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.

Elon Musk has provided an interesting perspective, focusing on productivity and achievement without recognising human wellbeing, burnout and how belonging counts so I will observe how his organisations move forward.

I believe we need to challenge the hero status of sleeping in the office and how hard we are working to how good our decisions are and how much of a difference we are making.

COVID has changed us – CEOs are discussing our wellbeing, athletes are talking about recovery for peak performance – and we all recognise the need to work smart – not just working hard.

I believe we need to prioritise alongside our own health and well being, our families and our loved ones.

In The Maslow Foundation, in keeping with the hierarchy of needs and our own values, joy, hope and meaning, we commence meetings with what has given us joy this week. The majority of the time, this has celebrated our wider connections, rarely work tasks – so holidays, new puppies, birthdays and anniversaries, buying a house and simple time spent on beaches, walks or eating together creates our joy, hope and meaning. We have also noticed the sadness of our teams, with deaths of loved ones, illness and sharing frustration or just simply our tiredness. This has been a welcome addition to our meetings so we that we can reach out and help.

At Nurture Health and Care Ltd, our purpose to Nurture You to Nurture Others, has also been built on foundations of psychological safety, ambition, belonging and creativity and through sharing our proud moments and exploring our behaviours with psychological safety, the trend continues, family achievements have meant everything to us, first jobs, GCSE results, more dogs and puppies and a sports day including success in a judo competition have all featured in our lives and given us a shared experience of happiness.

This reminded me of sitting in my grandads shop waiting for customers to be served and therefore vicariously learning about customer service, or going to work with my mum, a Sister on a Care of the Elderly ward and how talking to the older people became a skill set. Many businesses are family run and the rise of the corporate entities has challenged this as a model of safe and effective practice.

Health and Safety, confidentiality and all the rules of work have divided our worlds, with work and home forming compartments rather than being part of our whole selves.

Our connections are a standing agenda item on all our meetings and we look forward in 2023 to bringing our families to work.

Our board meeting was held at a water-ski park and we celebrated with our families alongside setting our priorities for the year.

Our achievements should acknowledge our loved ones who often make sacrifices behind the scenes and offer their expertise or support.

I believe we need to re-imagine our work and bring our families to work.

Watching the success of Richard Branson and many who have lives of accomplishment, they delight in the contribution their families have made acting as sounding boards and forming the safe space for confidence building. Confidentiality is still in place with situations, not names often featuring in our what if scenarios.

Lets stop celebrating an outdated model of working.

The Victorian era and Mr Ford and his production line has created a world where we perceive ourselves as machines who need to run optimally – but humanity means we need to belong, involve our wider loved ones, enjoy creativity and look to imagine new ways of working.

My Learning Journey and Clinical Governance

As some-one with a lengthy career in health, I have had governance in my roles as both a nurse, doctor and in strategic leadership.

My first experience of governance was being the COSHH representative on ITU and being part of the implementation team for closed suction systems in the early 90s. We followed pre-prepared written policies, developed education programmes for people to be informed and demonstrated evidence of successful change being embedded through ongoing audit.

I had the support of the team leaders and used my positive personality to sell the changes and had easy topics to disseminate so negotiation was minimal and change was easy.

My next career move was to a research sister and the development of the nurse practitioner role which led to more governance conundrums. Many people felt nurses should not be undertaking roles with clinical examination and differential diagnosis which was outside our traditional competencies and core training. Interestingly the debate is ongoing today, thirty years later!

In order to establish the new service model which was transformational in nature, the business case for the role was established by the consultant and I was recruited. My job description included these new areas of development and I was supported by the Consultants to run a number of ‘nurse led services’. I did not think of my role as governance, however it was important to demonstrate the service outcomes were not detrimental to patient care and that the addition of nursing to the medical team freed capacity to undertake the work they needed to do. Medicines prescribing limitations were problematic and I was on the pilot MSc in Advanced Nursing Practice at Essex University to further evidence the capabilities needed to undertake this role.

Policies and protocols were written, proformas designed, new pathways communicated to GPs and wider teams and audit underpinned practice. These included demonstrating how accurate my digital rectal examination and detection of abnormalities was compared to the medical team, the volumes of patients seen and how waiting lists were minimal with the new services. We published our findings which showed safe and effective services and monitored any concerns and identified gaps and led to the potential for research – https://pubmed.ncbi.nlm.nih.gov/11119092/

On reflecting, I recognise that despite a solid evidence base of safe and effective practice, that we did not appreciate the possible unintended consequence of specialist roles removing nurses from the wards or the boundaries that professional identity confer.

Moving into primary care, occupational health, forensic healthcare and out of hours care, alongside training as a doctor, my roles included performance management of individuals and services, supervision and appraisal, disciplinary investigations, serious incidents and case reviews, root cause analysis and quality improvement building from audit to educational frameworks, policy development and implementation of services. https://pubmed.ncbi.nlm.nih.gov/20851355/

Governance therefore was at the heart of everything I did, as a golden thread, ensuring that our patients were safe and that we were current in our practice and that our staff were competent.

How Passion Based Learning enabled me to Discover My Purpose

Although currently leadership and training opportunities are available to me, my initial career pathway had little formal leadership or management education. My learning journey explored new topics through trial and error, with a leadership style where I wanted to befriend the world, avoiding confrontation and achieving success despite lack of delegation and goal orientated behaviours.

My values were always shining bright and I believed that we all came to work to do a good job. If things went wrong, our systems had let us down. I recognise that I demonstrate values based servant leadership, with psychological safety and creation of ‘a just culture’ as principles of practice throughout my career but now this has become on-trend.

As I have become a strategic leader and a healthcare entrepreneur, understanding leadership, management, followship and skills in governance are passionate topics and I try and ‘do something better every day’ as part of my routine.

I have needed coaching, undertake many courses including the FMLM Tomorrows Strategic Leadership course which I highly recommend: https://www.fmlm.ac.uk/tsl and explore new ideas to discover how to be better today than yesterday.

My new ventures, The Maslow Foundation and Nurture Health and Care Ltd mean that I continue to have an exponential learning curve and now include philosophy to my passion-based learning journey.

My inspiration comes from being able to support amazing people and enabling them to be the very best they can.

My current exploration is to shift away from the ‘one Job Description fits all’ to enabling people to focus on things they are naturally good at and build teams that cover the entirety of workload sharing accountability. How we can demonstrate this within a governance framework which embraces culture and values is yet to be discovered.

Sharing Our Passions and Purpose to Create Safe Systems

Within Health and Social Care, the new patient safety strategy, Just Culture and our wellbeing and equality priorities have created the right environment for a new direction. We now need to create the learning cultures to tackle change and support our institutions to be the best they can be.

Passion-based learning is meaningful and by sharing our ideas with others we create collaboration. Through asking for help, co-creating and co-innovating and learning organically through action and reflection, we can deliver the new generation of services to the best of our ability.

Education, will need to motivate and provide the information to inspire change, but with our workforce who are tired and fatigued with exposure to yet another e-learning course and fearful of failure, we need to offer education in a different way. Social entrepreneurship, systems thinking, cognitive and human factors to understand ourselves and others, with situational awareness to be able to manage risk and uncertainty will prepare us for an ever-changing environment. This should be fun and practiced so no longer a certificate and Multiple Choice Questionnaire but real life participation.

The resulting interpersonal skills of empathy, respect, cooperation, negotiation, leadership and social awareness with hard work, doing something better every day and tolerance will form our new competency set.

People need to be encouraged to understand learning styles, ensure everyone has their perspective acknowledged and amplified if needed, adopt learning mindsets, share mistakes, successes, unlearning and enjoy celebration of our progress. Governance will naturally flow from these teams, without a policy or procedure written or an audit being undertaken.

By creating a purpose-inspired learning community in health and care, we can all align and share narratives and experiences to understand our world and make a difference.

By watching children, we can observe an enthusiasm for learning, for play and for making mistakes but in our educational system and working environment, we are encouraged to see the world in black and white, with correct and incorrect answers, following rules and protocols. We are discouraged from play and experimentation and have lost our own understanding of how we learn.

In my own experience, understanding topics such as contextual safeguarding and exhibiting professional curiosity, was not an easy skill to acquire and in many of our practitioners asking them to think the unthinkable appears beyond their reach.

Emotionally Bruised Learners

Many of us are emotionally bruised learners, so education and learning create feelings of failure rather than joy and the concept of curiosity is something that feels unsafe to practice.

As organisations, we are being asked to increasingly look beyond the ‘obvious’, whether as part of the new patient safety strategy or in buzzwords as part of leadership. Curiosity, creativity, and critical thinking are all now skill sets that we need to be able to master.

We have to encourage our workforce to play, to experiment, to formulate questions that activate learning, to re-frame problems and slow down our decision making to explore and discover. We need to share ideas with others and identify new possibilities.

Dr Steve Suckling blogs are great resources to consider why we need to explore and think differently – https://themaslow.foundation/category/steves-thoughts/ and how our imagination is critical in reaching our potential. https://themaslow.foundation/expertise-and-imagination/

Brian Sutton-Smith, a dean at the University of Pennsylvania stated that “THE OPPOSITE OF PLAY IS NOT WORK; IT IS DEPRESSION”

Serious Play and Meaningful Work

Serious play and meaningful work generate ideas, improve performance, motivate, and should be a critical workstream for businesses.

These concepts enable:

• The ability to participate
• Being able to learn and develop
• Produce creativity and fun
• Provide inspiration and vitality

Stuart Brown, MD, author of Play: How It Shapes the Brain, Opens the Imagination and Invigorates the Soul, Penguin Books, 2009 and founder of the National Institute for Play: https://www.nifplay.org/about-us/about-nifp/ promoted play as an absorbing activity that provides enjoyment and a suspension of self-consciousness and sense of time. It is self-motivating and makes you want to do it again.

We need the newness of play, the sense of flow, using our imagination, and the energy of being in the moment that play provides.

We also need the purpose of work, the economic stability and sense of meaning it provides and being competent in a role that gives us worth.

Through both play and work, we connect with others and generate strategies, we face challenge and exhibit resilience. If we deny our need to play, we succumb to stress and burn-out which is a feature of our current health and care world.

Curiosity as a Skill Set

Wisdom comes from combining our factual and procedural knowledge, our life experience with situational awareness and utilises active open mindedness with reflection to value view points, appreciate and aspire to change.

In order to create meaning, we need to understand our own minds, the minds of others and the eco-systems in which we exist and ask questions.

Doing what we have always done may feel safe, but it prevents the spark that can lead to new possibilities which can be created through curiosity.

Curiosity improves decision making because it reduces our susceptibility to stereotypes and to our cognitive biases, it fuels our engagement and collaboration with others and fortifies our resilience by prompting creative problem solving in the face of uncertainty and pressure.

Innovation

We encourage staff to “innovate,” yet what does that truly mean? https://www.england.nhs.uk/ourwork/innovation/

The art of innovation is the creativity and curiosity to think outside known parameters and systems. In order to embark on such creative journeys, health and social care organisations must look inwards and ask ourselves questions.

• Where in our organisations, do we value inquisitiveness and play?
• Where in our protocols do we value common sense and intuition?
• Where do we discuss our different perspectives and balance tradition, risk taking and innovation?

In order to change the world, we need to campaign for the right to be curious and use our imagination and play as part of our roles and responsibilities.

So lets co-create play, curiosity and meaning making together

Understanding our own play personality can help us look at ourselves. Am I a collector? a competitor? a creator? a director? an explorer? a joker? a story teller? or use movement in play?

By participating with others and sharing our thoughts and feelings, we can think about how we all come to different choices. By exploring these together, we can generate insight from the analysis of other people’s perspective. By being active learner we can participate in shared activities, ensuring we can understand how we can find a shared meaning and distributed cognition.

As an active learner identifying new ways of being able to approach activities and manage both negative and positive social interactions such as judgement or self-critical thinking helps us feel safe in exploring choices and enabling new possibilities to emerge.

So what Key Performance Indicators capture our culture.

Having an appetite for knowledge and shared understanding creates curiosity. By contrast, when are not curious, we become deceived, acquiring false beliefs which generates rigid structures trapping us and making us feel anxious and distressed.

As leaders and entrepreneurs we need to move beyond the open door policy or our reliance on dashboards and create new mechanisms on how we measure success.

I propose the following:

• Hearing Laughter
• Creative Enjoyment
• A Common Sense of Meaning
• Caring Contact
• Inspirational Activities

By creating active open mindedness and challenging rigid mindsets, by understanding our own selves and that of others and being confident rather than bruised, we can share our thinking and broaden our range of responses by gaining insights from others.

Learning how to learn | Barbara Oakley | TEDxOaklandUniversity – YouTube

So lets relook at the role of play and having fun together, creating a learning journey and seeing the value in camaraderie and coffee!

In the last week, we have had interesting discussions about civility and its role in improving safety and quality of care and was presented at a Freedom to Speak Up conference. https://www.civilitysaveslives.com/

This led to further conversations about rudeness and manners and how those who have good manners seem to do better than those who are impolite.

We also recognise that there are cultural norms and those with neurodiversity that could be disadvantaged within this convention. We discussed how  teaching negotiation skills was critical as part of communication style and that these could bridge these gaps.

The research cited in Civility Saves Lives included randomised trials such as ‘The Impact of Rudeness on Medical Team Performance: A Randomized Trial’ Riskin et al Pediatrics. September 2015, VOLUME 136 / ISSUE 3, where teams participated in a training simulation involving a deterioration in a patient. Participants were informed that an expert would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert’s comments included mildly rude statements completely unrelated to the teams’ performance) or control (neutral comments). The videotaped simulation sessions were evaluated by 3 independent judges (blinded to team exposure) who used structured questionnaires to assess team performance, information-sharing, and help-seeking.

Rudeness had adverse consequences on the diagnostic and procedural performance of the team and other research also reinforces that effective communication is critical for patient safety and threats to communication such as incivility should be eliminated from our organisational culture.

“Incivility often occurs when people are stressed, unhappy, and rushed. When these coincide, anything can happen. Incivility erodes self-esteem, damages relationships, increases stress, contaminates the work environment, and may escalate into violence.”

People are less creative when they feel disrespected, and people will reduce the quality of their work ‘quiet quitting’ or even resign.

Understanding how to negotiate may create different communication strategies available to us as an alternative to rudeness when under stress. It is noticeable that these are not taught in our traditional health and social care environments.

Negotiating Skills

Competitive      

This competitive style which is often seen in our environment prioritises outcomes, adopting a position to succeed in goal achievement at the compromise of relationships. It can be characterised as a win-lose strategy.

Collaborative    

The collaborative style of negotiation reflects a high importance for outcome, and a high concern for the relationship. This strategy tries to identify win-win opportunities and creates out of the box thinking to generate positive outcomes.

Accommodating              

The accommodating style of negotiation reflects a low importance for outcome, but a high concern for the relationship and can be referred to as a lose-to-win strategy, where the accommodating party will back-off or give-in to preserve the relationship.

Avoiding             

The avoiding style reflects a low regard for both outcome and relationship. A person adopting this position will withdraw. While this can be characterised as a lose-lose strategy, it usually involves ignoring the problem or walking away or may be perceived as ‘passive aggression’.

Compromise     

The compromise approach to negotiation recognises both the relationship and outcomes, but rather than creating additional value so that both parties can get what they need, this style will “split the difference”. It is a useful fall-back position but does not always solve the problem.

Other forms of negotiation can be seen as borrowing, where the rules of reciprocity are not followed and solutions are presented as their own, without acknowledging the origin. This contrasts to the ‘con’ which is an unethical style that reflects a high importance for outcome, and deliberately inflicts damage on the relationship in order to achieve that outcome.

https://www.negotiations.com/articles/negotiation-style/

More complex styles of negotiation are captured in approaches such as ‘Walk in the Woods’ which is a method in which the parties identify the problematic issues and resolve the conflict through a systematic four-step process. This method is focused on a multidimensional approach to problem solving through interaction and creativity in order to reach to a mutually beneficial ‘shared solution’ and can be used with groups or between organisations.

The four steps of the ‘walk in the woods’ model are:

Step 1: Revealing Self-Interest

The first step is designed to break the ice between parties. At the very outset, the parties actively listen to each other in a non-adversarial manner in order to reveal the underlying interests of each party. This step helps to build trust, create self-awareness and better understanding between disputing parties.

Step 2: Enlarging Interest

In this step, the parties are directed to identify and list the points on which they agree or disagree. Then, the lists are compared to determine whether the agreements outnumber the disagreements or vice versa. This step helps the parties to focus only on the areas of disagreement and plan accordingly.

Step 3: Enlightened Interests

Once the points of disagreement are recognised, the parties brainstorm to identify preferable completely new and innovative ideas which were unlikely to be considered before.

All the new ideas are then categorised (1 = Consensus, 2 = Ambiguous, 3 = Complete Disagreement). The ideas in Category 2 are further reviewed before finally reaching a decision on acceptance or rejection. Now the parties are ready to approach the final stage.

Step 4: Aligning Interest

This is the conclusive bargaining phase, where the parties prioritise both what they want to ‘get’, and what they are willing to ‘give’. Based on the prioritisation, the parties finally negotiate and reach a conclusion that is mutually advantageous.

We recognise that negotiations often fail because of not understanding each other’s perspective and lack mutual respect. Trust and building relationships to see each other as connected not separate, is part of finding new solutions.

Marcus, L. J., Dorn, B. C., & McNulty, E. J. (2012). The walk in the woods: A step-by-step method for facilitating interest-based negotiation and conflict resolution. Negotiation Journal , 28(3), 337-349

When people become frustrated, rudeness is often seen and where this appears within teams or organisations, toxic cultures at work are the result.

Bullying, fear and burn-out are all consequences and further cause mental health challenges and distress. This leads to NHS safety (or wider organisations) issues and quality of care suffers.

In order to address culture, we need to relook at our human side ensuring psychologically safe spaces and consider how kindness, respect and empathy as a strategy are important foundations. Role modelling, coaching and understanding ourselves, others and the world we work in, alongside negotiation skills and creating a shared perspectives can enable us to move forward.

I am reviewing patient safety, human factors and system design as part of looking at our investigation processes. In reviewing our past investigation reports and thematic reviews, it is apparent how people struggle to see the world in a different way and have to respond to the constant addition of new risk assessments, templates and multiple processes – surely no-one can remember them.

As part of our Wisdom Academy, we are reflecting on how can we create educational content to support continuous improvement and our personal learning journey. At the heart of this is the art of reflection. We need to be able to consider ‘being wrong’ without the emotionally feeling of punishment and failure. This is usually generated from within – even where our coaches and supervisors are telling us how great we are.

This focus on risk management through risk assessment checklists, policies and procedures aims to minimise “practice mistakes” which are seen as consequences of professional judgement and action. These prescriptive processes represent rationality and is perceived to be effective in managing uncertainty and unpredictability. This is considered to minimise or eradicate “practice mistakes”. Professionals are expected to adhere to procedures leading to accountability to the organisation rather than doing the right thing in the moment.

Uncertainty is not valued in our systems and we are taught frameworks that believe in right and wrong answers, yet we live in an uncertain world where decisions need to be made based upon our experience, emotional responses, intuition and instinct and is a skill which needs to be practiced.

So this blog is to think about how we view the world, make decisions and are able to look at things in new ways using supervision as a forum to develop this talent.

We are complicated!

Our brains experience the world but then we have to pay attention against a massive background of distractions.

We have to make sense of complexity recognising that the world is unpredictable, has multiple interfaces and the passage of time exposes new realities.

Then we have to reason and make decisions with multiple frameworks, personal, professional, organisational and within systems and legislation and take action.

This then forms our memories and becomes part of our formula for pattern recognition when exposed with the same situation next time.

We need to remember however, when we are learning, we rarely have the knowledge of the consequences of our actions. We move through roles and organisations only looking forward and often feel we are a failure when we discover we made an error or that a series of events lead to a negative outcome of which we were a part.

Supervision Styles

Supervision, which is an overused word, is a safe space for us to discuss our actions, thoughts and feelings and how we can consider different options. In work, it is also being used to monitor our tasks, challenge our competencies alongside looking after our emotional wellbeing.

Supervision is presented as a timeline of events without emotion and feelings, with a comparison of our own practice to known policies, procedures and the evidence base acknowledging our wrong doing (if we are observant) and promising we will not do it again.

Restorative supervision has been designed to create a safe space but if the supervisor struggles to see the world in different ways, even when creating a safe space, it will not create new possibilities. It is still valuable as a place to provide an emotional outlet which will increase our ability to learn, but if we continue to use the same decision making framework, we will be unable to move forward.

Decision making and action involves connecting with others and interacting with our environments influenced by a million variables and the complexity of humanity.

So what next?

We need to have the knowledge and awareness of how we all have different perceptions of the same events and allow difference of opinion to occur. We need to accept inconsistency and the experience of not knowing the answer to be normalised.

The definition of reflective practice is to explore an experience and identify what your role in the experience including your behaviour, thinking and related emotions to be able to create patterns for the future to be a confident practitioner.

What, where, and who—the situation

We need to think about the situation in detail: What happened exactly and in what order?  What part did you have to play? What was the final outcome?

How did it make you feel—your emotional state

We are becoming familiar with the opportunity to discuss our emotional responses. What was running through your head and how did you feel about it? We need to be honest: were you afraid, confused, angry or scared?

Why did it happen—making sense of the situation

This is clearly the key to personal growth. By thinking about the situation in greater detail enables you to recognise things that would have otherwise gone unnoticed and enables you to explore the reasons for why the circumstances played out. Currently, this rarely recognises the context, alternative options and the role our systems play in the outcome.

This additional layer in making sense of situations is captured in the concept of reflexivity, which looks at where the actions taken came from? Reflexivity is felt to be valuable in professional practice, particularly in relation to working with uncertainty and as an important feature of ethical practice which addresses the reason why?

Could you have done anything differently requires critical review and development of insight to create change and allow the bigger picture to emerge.

In order to reduce the stress in our environments, we need to re-discover the skill of professional discretion, judgement and autonomy to address the complexity of our environments and discuss the tension between theory and practice.

Self-confidence is required to engage in critical or reflexive approaches to autonomous practice, critical thinking and experimentation. We need space to analyse and think creatively of different options.

Expanding our questions

So by expand the building blocks to break down our role in a situation, I propose the following questions to ask yourself.

• What was I paying attention to?
• What was going on that I was not aware of and do I have a sense of this?
• What did I feel and was it a stress response?
• What was my mind thinking?
• What was my body doing?
• How was I connecting to others?
• What was I saying?
• Was this in any way related to knowledge that I have been taught or acquired somewhere?
• Was this in any way related to processes, procedures, custom and practices which I followed?
• Was this in any way connected to wanting to do what others wanted or rebel from what others wanted?
• Who held the power in the relationships?
• Who else has relevant ideas and what would they say?
• What did the context tell me – what is the unknown or the surprise?
• Did I use my imagination to identify a way forward from first principles?
• Did I use intuition and felt it to be right or wrong?
• How did this align with my values – did it feel fair or unjust?

The final question we need to explore is the most difficult.

• I would propose that we need to take a different position and identify what this could look like and create a debate that makes our alternative version, the correct approach to build our ability to see other perspectives and understand our assumptions better when we make choices.

Using a wider questioning technique allows us to understand our experience, discuss our ability to self regulate and analyse the options available to us. We have the capacity to learn and adapt. It also allows us to participate in organisational improvement and enable professional challenge and sharing of ideas for doing something better.

Our Emotional Responses

Just to remind ourselves about emotionally self regulation, it is important to remember when we scan our environment, we have an emotional reaction and this is normal. We are wired to recognise patterns and respond and have a primitive reaction to rejection and stress which triggers our fight, flight, fight response.

As practitioners, my experience of supervision and reflection, is that we view the world as a third person observation, detached from the events. Reconnecting with our emotions is an important element to consider.

Psychological safety is an important underpinning principle for supervision and learning.

We often discuss empathy for others and responding compassionately to distress but we also need empathy for ourselves and to accept our vulnerabilities without fear.

We need to understand that trauma, loss and making errors alongside positive outcomes enhances resilience and deepens wisdom and personal growth.

Hiding our flaws behind a carefully curated mask is not only stressful but also undermines our own perspectives and creates an internal tension, which is seen in burnout and compassion fatigue.

Sense Making

Sense making is critical to reflection and self improvement but is often overlooked in our discussions.

We need to identify how we understand our own minds, the minds of others and the eco-systems we exist in.

Through this process of active open mindedness, using reflection to balance view points, explore options, and aspire to change, we can create understanding.

We need to value the acceptance of imperfection, the unknown and mystery alongside the facts, application of knowledge, wider perspectives and context to enable synthesis of ideas, creating experiences that allow us to be flexible and adaptable when needed.

The Meaning of Supervison

All forms of supervision are important in our roles but rather than confuse operational capability, emotional wellbeing and competency assessment, we need to name these interactions correctly. To develop further, we need to form a safe space for our learning journey which can be labelled as such.

This safe space is where we can discuss uncertainty and build new decision making frameworks based upon our experiences, emotional responses, intuition and instinct.

Through self discovery and practice, we will embed our ability to make decisions, explore our landscape of options, recognise when we can use our own intuition or connect with others to share ideas and knowledge.

Mastery of decision making in complex environments requires endurance, dedicated time and continuous effort. It takes hundreds and thousands of repetitions, trial and errors. Then through our growth mindset, we can discover our untapped potential.

The link between leadership, management and performance is widely understood and accepted.

The ‘leadership triad’—leadership, management and followership is less discussed but equally important.

For those of us interested in our approach to leadership, the principles of followship, servant leadership and ethical principles are important models to explore.

No-one leads all the time and most of us are in a follower relationship with someone. Even as a entrepreneur, CEO or Board level role, we comply with legislation, follow those who are our system leaders and are influenced by our sustainability and social value role models.

Role modelling behaviours is a powerful tool of communication and influence. Having a robust understanding of our own values, our organisational purpose and our leadership approach is critical to enable followship.

Servant leadership, followship and ethical principles are important dimensions when we are trying to build resilient and fulfilled workforces and organisations. This is particularly true in an uncertain and complex world, where we must embody sustainability to ensure we preserve our resources, social value to ensure that we address disadvantage alongside growth and performance ensuring we all thrive and meet our triple bottom line responsibilities.

I believe in servant leadership and try to serve in my own organisations, creating ethical frameworks and ensuring that I both lead and follow to create opportunities.

Followership is the ability to take direction well (which I can struggle with sometimes!), to get in line behind a mission, to be part of a team and to deliver on what is expected of you.  How well the followers follow is probably just as important to ensure success as how well the leaders lead.

Where followership is a failure, not much gets done, we have low morale and we will be with distracted from our goals, There will be lost opportunities and quality and safety consequences.

Good followers have a number of qualities.

• They exercise Judgement where they take direction but have an underlying obligation to follow ethical principles.
• They require Competence to undertake their role to the best of their ability, with motivation and completion of the activities that they commit to.
• They require values of Trust, Honesty and Courage enabling the ability to give constructive feedback, embrace change and support activities. 
• They should be Engaged, Independent and Critical thinkers who are supportive and can empathise, negotiate and mediate when differences arise
• They should Value themselves as an asset, looking after their own wellbeing and of those around them recognising strengths and positivity.

Leaders and followers should not in opposition or competition to each other, but co-exist in a productive and harmonious manner.

Good leaders therefore have a number the same qualities.

• They exercise Judgement where they take direction but have an underlying obligation to follow ethical principles.
• They require Competence to undertake their role to the best of their ability, with motivation and completion of the activities that they commit to.
• They require values of Trust, Honesty and Courage enabling the ability to give constructive feedback, embracing change and support activities.
• They should be Engaged, Independent and Critical thinkers who are supportive and can empathise, negotiate and mediate when differences arise
• They should Value themselves as an asset, looking after their own wellbeing and that of those around them recognising strengths and positivity.

Even today the spotlight is on the leader rather than the followers who are largely seen as passive and compliant to the actions and instructions of the leader however this relationship is intricately entwined and must be understood.

Servant leadership further embodies followership.

Robert K. Greenleaf first coined the phrase “servant leadership” in his 1970 essay, “The Servant as a Leader.”

“The servant-leader is servant first. It begins with a natural feeling that one wants to serve, to serve first, as opposed to wanting power, influence, fame, or wealth.”

― Robert K. Greenleaf, Servant Leadership: A Journey into the Nature of Legitimate Power and Greatness

As a servant leader, you’re a “servant first” focusing on the needs of others, especially team members, before you consider your own. You acknowledge other people’s perspectives, give them the support they need to meet their work and personal goals, involve them in decisions where appropriate, and build a sense of community within your team. This leads to higher engagement, more trust, and stronger relationships.

Servant leadership can be considered a mindset rather than a ‘toolkit’ which creates behaviours which are consistent.

• Being authentic to our purpose with self awareness to understand our own emotions, strengths, weaknesses and contributions
• Valuing others and ensuring inclusion by appreciating all perspectives
• Growing our people by understanding their strengths and uniqueness and supporting them to be their best selves
• Providing direction through influence rather than authority gaining consensus, motivation and sharing leadership
• Serving others, with humility to build community and show stewardship taking responsibility for our resources
• Demonstrating insight and patience using intuition alongside conventional wisdom to understand consequences to enable us all to move forward

Greenleaf wanted to promote a counter movement to altruism determined by new styles of businesses and in 2022, the context is unchanged.

The Disadvantages of Servant Leadership

Servant leadership has disadvantages as many leaders or managers are unfamiliar with this philosophy and therefore may not be accepted. They may like direction and prefer a more autocratic culture and as a servant leader, you may find a lack of respect is shown with little confidence in your actions.

Where serving others and co-production form part our daily purpose, decisions take longer and this at times is problematic especially in crisis situations.

It is important to remember that servant leadership is about focusing on other people’s needs. Servant leadership does not mean avoiding unpopular decisions or avoiding giving negative feedback or challenging the status quo.

I believe that many forms of leadership can co-exist and these alter according to circumstance and context. I recognise that I switch between styles but am passionate about ethical principles, values based culture and leadership where we place others at the centre of our decisions.

The five ethical attributes for leadership which I consider important are:

• Justice
• Humility
• Trust
• Respect
• Shared Vision

Collective Power

Through the frameworks of servant leadership, followship and ethical principles, we must recognise the consequence of collective power.

When individuals and their united community create a voice, they will form an important alliance which can deliver a powerful message. This can be adopted by a leader and will help you tackle difficult or intransigent issues.

As a servant leader we can adopt ‘leadership through followership’ involving the collaboration formed by our followers and enable them to take leadership of a situation. We can champion and advocate their voice using our servant leadership model.

This can be particularly powerful as a ‘collective emotion’ can potentially unite and lead to transformation for good and harnessing this can be an asset that no leader alone can mobilise.

What is psychological safety?

Psychological safety creates a space where we are included, safe to learn, safe to contribute, and safe to challenge the status quo – all without fear of being embarrassed, marginalised, or punished in some way.

Stage 1: Inclusion Safety

Inclusion safety satisfies the basic human need to connect and belong. Inclusion safety allows us to gain membership within a social unit and interact with its members without fear of rejection, embarrassment, or punishment, boosting confidence, resilience, and independence.

Stage 2: Learner Safety

Learner safety satisfies the basic human need to learn and grow. It enables us to feel safe as we engage in all aspects of the learning process—asking questions, giving and receiving feedback, experimenting, and when we make mistakes.

Stage 3: Contributor Safety

Contributor safety satisfies the basic human need to contribute and make a difference. We lean into what we’re doing with energy and enthusiasm. We have a natural desire to apply what we’ve learned to make a meaningful contribution.

Stage 4: Challenger Safety

Challenger safety satisfies the basic human need to make things better. It’s the support and confidence we need to ask questions such as, “Why do we do it this way?” “What if we tried this?” or “May I suggest a better way?” It allows us to feel safe to challenge the status quo without retaliation or the risk of damaging our personal standing or reputation.

https://www.leaderfactor.com/4-stages-of-psychological-safety

So how did we reach challenger safety as a team in Nurture Health and Care Ltd and in The Maslow Foundation.

Shaney Ann and I will share our experiences of creating challenger safety in a new business.

We recognise we are small teams however we still practiced the skills to role model psychological safety.

We have become used to teams that are resistant to change and leaders who are frustrated or through fear, shut down and create distrust and their teams who feel over-whelmed and ‘stuck’ unable to find new solutions.

What we have discovered is that our own teams are flexible and excited to try new ideas and experiment.

Our values in the two organisations have psychological safety at their heart, directly in Nurture Health and Care Ltd, with Belonging, Creativity and Ambition. The Maslow Foundation built on Maslow’s Hierarchy of Needs, recognising that belonging and safety are crucial which creates self esteem and Hope, Joy and Meaning.

Our meetings start with what our joyful moments and what we are proud of and although initially was an alien experience, learning about each other outside work and appreciating and celebrating our experiences enables us to understand each other and gave us the opportunity to support each other when things were hard in the outside world.

We have held our meetings in great locations, included our families and have organised opportunities to have fun together.

How do you create inclusion safety?

We believe passionately that every person has value, has strengths which we can champion and as facilitators in meetings, ensure that those who may feel an outsider are enabled to have their voices elevated. Those who are shy, are enabled to sharing their opinion. Those of us who have opinions, stand back and listen.

We practice embracing differences of opinion, differences of style and sharing personal information about ourselves which started with our profiles – and I was proud to be a warrior!

Everyone was welcome – there are no silly questions and no ego.

Inclusion safety is created and sustained through proven acceptance and respect to the group. This reinforced why onboarding is critical when we recruit and this includes an introduction to your group and as leaders we should demonstrate how important you are to that group.

How do you create learner safety?

As some-one who loves learning and is constantly exploring the world, I have taken on board philosophy, technology and really seen the value of proactively role modelled note taking, sharing what I learn and most importantly identifying when I was wrong and when I felt I had changed my mind.

I do need however to remind myself that others experience of learning is often traumatic with failure being showcased and ridiculed and challenged their self esteem.

Our teams bravely collaborate and demonstrate exciting moments of discovery. Our teams always exceed our expectation and imagination.

We need to practice being quiet and allowing others to express their own ideas, disagree and not only champion our own ideas which often do not have the quality of our collective wisdom.

We showcase our wrong assumptions and errors so we can feel confident in the reactions of others when things do not go as planned.

The joy we experience by watching others thrive beats any other investment that we have made. Realising how every person brings greatness to our team is inspiring.

How do you create contributor safety?

Within our small teams, we moved away from job descriptions and accountability to what things have we got to do this week and who is best at what.

We know that it is our differences that enable great ideas to be formed and that the totality of tasks were completed by those who enjoyed them most. Paul Jennings (Operations Director -Nurture Health and Care Ltd) became our telephone agitator chasing placements, James Westwood (CEO – The Maslow Foundation) enabled us to bring together the diverse voices of a team and ensure we all pull together in the same direction.

We ensure everyone has a role and aligned this to their strengths and talents and we mucked in and celebrated our achievements.

In a nurturing environment that offers respect and permission, we entered the stage of contributor safety, which invites us to participate as an active member of the team. Contributor safety is an invitation and an expectation to perform work in an assigned role with appropriate boundaries. Competency and mastery is another topic on which we have blogged.

How do you create challenger safety?

The final stage of psychological safety allows you to challenge the status quo without retribution, reprisal, or the risk of damaging your personal standing or reputation. It gives you the confidence to speak truth to power when you think something needs to change and it’s time to say so. Armed with challenger safety, individuals overcome the pressure to conform and can enlist themselves in our improvement processes.

If you can banish fear and create a nurturing environment that allows people to learn and grow, they will perform beyond your expectations and theirs. Our mission is to ensure we have clear activities and goals and a shared purpose to enable us to deliver results.

I feel as leaders we can be flexible in our approaches and offer many different styles of leadership however for us the presence of fear in our teams, is a failure of our leadership.

At all our meetings, we are able to explore what went wrong alongside what went well safely and consider why this was and learn. This creates a feeling of positivity and moving forward.

Then we ran a pivot or push day and we challenged all over the place!!!!

What prevents human flourishing?

In blogs I have discussed power, desire for individual merit or organisational greed, and the need to work with collective wisdom to enable us to navigate the complex unpredictable environments in which we work. It is connection, not targets that allow us to flourish.

Creating silos of activity is not our normal response to situations. Belonging and connection are far more valuable however our own insecurities and need to feel good enough or the power dynamics leads to exclusion. When we form communities, this leads to differences and loyalty to the group. In our society, this leads to different niches, teams, organisations and systems and comparison becomes embedded, empathy is ignored and fear or envy emerge. Conflicts then start and the impulse to win, compete and foster malice appear.

 ‘Ironically, in our digital age, we connect and feel alone, compare and feel inadequate’.

Understanding how we are all amazing and that we all belong to the same community overcomes this desire for separation.

Looking at the stagnation of statutory bodies and watching commercial organisations that fail, they frequently cannot change and respond to new sets of circumstances. They are entrenched in habits, custom and practice and create infrastructure which continues the status quo.

The NHS momentarily in COVID gave permission to transform, pivot and change regardless of results but this quickly reverted to blame and sanction.

The process of challenging the status quo should experience conflict, disagreement, and sometimes chaos. When there is punishment and intellectual debate turns into interpersonal conflict, when fear becomes a motivator, the process collapses and people go silent.

How to create Psychological Safety in your team

• Start with yourself, admit that you are human and make mistakes and that we do not have all the answers.
• Be grateful for things the team do for you and others.
• Talk about non work-related matters with your team members and recognise its value.
• Talk about our feelings, we have trapped ourselves into third party communicators divorced from our emotions, but understanding our thoughts AND feelings is important to enable people to reach their potential.
• Make psychological safety an explicit priority, facilitating people to speak up, practicing celebration of things going wrong so we can manage experimentation and ‘reasonable’ risk taking and creating space for new ideas, especially out of the box thinking.
• This builds trust and underpins psychological safety.

As a blogger on healthcare entrepreneurialism, we have a real life interesting dilemma which I can share and currently do not know the answer. This is on whether we pivot and change direction or continue to push on doors as a new start up business.

We have recognised our own skills in creating workforces with purpose that are happy and enjoy being part of a family and wished to scale our expertise to support wider industry.

For 6 months, we have approached NHS strategic figures, local organisations, both NHS and private to disrupt the locum model of staffing delivery. We believed that we needed to employ staff and support them with a robust wraparound service. This includes training that enables staff to be resilient, understand their emotions and be part of the solution creating a positive culture of ‘Nurture Ripples’. Our model was unfamiliar, with an attempt to provide 3-6 month placements rather than crisis workforce solutions and our staff were paid standard banding salaries but with our nurture support, rather than the elevated agency/locum rates.

On commencing our marketing and due diligence, we identified that there are staffing frameworks which are currently closed until next year. Although, we found possible alternative mechanisms for funding, our model was difficult to explain and possibly confusing and in addition there is distrust of the industry and the anticipation that anything offered is ‘to good to be true’ and ‘we have been promised and let down before.’

Even placing people for free, led to conversations about whether we were going to fund any additional training needs, honorary contracts and secondment that required processes which were already overwhelmed and poor understanding of where accountability and risk lie creating further barriers.

We have reinforced our knowledge that health and social care staff need additional support, that their careers are not meeting their expectations and that they are overwhelmed and often unhappy. Our health and social care workforce themselves are also prepared to talk to new businesses and are asking for support.

We know that our values and content are aligned to the current eco-system with shared language of psychological safety, trauma informed organisations, inclusion, freedom to speak up, authentic leadership, activation to hear hidden voices, sustainability and shared perspectives.

In starting a new business, obviously the best outcome, is that all your assumptions are correct, that the resources flow and that scaling and growth are achieved without challenge.

However, our initial assumptions are incorrect.

• We assumed health and social care would jump at the opportunity for staff
• We assumed attracting the workforce would be difficult

In studying pivot and change, many businesses significantly pivot during their life time.

The path to enduring success is rarely a straight line. ‘Cornelius Vanderbilt switched from steamships to railroads, William Wrigley from baking powder to gum. Twitter launched as a podcast directory and YouTube was once a dating site’.

Research shows that new ventures that reinvent their businesses—even multiple times—cut their chances of failure by conserving resources while continuing to learn more about customers, business partners, and new technologies.

Being able to say I am wrong!

Changing your mind is always hard. Asking questions, challenging assumptions and swallowing your pride is never easy but is part of running a service and creating innovation as it is only through experience that we can learn.

Accepting or Rejecting Conventional Wisdom

When looking at our next step, we have to consider our risk appetite.

My heart says that we should risk everything to make a difference to those we serve and that even the smallest chance should be taken to create a health and social care workforce that thrives.

I, however, recognise that this is irresponsible where resources are stretched and that we need to make the best decisions which utilise our resources wisely and enable us all to have security in our roles.

In addition, many of us have mortgages to pay, limited hours to spend on new endeavours and need to ensure that our futures are secure so cannot take any risk.

Our current position sits between these extremes. We are fortunate that we can take some risk and afford to experiment and redesign but basing this on evidence creating realistic solutions to build success.

So it is our choice whether to pivot or push.

We believe we are looking at true transformation and therefore have to accept a real chance of failure alongside success and this is OK providing:

• The difference we make, really will change culture and enable people to thrive

and

• That we enjoy the journey and through exploration are learning and moving forward

Doing Our Due Diligence

Everything is unpredictable, however we have looked at all our insight from all our sources.

We clearly have the continued crisis of staffing: https://committees.parliament.uk/committee/81/health-and-social-care-committee/news/172310/persistent-understaffing-of-nhs-a-serious-risk-to-patient-safety-warn-mps/,

We have tested the market place and know we can make a difference:

• Helping Hands Team
• Wisdom Academy

Our Business Analysis shows that across our landscape there is significant competition, so our employers have lots of choice and do not have time to analyse competition. They have their own workforce strategies which appear to have many similar threads to our own offering although their ability to provide sustainable change is proving challenging.

Our workforce, despite having numerous organisations, statutory, private and third sector, employer programmes and employer assistance with access to a multitude of education and wider resources are still asking for something different.

Focussing on our workforce as our customer therefore feels the priority, with the challenge of demonstrating credibility, creating a unique USP and a strong brand with an offering that people value and want to return is our challenge.

How to make the best from our pivot position.

While pivoting can breathe new life into something that might otherwise fail, it also means starting from scratch and abandoning the investment that you have put in up until this point.

We do not underestimate the barriers to entry but want to create happier staff, who feel psychological safety in their day to day practice. This enables them to belong, be creative and achieve their ambitions. In turn, they can create a ripple of positivity enabling culture change in health and social care. We believe we can achieve this one person at a time!

In chatting to our workforce, they feel exhausted, overwhelmed and that they came into a role to care for others and find themselves unable to care for anyone. Enabling them direct access to our Helping Hands Team and to source education that supports them to understand how to manage risk and uncertainty, toxic cultures and how these come about, will be our focus.

We have decided to pivot and I can share whether this is a successful strategy from our blog and will share what we learn from the experience and how we move forward.

Below is an interesting Masters of Scale Podcast which explores this subject.

https://mastersofscale.com/jack-conte-2/

The concept of work-life balance implies that work is bad and life is good; it suggests that work and life are two different entities that need to be strictly separated and kept at a constant value.

I believe there is a misconception that less work equals more happiness.

Work is seen as a mechanism for financial support and to be difficult, whereas our home environment are believed to inspire joy and happiness and feel easy.

In my experience, work-life balance is more like a rollercoaster than a constant and our challenges are as likely to be in our own homes as in our working environments.

Joy and happiness can be experienced through all our interactions which include work.

Dr Steve Suckling and his blog: https://themaslow.foundation/towards-the-innovation-paradox/, has interesting insights into the concept of life, a good life or a better life and that is a more appropriate journey to consider aligning to.

Our work needs to be more than just be a job. Whether we are artists, educators, healthcare professionals, managers, scientists or even entrepreneurs, many of us find genuine joy in our work. Some days, we may feel this is strenuous and tiring while other days, it is productive and creative but all occupations, team work, making a difference and showing skill can all enable us to feel pride and success.

There is also work in our home lives, with children, household tasks and wider demands, which may inspire however can be hard and exhausting. Embracing the chaotic nature of life is to accept that some periods of your life will be filled with ‘work’, while other points may be more ‘soul nourishing’.

What we all need is time to feed our soul!

Reading may be the space to find joy, which can be a rare treat but could be built into our days. Walking might be our sanctuary and should be placed as a priority. Spending time with friends and family can all feed our soul. For me making a difference to some-one is rejuvenating, which can be saying thank you at a supermarket or part of my working routine but makes me smile.

One of our human flaws, is that when something joyful happens, we feel a flood of positive thoughts and feelings. However when it happens for a second or third time, that same event loses its magic. In a working day, where routine abounds, we need to notice the good and work on how do we keep noticing!!!

Understanding our energy resources is a more useful concept than work-life balance

Rather than identifying a work-life balance maybe we could consider energy as a concept and to identify our own energy production activities and dedicate time to these. We also need to understand the support we need when energy draining experiences occur.

When we have joy and energy creation, this is transferable so can give us resilience to survive the difficult or enable the capacity to grow.

When we are supported and lifted up by our community, we can be inspired.

When we are being pushed down and constrained, we feel apathy and not being ‘good enough’.

What is impossible to achieve is the perfect family with the perfect job, within the perfect company, living in the perfect location, with enough money and resources to create a perfect life.

By changing our mindset to identifying whether we are passive recipients of life, enjoy a good life or want to have a better life is for us to choose.

Through feeding our souls every day, enjoying the journey that is appearing and finding ways to be resilient when needed, this ensures that we all experience joy, happiness and laughter which we can notice. When darker times occur, we should have strategies at hand to move forward through sadness, anxiety and tiredness.

We need to analyse all our commitments as an employee, partner, parent, carer, friend, leisure and soul feeding opportunities and factor these in our healthy lives.

Unlocking Energy with Purpose

By having a sense of purpose, this has been shown to increase our energy levels and the East has some interesting concepts which we can learn from to consider as part of our approach to a Healthy Life.

Ikigai is the Japanese art of living and although there is no direct translation, it has been defined as:

“essential to happiness in this life are something to do, something to love, and something to hope for.”

“Our ikigai is different for all of us, but one thing we have in common is that we are all searching for meaning.”

“There is a passion inside you, a unique talent that gives meaning to your days and drives you to share the best of yourself until the very end. If you don’t know what your ikigai is yet, your mission is to discover it.

“Your reason for being gives you a reason to live”

Ikigai is not related to work or money but what gives us meaning. This is for us to decide but could be ever changing and a journey of discovery. Alongside work, it can be family, a dream or simply an experience that you create. It is often found in the ordinary not the extraordinary. It can be multiple ideas and is rarely a destination but the path we follow.

Here are some websites that look at the concept of Ikigai:

Ikigai: The Japanese Secret to a Long and Happy Life (Book Review)

https://www.linkedin.com/pulse/10-rules-ikigai-japanese-secrets-long-happy-life-shiv-yadav/

As leaders how can we create these energy generating environments

As an employer or as a leader, our responsibility is to support everyone to be the creator of their own life canvas and provide healthy work and healthy life opportunities which feed the soul as well as demand energy.

We never want to find our workforce working excessive hours which can do harm or working in environments that are unsafe however choice should underpin decisions and where stressors are abundant, we find new opportunities to distract and give alternatives.

Remote working has diminished the separation of home and work, however our natural world would have been a blended environment, so identifying and fulfilling our own needs is more important that setting hours at work.

My priorities are:

• Creating purpose which connects us generating shared meaning and joy.
• Ensuring we take time to enjoy and celebrate our journey, without the pressure of speed to achieve and noticing the world around us.
• Through tough times, working with people to manage those demands, understanding the energy deficit which is occurring and ensuring some energy credits are available.
• Build our teams that enable inclusion, with positive psychology, psychological safety and understanding, whilst recognising and noticing peoples true potential.
• Share our successes and seeking to ensure social value and flexibility to meet the needs of our workforce and enjoy the experience of giving back.
• Reconnecting with nature through walking, spending meetings in inspiring places alongside sustainability and ensuring we have a minimal impact on the planet
• Celebrating contribution, being grateful and giving thanks

Ikigai is one idea which I found interesting to bring energy creation to transform our workplace culture for the better. By searching and learning together we can all aspire to be part of something that wants to do something better every day. To do this as leaders, we need to find time to feed our own soul and that of those we serve.

Todays blog looks at Power and Influence and how this impacts on evidence based medicine (EBM).

I believe that discussing how power interacts with EBM is uncomfortable, as it suggests inequality which I think makes this a particular challenge for those of us who believe in Equity and Fairness.

My personal experience which has spanned roles on Boards, being a doctor and being a nurse, alongside being a patient and a family member supporting others, enables me to really understand how power, status and ‘being a patient’ are important considerations.

As a doctor, my ideas seem to have more validity and carry more weight, however as a nurse, communication is easier with people and leads to different conversations. As a patient, I may not identify as a healthcare professional as feel this might lead to consequence, but I do use this when supporting family members and have leveraged this to direct outcomes.

It is critical therefore that we understand how power, relationships and communication underpin shared decision making and therefore form a core component of EBM and that power, finance and resources, feeling safe and knowledge are intimately related.

What does power look like?

The ‘actors’ can be at an individual, team or organisational level, a placed based system or even a global community.

In life, the decisions we make create winners, losers, positive and negative outcomes.

How this is shaped is through our knowledge and experience, our situational awareness and the predictability of the decision including how much control we have over our actions. Resources and infrastructure all inform our ability to move forward.

We all have power in a situation to act, to be inactive or to be a counter power and act as resistance.

Interactions can also be blocked. If A knows B and B knows C, but A does not know C, both A and C require B to mediate. B occupies a ‘structural hole’. They may act as a bridge overcoming the gap, exploit this gap creating competitive advantage, or block the gap completely.

Hierarchies and complex systems have ‘structural holes’ which can be overcome in fully distributed networks, where all nodes are effectively connected to all other nodes, enabling shared understanding.

Mismatched structures and resources, knowledge ownership and status or having different value sets leads to differences of opinion which creates tension. How we manage these tensions will ensure success or failure for collaboration.

Problems arise when powerful actors, have a blind pursuit of relative advantage and neglect structural order and rules particularly when they have access to wider resources.

By understanding these dynamics, we can influence how our world changes.

• You can enable agency of others, creating the capacity to achieve goals.
• Through sharing of knowledge, you can enable facts to be discovered, and create the mechanism for this to be available and others to create change.
• By role modelling, you can influence how we all behave.

Looking across our health and social eco-system, we know hierarchies exist, with many structural holes and power, finance, safety and knowledge interact which impact on the achievement of EBM.

Power and our Patient Relationship

Healthcare interactions are characterised by socially prescribed roles which have status creating an imbalance of power and influencing our behaviour. This includes both professional roles and the role of ‘Patient’.

In a consultation, the professional is perceived to have higher status, greater familiarity with the system, greater academic knowledge of disease processes, and more extensive access to further information and resources. They typically control the agenda and the use of time and direct the outcomes offered.

The Inverse Care Law

Because of the impact of social determinants of health, such as poverty, social exclusion, education and other structural inequalities, individuals most in need of healthcare are least likely to seek it or receive it.

Patients, in order to gain access services, have to continually reframe their symptoms and concerns to fit organisational categories and some are better at this than others.

Even when patients have greater knowledge about their condition than the person treating them, the power dynamic is such that the professional views tend to trump the patient’s perspective. This is particularly true when the patient does not follow the rules expected of them and may be perceived as a ‘heart sink’ patient or a problem.  

Power imbalances suppress the patient’s voice.

We need to create mechanisms to amplify our patients voices and include the role of those with ‘lived experience’ to co-produce EBM.

Peer support is founded on a non-coercive, human rights-based approach that focuses on building relationships purposefully sharing their own experiences, and through the mutual sharing and commonality of experience, embodying hopefulness. They maintain equality with, and work alongside, others facing similar experiences underpinned by mutuality and reciprocity, widely recognised as core principles, with the central focus being on building trusting relationships rather than intervention.

By acknowledging these power dynamics and building a new skill mix, we can ensure that the patient voice and their families and carers are represented and this will be key to successful personalised care.

This requires fit for purpose systems, along with appropriate allocation of resources across the landscape of health and social care. Part of the transformation needed is to recognise concepts such as psychological safety, so that we can share our perspectives and the knowledge gained, including those with lived experience. This knowledge then should be perceived as ‘valuable and credible’ as part of our evaluation.

Power and Team Dynamics

When we undertake roles in organisations, we form teams and become leaders, followers or resistant power holders who have the capacity to action but also influence other’s attitudes and behaviours.

Understanding the power we hold is critical to building success in our organisations enabling people to flourish and the health and social eco-system to thrive.

Power can be related to our job title or as part of a role as gate keeper to resources however this is a simplistic view with social assets such as knowledge, information, expertise, respect, friendship, social approval, decision-making opportunities and cultural considerations all being key in understanding how power unfolds in our teams.

Power and politics go hand-in-hand so understanding the context that surrounds our teams is important and understanding whether there is a single source of power, distributed power or a power struggle will enable us to identify strategies for success.

Individuals or teams, who are content with the status quo, feel safe and are satisfied will be empowered to lead, follow, advocate and challenge effectively. Where conflict occurs and tension arises, people become more focused on negative aspects of team dynamics leading to paranoia, anxiety and harm performance.

We need to be able to consider the dark side of power in teams alongside the benefits of leveraging our power.

Power dispersal which elicits differences in perspectives and interests between members and is critical for inclusion and distributed wisdom, can also have negative outcomes if there is confusion of goals and ambitions, or lack of structure to facilitate decision making.

We also need to identify our ‘structural holes’ in our teams and bridge these to ensure that we communicate effectively across whole teams.

At times, power struggles are overt, and can be explicitly seen but often they are more subtle with disagreements about goals and outcomes, personality or value clashes, and conflicts over team logistics, such as meeting times or task allocation.

In order to gain more power, individuals, teams or organisations, may both try to pull others down or to bring oneself up. They may engage in behind-the-scenes coalition formation, purposely withholding information from each other, or gossiping about one another. They may explicitly refuse activities or more implicitly ignore them or take credit for others work.

Power struggles are notoriously difficult to clearly identify and resolve and divert energy away from our true purpose.

Conflicts can only ever help performance when the real issues are brought to the table and discussed. This requires trust which is often absent. Power, therefore, is a sensitive topic, which people find difficult to openly talk about, making their eventual resolution very problematic and the chance of escalation likely.

Power struggles are contagious and create a wave of negative behaviour.

By understanding the mechanisms and levers by which power can harm teams, we can seek to remove the deleterious effects of power for team outcomes. Without understanding the dynamics of power, you create the unintended consequence of perceived unfairness and of toxic cultures.

In order to create safe systems in which EBM can be delivered, we need to create teams, that build on psychological safety, understand how power feels within that team and have organisations that ensure inclusion including that of our patients, families and staff.

The Power of Organisations in Health and Social Care

It is well known that socio-economic factors play a huge role in determining people’s long-term health, and contribute significantly to inequalities and therefore working collaboratively at an eco-system level is essential to improve outcomes but we have paid little attention to the power holders across our environment including Integrated Care Systems although we will be aware of models such as: Mendelows Matrix to analyse stakeholders.

Anchor institutions are large organisations that have a significant stake in a local area. They have sizeable assets that can be used to support their local community’s health and wellbeing and tackle inequalities, through procurement, employment, training, professional development, and buildings and land use. These anchor organisations are therefore critical power holders in our communities.

The Kings Fund has identified that the NHS is a significant stakeholder in terms of its role as an anchor institution with local authorities holding significant infrastructure. Wider, place based assets include commercial organisations, voluntary sectors and other stakeholders such as housing and education all participate in the health and social care eco-system.

Currently, many organisations are in crisis but hold power and at the same time are ‘stuck’ in reactive management.

We need to support all our organisations, including our anchor organisations, to provide psychological safety, active open-mindedness, distributed power models, collaboration and focus on improvement over time, rather than comparison.

The challenge is that our current model of health and social care is built on competition for finance and workforce resources, alongside regulatory oversight, reputation concerns and achievement of outcomes which leads to tension.

What we can achieve by understanding our power

No one can gift us power.

We may be promoted, elected or admired and be senior in roles, however if we do not own or understand our power and influence, this will dissipate and lead to a lack of achievement in the opportunities which present.

Organisations may be assumed to hold power, but if we are not responsible with this or understand how we impact on others, we create unintended consequence and systems fail to achieve their potential.

Authentic power does not come from an external source or important title. True power is generated from within.

Understanding and role modelling Psychological Safety, allows connection and empathy to be shown.

Wisdom allows an understanding of facts, procedures, perspectives and emotional responses and through participation, we generate distributed understanding and transform.

Owning our power leads to increased confidence and an understanding of our role in current situations and how we can help in the achievement of objectives.

Understanding power allows us to connect and maintain relationships and address our ‘structural holes’. It enables negotiation and adjustment.

When we understand our values and those of others, we create visibility and credibility enabling advocacy for ourselves and others.

The admission that we don’t have all the answers, rather than making us powerless is a power move.

Addressing culture that rewards busyness, and moving to one that creates opportunities to discuss topics allows creativity to be born.

Ensuring we all have an open mind and create learning journeys leads to growth and mobilisation of power.

Through this understanding of power and influence, our model of EBM will be created that meets the next generation of health and social care outcomes for everyone.