the 1940s onward, saw a significant shift in many professional fields towards a more business-oriented and technically precise language. This shift was driven by numerous factors, including the rise of large corporate structures, increased global trade, and the rapid advance of technology.

In healthcare, this shift was reflected in a growing emphasis on medical research and evidence-based practice, which necessitated a more precise, technical language which lacks constructs surrounding connection, imagination, creativity and belonging.

Introduction of Philosophy

In recent years, there’s been a growing recognition of the importance of communication in healthcare, and efforts are being made to strike a better balance between the technical/business language and the language of empathy and understanding.

Toxic language, such as harsh criticism, insults, dismissive language, and frequent negative feedback can foster a toxic culture. It can lead to low morale, decreased motivation, high stress, and we feel undervalued and disrespected. Strength based approaches which build on relationships of trust are being cited as critical.

Adopting respectful, inclusive, clear, and positive language is crucial in building a healthy work culture. The language used in philosophy can provide inspiration for change.

Philosophical language often deals with abstract concepts and principles, such as truth, justice, morality, existence, consciousness, and the nature of reality. The goal of philosophical language is to clarify concepts, question assumptions, explore possibilities, and stimulate thought and discussion. This language is often subjective and open-ended, allowing for a wide range of interpretation.

On the other hand, business and scientific language aims to be more objective, precise, and efficient. The goal is to convey specific information clearly and concisely, make decisions, solve problems, and accomplish tasks.

These two forms of language reflect different ways of understanding and interacting with the world. Philosophical language encourages reflection, questioning, and exploration of ideas, while business/scientific language focuses on accuracy, clarity, and efficiency in accomplishing specific goals. Of course, both forms of language have their value and are necessary in different contexts.

Lets study language as a theme within patient safety

I propose we should analyse our conversations and that a well-rounded approach should incorporate elements of both philosophical language which can ensure that we take into account the full range of human experiences and values, alongside business and scientific language which allows for precise communication and efficient operation within the healthcare system. Combining these approaches can contribute to more effective, compassionate, and patient-centered care and I propose that we measure how language can underpin our safety cultures.

Artificial Intelligence in Healthcare

The healthcare industry has been undergoing an immense transformation, largely propelled by advancements in technology. The rapid shift towards personalized care, fueled by insights from genomics, biochemistry, neural networks, and cultural perspectives, has revolutionized the way we approach patient care. Among these advancements, the introduction of Chat GPT AI, a powerful AI-driven tool or the equivalent could transform our services.

As a healthcare leader, I have personally witnessed the transformative impact of AI. Tools like Chat GPT have become an indispensable part of our processes, managing everything from our social media campaigns and job specifications to answering questions and fostering creativity. Alongside Runway for image creation and Gamma AI for resource development and presentation construction, these AI tools have changed our day-to-day operations.

However, we must acknowledge that these systems operate separately from our sensitive data, due to our current inability to ensure robust information governance within them. All our data must adhere to NHS Digital’s identified standards for protection. The integration of multiple platforms with AI can pose a challenge to data security, a subject that government bodies must address.

Complexity In Healthcare

Leadership in the healthcare industry is a demanding role, given the inherent complexities of the sector. The surge in patient needs, coupled with the intricacies of large system management, can often overwhelm even the most seasoned leaders. That’s where AI-driven tools like Chat GPT AI come into play. By analyzing vast amounts of data in real-time, these tools can provide valuable insights into trends, patterns, and potential solutions, enabling leaders to adapt swiftly and make informed decisions.

However, AI, despite its profound capabilities, should not be viewed as the ultimate problem-solver. In my experience, it serves more as a facilitator for exploration and dialogue, assisting in question formation and problem consideration. It has its limitations, with a tendency to confirm existing biases and ideas rather than generating novel solutions. Like a calculator to an accountant, it is a tool that aids rather than resolves.

We must also acknowledge the unintended consequences of technological advancements. The speed at which we make decisions and the sheer volume of work we undertake can lead to a sense of being overwhelmed. This relentless pace adds layers of complexity to our lives, exacerbating the challenge of maintaining balance and well-being. Perhaps it’s time to reconsider our work hours, allowing us to recover and find time for our own well-being.

Our world’s complexity is reinforced by the capitalist lens focusing on profits and efficiency, alongside technology innovation and we have experienced an accelerated pace of decision-making. The growing volume of work, the decline of spiritual and religious constructs to explain the unknown, and the diversity of our global communities means we are navigating a dynamic landscape which requires adaptability, connection, and a willingness to learn and grow.

Global Healthcare Communities

By acknowledging these factors, we can appreciate the intricacies of our world and work towards cultivating a more harmonious existence. By maintaining a balance between AI-driven solutions and human engagement, we can maximize the benefits of technology without losing the insights unique to human experiences.

Listening to Sir Mark Rowley (Metropolitan Police) answering questions from the public, we realise the enormous challenge that policing has to change their culture and enable the community to be confident.

Watching the striking doctors, along with the wider ongoing crisis in health and social care, we continue to struggle with a depleted workforce and systems that do not meet the needs of our communities.

This dysfunction continues across our public sector landscape: Education, Fire Services, Criminal Justice System and even Housing.

Why Are Our Systems in Chaos

When we are fearful, adrenaline and our neurochemical makeup causes our brain to focus on the presenting risks. This leads to tunnel vision, fear of rejection, defensiveness, withdrawal, compliance and the experience of being overwhelmed. Memory impairment and lack of creativity enable the threat to be prioritised and managed psychologically.

As individuals, organisations and systems, we appear to be traumatised and unable to move forward.  

How Do We Create Curiosity and Deliver The Service Models which we need across the UK.

As a leader myself, I was fooled into the belief that governance with policies, processes and communication strategies, enabled our workforces to be competent and confident in dealing with their environments and through audit and feedback closed the loop to demonstrate completion of our quality outcomes.

I experienced the sense of chaos and fear leading to myopia, fear of rejection, defensiveness, withdrawal, and yet have continued to find spaces to be creative and innovative and can still thrive.

Although traditional models of governance and Business as Usual need to be woven into our services, these should not be prioritised over Sensemaking Capacity, Connectivity Capacity and Entrepreneurial Capacity.

Sensemaking Capacity

In order to make sense of the world around us, we need to understand our own minds, the minds of others and the context in which we are viewing the world.

This requires active participation of our communities in our sense-making processes, embracing and harnessing differences of opinion to create sense-making structures. These need to happen at all layers of organisations knitting together ideas and insight into a coherent strategy.

Rewilding Knowledge Management

Rewilding knowledge management moves away from the traditional, linear approach to knowledge management, and embraces a more holistic, organic, and dynamic approach. It involves creating a culture of curiosity, collaboration, experimentation, and open communication. This approach recognises that knowledge is not just a static asset that can be managed, but a living organism that needs to be nurtured and allowed to grow and evolve.

Through sharing knowledge organically, we can learn from our experiences, experiment and change.

Understanding How We Make Decisions

Cognitive aspects of decision-making refer to the mental processes involved in making a decision. This includes the ability to gather, process, analyse, and interpret information to arrive at a conclusion or choice.

Mental processes such as perception, attention, memory, reasoning, and problem-solving all need to be explored. Perception involves how individuals interpret and make sense of information in their environment. Attention refers to the ability to focus on relevant information and ignore irrelevant information but mindful of the bias this creates. Memory involves the ability to recall relevant information from past experiences. Reasoning involves using logic and critical thinking to analyse and evaluate information. Problem-solving involves identifying a problem and developing a solution to address it. These need to be considered as part of sense making and understood to create confidence.

Connectivity Capacity

Connection as a skill critical to build broad networks which drive creative collisions. This impact enables shared understanding, innovation and together with diplomacy create new opportunities and motivation.

Valuing People

Our competitive capitalist perspective has treated people as resources who are expendable, rather than unique talent. Our networks are often constrained into silos of like-minded individuals and form barriers rather than incubators for ideas and discussion.

Emotional Expression

The importance of emotional expression cannot be overstated. Our organisations are not just a set of policies and decisions, but a reflection of our values, beliefs, and aspirations. When we suppress our emotions and feelings about our lives, we are also suppressing our sense of agency and responsibility as citizens. It is important to acknowledge and express our emotions about our working environments, whether it is anger, frustration, disappointment, or hope. This can help us to build stronger connections with others who share our values and beliefs, and to mobilise collective action towards meaningful change.

Entrepreneurial Capacity

Together with sense making structures and connectivity, we can utilise entrepreneurialism to take ideas and translate them into reality.

Organisations and Context

Through understanding context, different action orientated capability can be explored. This requires a deep understanding of the different set of circumstances in which we operate, and the ability to adapt to match the demands of each context.

We all need to be able to identify whether a situation is simple, complicated, complex, or chaotic, and then respond accordingly. In simple contexts, we can rely on best practices and process-oriented approaches, while in complicated contexts, they need to be more analytical and often benefit from an expert perspective. In complex contexts, we need to be patient, experimental, and open to emergence, while in chaotic contexts, acting quickly to establish order and manage innovation in parallel may be a choice.

What Concepts Look Like In Reality

Through implementation of frameworks such as psychological safety, inclusion and trauma approaches we create trust to build the foundations for our systems to work effectively.

I have real experience of creating safe spaces which enable creativity to emerge but this needs role modelling, group dialogue, consistency of approach and true celebration of experimentation, error and learning from our experiences.

By practicing design thinking using a human-centered approach which involves understanding our users and ignoring the systems present, we can define the problem, ideate potential solutions, prototype and test which can reveal new models of delivery.

Ask interesting questions of people:

1. In your view, why are we doing this?
2. How do you see your role in this?
3. What do you need to make this change?
4. What do you need to re-prioritise?
5. What is happening emotionally?
6. Is there anything that you see that could go wrong?

Look for signs of energy, excitement and evidence of moving forward rather than traditional outputs and key performance indicators which litter our dashboards.

Lets remove the fear of not knowing what to do and replace with the worry of how this will impact me.

Lets remove risk adverse cultures, with the thrill of taking a risk and seeing what happens.

Lets create supportive structures where our wellbeing and individuality is celebrated so the worry and excitement can be shared and moving forward enabled.

The solution is to celebrate Entrepreneurship and the Agency of People to Change The System.

The tragic and preventable death of Ruth Perry, headteacher at a school downgraded by an Ofsted inspection, has sparked calls for a review of regulatory oversight. While safety and quality must be assured, it’s crucial to consider the impact of regulatory inspections on the well-being of passionate workforces facing complex and challenging environments.

The Association of Directors of Children’s Services stated to use a single-word judgment “for a complex set of services and differing local contexts tells at best a partial story and even risks weakening the very services the inspectorate seeks to improve”.

Regulatory bodies have been criticised for having a closed culture that is self-defensive, rather than forward-thinking, reflective, or receptive to new challenges. Bullying and toxic culture flow through regulatory bodies and continue into the organisations they inspect. Although organisations can undertake legal challenges, this is at a financial cost, and the current law gives little opportunity for success.

A Health and Safety Risk Assessment is a systematic process to identify hazards, evaluate the likelihood and severity of harm, and determine appropriate controls to prevent or mitigate those risks. Regulatory inspections must be recognised as a hazard in line with Health and Safety Executive regulations due to the potential harm they can cause.

Regulators, such as Ofsted, Justice Inspectorates, or the Care Quality Commission, have been identified as causing stress, pressure, reduced morale, and mental health issues that can be a source of risk. The regulators themselves are fearful of challenge, failure, and blame from government and public scrutiny.

The risks associated with regulatory inspections include disruption of service delivery, distraction from the main purpose of the organisation, reputational damage, and financial impact. To mitigate the negative impact of regulatory inspections, a trauma-informed approach should be adopted to create a safe, supportive, and empowering environment for both organisations and regulators.

To improve the regulatory process, context must be taken into account, and risk should be balanced within a whole system, rather than focus on an individual organisation. Instead of looking at the maximum adverse potential outcome from each failure point, the likelihood and unintended consequences should be considered at a whole system level.

Regulators should walk alongside organisations to improve rather than demand action. They should be jointly accountable for raising the standards of public services. If a provider fails, the regulator should participate in the improvement plan and be invested to succeed. Recruitment and training should create an inspection workforce with the credibility and skills necessary to foster improvement while maintaining consistency and objectivity.

How do we find creativity in regulatory inspections who are in crisis and that regulation assures safety, quality, and compliance across industries.

To assess progress, measures could be adopted such as:

• Identifying the quantity of new ideas that have been translated into action
• Identifying the sensemaking capacity within whole systems
• Identifying evidence of connecting leadership which builds bridges and demonstrates networks of shared understanding at all levels of systems
• Identifying staff that have energy, excitement and discuss moving forward

In conclusion, regulatory organisations must undergo a health and safety risk assessment to identify hazards, evaluate the likelihood and severity of harm, and determine appropriate controls to prevent or mitigate those risks. Regulatory inspections are a hazard that must be recognised, and a trauma-informed approach should be adopted to create a safe, supportive, and empowering environment for both the regulator and the systems they oversee. To improve the regulatory process, the context must be taken into account, and the regulatory bodies must walk alongside organisations to improve rather than dictate their actions.

A joint publication with Dr Steve Suckling looked at the role of regulators: The Unintended Consequence of Regulation (crimsonpublishers.com) which may be of interest together with the Kings Report 2018,  https://www.kingsfund.org.uk/sites/default/files/2018-09/cqc-provider-performance-report-september2018.pdf

A few years ago in relation to my role, I was informed I had to be professionally curious. My assessment and management plan needed to include this skill especially when safeguarding children and vulnerable adults.

Professional curiosity is commonly cited in serious case reviews, regulatory inspections and now included as a core skill in many roles but currently there is no clear definition of what this means.

In safeguarding, professional curiosity includes not accepting information at face value, seeking further information, disguised compliance and our assessment needs to consider if we have normalised behaviours and chaos, attributed exceptional crisis situations as appropriate actions and the presence of people as protective.

Burton V and Revell L wrote ‘Professional Curiosity in Child Protection: Thinking the Unthinkable in a NeoLiberal World’ where being professionally curious was critical to risk assessment and risk management.

How to Practice Curiosity and How Does This Overlap with Continuing Professional Development

Professional curiosity has also been aligned to a growth mindset and active open-mindedness.

People with curiosity have a desire to explore, learn and understand.

As such, they are flexible in their thinking and recognise that there may be different ways of doing things from what they have always done and are willing to explore different options.

This requires:

• Self-awareness to be able to critically evaluate ourselves and understand our own minds
• Persistence to pursue and explore information verifying it to ascertain its validity 
• Active listening and asking questions
• Being analytical to identify and define a specific problem, gathering key information from a range of sources to develop a deeper understanding and include different confirmatory evidence – triangulation
• Critical thinking to enable weighing up evidence, to discern the true from the false, the real from the unreal, and the facts from the fiction and identify solutions

In addition, we need to consider the wider perspective of others and how they weight and frame the same evidence. Individuals will interpret information differently through their lens of culture, heritage and identity, alongside appreciation of context and the influence of power.

Utilising the skills above correlate with continuing professional development and learning journeys.

Our Learning Journeys should be Built From Curiosity

When we create our own learning journey, we become masters of self-initiative and self-motivation and through reflection and reflexivity, understand and become skilled.

We can identify our own learning goals, identify resources for learning and create personal learning pathways.

Group and connection with others is important to consider as part of our learning journey. This builds self esteem, self-confidence, social communication, greater sharing and wisdom.

Organisational Training Needs Analysis should also be Built From Curiosity

Organisations, should be self-motivated and through organisational reflection, become thought leaders creating a learning community.

Their training needs analysis should be identified from their own experience of being an organisation and create a unique footprint of learning.

Where environments encourage competencies and compliance, they inadvertently discourage curiosity and exploration.

Our organisations should be curious to understand theories that help to make sense of their purpose, social need, disproportionality, effective use of resources and assist in decision-making especially in relation to taking risks where there is uncertainty.

Our Challenge is to Increase Curiosity in Those Around Us?

We need to ask questions:

• What’s the best way to challenge long-held views?
• When was the last time you changed your mind?
• What makes you say that?
• You have said that a few times, what does that mean to you?
• Please explain that to me?
• What evidence supports this?
• How else could you look at this?
• What are the positives and negatives of this viewpoint?
• How might someone else see this differently?
• What could happen as a result … and how would that impact on you and others?

Curiosity helps people explore new ideas, take risks, and adapt to change.

Models of supervision, through diverse groups creating distributed wisdom utilising mechanisms to create curiosity are critical going forward.

Nurture Health and Care Ltd has developed a new model of supervision to bridge this gap and make curiosity a priority.

“Curiosity is the engine of achievement” – Sir Ken Robinson.

 How does it Overlap with Learning and Education?

Society and professional knowledge often dampens our innate curiosity.

Children are curious about the world. They ask endless questions about how it works and constantly ask the question, why?

As you get older, society drums this out of you. In school, everyone follows the same curriculum, universities feed us core information in relation to a topic and as a professional group, you acquire competency in a role.

I would argue, we have become compliant learners and have no time to practice curiosity. Rather, we are designed for productivity and routine not curiosity and exploration.

When you replace curiosity with compliance you lose your creativity.

Mandatory and statutory training are organisational requirements for learning and the modules which we are expected to undertake is increasing.  This is often due to the need to cover the recommendations of the mistakes of the past acting as tick boxes rather than true understanding.

Our competency frameworks attempt to describe job roles and tailor critical knowledge, skills and behaviours to be safe and effective practitioners but fail to stimulate innovation.

Success may be seen in the simulation play drill of Basic Life Support and Intermediate Life Support. This is when it is not delegated to an e-learning package. When scared and adrenaline pumps round our bodies, the ability to still remember how to call for help and do chest compressions from our deep memory is life saving.

Critical skills will need to be taught and other specific knowledge, skills and behaviours may need more traditional teaching methods but there is a balance to be struck between competency and encouraging creativity, adaptability and curiosity.

Following our genuine personal curiosity must be a better foundation for career building than following what has been laid out before us, albeit safety and risk need to managed, skills demonstrated and capability to undertake roles effectively important.

Our workforce strategy, due to shortages of people, have new roles evolving to meet gaps, staff are rapidly promoted and loss of experienced practitioners is apparent. When time and exposure to events builds our intuition, how are we creating wisdom in our systems.

We need Time to be Curious

If we are busy with the tasks of the day, the constant background chatter of social media and do not create any times free of routine to find those curious moments, when will true learning occur.

When People are Curious to Learn the Answer to a Question, they Remember More

Researchers discovered a connection between memory and curiosity levels. There key findings were that participants had greater recall of unrelated, extraneous or incidental information present at the time when people were curious. https://www.universityofcalifornia.edu/news/curiosity-helps-learning-and-memory

Scans revealed when people were more curious, brain activity rose in regions associated with memory and reward. When we are curious, we are open-minded and learning feels positive and we remember more.

When we are rote learning and undertaking facts acquisition, curiosity is low, we become task orientated, unstimulated and closed to inspiration.

What is the impact when we roll out mandatory and statutory training or competency frameworks for roles without creating curiosity. We will only acquire the minimal information and are highly unlikely to create true understanding or be able to apply our new knowledge to different situations.

When Faced with Something New, Our Brain Weighs the Risks and Rewards

It is human nature to ask the question – Is this worth my time?

If the world feels risky, you close down learning something new in favour of the status quo and as we tend to see new knowledge as a threat, we are therefore naturally closed from curiosity as adults.

We therefore need to practice curiosity.

When was the last time we discovered something new in our favourite topic? If we are not learning every day, we need to appreciate that our experience of education is hampering our ability to be agile, flexible and change.

Interestingly, people who are curious, have increased patience as when you practice curiosity, the  answers are not immediately available and we have to wait.

If people are closed to learning, we remain in our bubble of custom and practice but are rapid decision makers wanting to jump straight to the answers.

​Practicing Curiosity: The Internet Is Your Personal Curiosity Machine.

Whatever you’re curious about, the internet has an answer and now we have Open Source AI, which is amazing. In creating this blog, I conversed with AI to explore this topic and although have written my own conclusions, had a fun weekend acquiring new skills.

Our technology may not always identify the right answer, but with exploration and some critical thinking, you can learn almost anything and it’s open 24/7/365.

It is not the means of education or the means of learning that are scarce, but the desire (or time) to learn that is lacking.

People with a growth mindset have a desire to explore, learn and understand – they are curious.

This requires:

• Self-awareness to be able to critically evaluate ourselves.
• Tenacity to be determined to pursue and explore information, verifying it to ascertain its validity. 
• Active listening and asking questions recognising the unique experience of others and their wisdom which we can learn from.
• Situational awareness and appreciation of context to frame out thinking.
• Being analytical and utilising critical thinking skills.
• Using our imagination to explore the ‘what if?’ and ‘think forward’.

All of these correlate to the purpose of continuing professional development

Learning Journeys should be Built from Curiosity

Self-determined learners have self-initiative and motivation and through reflection and reflexivity, they become masters of their subject.

They can identify their own learning goals, identify resources for learning that meet their own learning style and create personal learning pathways.

Group and connection with others is critical to gain self esteem, social communication and different perspectives.

Our workforces need to create a learning community and curiosity must be a critical feature of this.

Our Curiosity Approach

Organisations should review their Curiosity Approach and consider using models of supervision, distributed wisdom and other mechanisms to create curiosity to meet our future system needs.

Nurture Health and Care Ltd has developed a new model of supervision to bridge this gap and make curiosity a learning outcome, with generation of your own learning strategy to identify mechanisms of managing complexity, risk and uncertainty alongside restorative approaches.

We should all seek to have a light bulb moment where we changed our behaviour, thoughts or a belief and came to a new conclusion.

What is Clinical Supervision?

Over the last few decades, Clinical Supervision has become part of the requirements of nursing and wider professions such as therapists and is recommended in public policy statements alongside regulatory inspections.

Credible research evidence has accumulated to demonstrate that supervision has a positive effect on the well-being and workplace burnout (studies such as Tomlinson: BMC Med Educ. 2015; 15: 103 – Using clinical supervision to improve the quality and safety of patient care: a response to Berwick and Francis).

However, much less data is held on the quality of the supervision and therefore evidence of long term impact is minimal.

Logic would predict that it is unlikely that a one size fits all approach will work. This recognises that we are all individual in our learning style and therefore research needs to explore how practitioners best access supervision, how they best learn and how they can experiment and embed new knowledge, skills and behaviours.

The contemporary priority is to document the volume of supervision activity to ensure we are compliant with regulators, to count how many and how often staff access supervision but they do not focus on the quality of provision.

The NMC revalidation requirements includes practice-related feedback, written reflective accounts (Gibbs templates provided), reflective discussions (https://www.nmc.org.uk/revalidation/resources/forms-and-templates/)

Tthe GMC has quality improvement embedded with documentation of continuing professional development that has collection of information, reflection and discussion included as part of annual appraisal and revalidation https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/reflective-practice/the-reflective-practitioner—guidance-for-doctors-and-medical-students

Wider professions utilise supervision as part of their standards, https://www.bacp.co.uk/events-and-resources/ethics-and-standards/competences-and-curricula/supervision-curriculum/ and social workers have included supervision as a critical part of their practice – https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/778134/stengths-based-approach-practice-framework-and-handbook.pdf. The HCPC identifies CPD as core to registration. https://www.hcpc-uk.org/cpd/your-cpd/our-standards-for-cpd/

It therefore makes sense, that supervision models are transferrable across the health and social care landscape but we should consider how this incorporates wider non clinical roles, strategic roles alongside registered professionals. Integrated Care Systems create an opportunity for multi-organisational supervision.

As a practitioner who has worked in justice settings, consideration should also be given to whether wider public sector roles would also benefit namely policing in light of their cultural challenges.

How do we measure success of supervision?

We need to evaluate what is the measurable impact of supervision?

Is there a model which creates better outcomes?

How much do these cost?

And which groups would benefit from supervision?

• What are staff retention rates in groups experiencing supervision vs no supervision?
• What are the staff retention rates between models or if a range of models are accessed?
• How confident are practitioners in managing a scenario which includes risk and uncertainty  with supervision vs no supervision?
• How has the organisations staff survey altered in response to introduction of a model of supervision?
• Can we demonstrate that those who experience supervision continue to create their own personal supervision opportunities in the future?
• Does group supervision Vs Individual supervision improve outcomes of supervision?
• Is supervision better delivered at peer level?

It is critical for successful implementation of a workforce strategy that clarity on the nature of supervision is needed.

The Clinical Supervision Evaluation Project (CSEP; Butterworth et al. 1997) utilise The Manchester Clinical Supervision Scale© (later the MCSS-26©; Winstanley & White 2011) but has not been developed to consider the elements of inclusion, shared perspectives, freedom to speak up and complex decision making.

In recent times, supervision has become used as a term for coaching, mentorship, peer review, competency assessment, preceptorship, clinical teaching, buddying, debriefing and other oversight encounters. Not uncommonly, it has involved ‘personal performance review’, case review and even therapy.

In addition, organisational culture and supervision interface in how the confidential nature of supervision has to acknowledge the contexts of a ‘duty of candour’ and Freedom to Speak Up, which may or may not be trusted

What do our practitioners consider important?

Supervision is a resource that people feel is poorly delivered and rarely use as a safe space to explore how the flow of experience leads to a state of arousal, our emotional response and enables decisions to be made through intuition and pattern recognition, alongside critical thinking and judgement.

It is important to explore these aspects as much of this occurs at an unconscious level and interestingly rather than becoming more confident and resilient through experience, evidence suggests we are overwhelmed and unhappy.

Situational Decision Making has been included in the NHS People Profession Map https://peopleprofession.cipd.org/Images/full-standards-november-2022_tcm29-112150.pdf and The Messenger Review: Leadership for collaborative and inclusive future explores skills required for our practitioners. https://www.gov.uk/government/publications/health-and-social-care-review-leadership-for-a-collaborative-and-inclusive-future/leadership-for-a-collaborative-and-inclusive-future.

The other consideration, which should be addressed in the model choice for supervision is how this could support the loss of experienced staff and their contribution to complex decision making and regain the insight that has been lost to enable our junior colleagues to ‘catch up’.

Nurture Model of Supervision

With skilled facilitators of supervision, we have opportunities to create new models of delivery and would consider anyone interested in this topic explores Ian McGilchrist work: https://channelmcgilchrist.com/home/ which considers insight, intuition and imagination.

Our Nurture model of supervision has built on Models of Reflection (Gibbs), Seven Eyes and restorative clinical supervision, alongside reflexivity and psychological safety to explore how to make decisions where there is risk and uncertainty.

Our model explores the four types of knowing:

• Propositional (facts)
• Policies and Procedures
• The perspectives of others
• Context, intuition and imagination

In addition, we consider connection, arousal response, emotions and empathy by understanding how we think and feel, how others think and feel and respond to distress with compassion for ourselves as well as others.

This allows us to understand context, value intuition, respect other perspectives, celebrate uncertainty and create a workforce that can manage risk feeling confident to apply strategies and achieve goals.

In the Matter with Things (2021), McGilchrist raises many fascinating points which are relevant to expertise and practice. McGilchrist’s research is focused on the role the left and right hemisphere of the brain play in human existence. The left side likes procedures and processes. The right side of the hemisphere is concerned more with context and establishing the bigger picture. Synthesis of these two sides, enables us as human beings to make sense of our surroundings, and work out what to do.

When we discover and try something new, we use the right side of the brain. The new situation requires us to draw from our intuition, what does this experience feel like, what feels right and what feels wrong. We use our imagination to try and make sense of the situation and how we could effectively participate with it.

As you became more proficient the left side of the brain becomes more dominant. You develop routines based on what works well and what doesn’t. You do not need your imagination and intuition because you know what will happen.

We need however to ensure that expertise does not become our automatic default, as we will miss cues and should attempt to use our imagination regardless of our familiarity with situations. We must always ask of ourselves and others, what else could this be? Does this feel right or wrong? If we do, then the mind is likely to remain far more receptive to the external environment, and we’ll be using both hemispheres of brain.

So lets explore models of supervision to provide creative solutions to retain our workforce, enabling them to be confident practitioners, who enjoy exploring and documenting their thinking in relation to risk and uncertainty and find new ways of practicing.

Lets celebrate using our imagination.