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.

Over my career I’ve written, reviewed and formally evaluated loads of job descriptions and specifications. I have interviewed and onboarded and realise that the use of job descriptions was because it was part of the rule book for recruitment. We believe that this method ensures people have clarity over their roles and responsibilities and leads to increased performance.

In a strength based inclusive workforce, do we need to reconsider job descriptions?

When you are embedding positive psychology, strength based practices and processes and inclusivity, I realise how damaging job descriptions can be!

They are static documents which box people in – they don’t encourage innovation or personalisation and are often are used as a reason for why they cannot go the extra mile.

They are out of date as soon as they are written.

They are often works of fiction – they don’t describe how a job is actually done.

They don’t capture the true value or purpose of a role.

They get lost in the organisation Human Resources files.

Job Descriptions stop people from being fully engaged and energised by their work and creates restrictions and constraints in how they are able to perform their jobs.

If our weaknesses are celebrated and accommodated – does a job description work?

I believe the job description prevents inclusion.

They limit a sense of personalisation, individuality and personal growth which are the very things that give people joy and meaning.

They tend to be used if we are trying to flag an area of performance and form part of the performance management plan.

They are used by those employed in a role, to refuse to do something new as it is outside their job description.

Most of us want to feel a sense of meaning in the work we do, yet we seldom design job descriptions in a way that supports this.

What’s the alternative to a job description?

If job descriptions aren’t fit for purpose and don’t reflect our modern ways of working what’s the alternative?

In The Maslow Foundation and Nurture Health and Care Ltd, we are describing our purpose, identifying the gap that is needed and the vision we have and will be asking our teams to define their own job roles and personal development plan including their own measures of success.

We believe in dynamic teams which work together to achieve goals, building on individual strengths, recognising and accepting our weaknesses. The wider team absorbs the needs of the organisation and we pull on our team mates to achieve success.

We are job crafting, creating mastery and supporting our strengths with a plan for those areas we find challenging.

We can create opportunities to achieve balance and ‘flow’ in our work. This needs appropriate levels of stretch with problem solving and challenge and creates opportunities to network and connect with others in proportions that meet our individual requirements.

We believe you can have accountability and clear achievement of goals with good communication and a healthy action plan when the ‘to do’ list is divided amongst the team.

We have written our own ‘job canvas’ and this includes identifying our challenges, building on our strengths and identifying our goals to achieve in the next 3-6 months which align with the organisational vision.

Many roles include core competencies to be able to be safe and effective but these can be captured in a competency framework. We record our Mandatory and Statutory training and our compliance with legislative and organisational policy in our education passport and staff handbook.

So lets roll out job crafting and include in our job canvas, our passions and ambitions, with innovation and quality improvement documented with our values and shared goals.

https://tailoredthinking.co.uk/jobcrafting

Choose a job you love, and you never have to work a day in your life                         Confucius

In order for our teams and staff to achieve their very best, we can create a sense of fun and happiness in our workplaces. This is often referred to as positive psychology and encourages a strength based focus to our practices.

I believe that we have forgotten how to do this so we need to refocus our minds on:

How can we enjoy doing the tasks assigned to us and do them better and in new ways?

How can we feel we belong with those who we are working alongside?

How can we feel respected and noticed?

Happiness at work is critical and those who spread happiness and joy enable others to be motivated and builds positivity. When we become stressed, we lose focus, and have negative thoughts like “I have to quit”, “I cannot take it anymore”, “I am not worth it” which drain teams of energy.

Finding happiness and fun encourages team building and enables people to work together for the common good.

Self Determination theory identifies that individuals need autonomy, competency and connection in order to be motivated. Building on these principles with a positive strength based lens allows individuals to be empowered and confident and enables fun to be felt within the team.

Problem solving can be the source of team work and creativity.

Team work can create recognition and enable exploring of others views.

Succeeding in an achievement enables a sense of winning.

Leadership creates sparks to increase motivation and reminds us to prompt others.

Making Change Happen

My experience of being in a strategic leadership position, is that as a team, you have an idea which needs to be implemented but then gets stuck in roll out and fails to embed. The recent tragic Ockenden review, follows many others, which all show that there is a failure to change practice despite an overwhelming reason to do things differently.

I feel that rather than speeding through our action plan, we need to step back and empower others to find their own path to creating solutions.

As projects grows in complexity and size, there will need to be more oversight but by creating insight in our teams, we will enable achievement of real change.

Project Management, Leadership and Followship

Even with improved project success rates and more technologically advanced tools and techniques to help improve team productivity, organisations today still face many complex challenges in setting and achieving their strategic goals.

Someone said that management is all about creating stability and embedding systems and leadership is about change so when achieving success in your projects and ideas, these elements need to be combined: change management to embrace the new ideas alongside embedding of the new ways of doing things.

We rarely however remember the critical elements of inclusion and followship.

It is important that the role of followers is considered as a positive asset alongside the leaders and the other roles which will be critical for success. This should be inclusive and representative for the whole team and the community they serve.

Learning how to become a better leader requires embracing our inner follower by showing trust and removing fear from our decision making to ensure that we can have a passionate and constructive debate of ideas.

Positive Psychology, Psychological Safety and Insight

Positive Psychology explores the science behind positive emotions since they link with the benefits of improved health, well-being, longevity, and a greater quality of life. On the flip side anger, anxiety, depression, and worry are related to poor health outcomes, often derived from systemic oppression and harsh, negative environments.

Improving the teams ‘productivity’ is a very difficult task to achieve. Teams are made up of human beings—people often with diverse personal culture, different skills, strengths, weaknesses, and different personalities so creating safe spaces to discuss and plan can be a true skill. Participating in this team, both as a leader and a follower requires an open mind, the ability to listen and being open to challenge.

Providing a safe space where each individual can thrive creates a happier team who can be more creative and ensures a supportive environment which enables insight.

Happiness can be increased by ‘noticing the positives in our every day experiences, recognising the roadblocks and identifying ways to overcome them. Once the first steps are taken, it becomes much easier to provoke change especially where failure is celebrated as part of the pathway of success and we all contribute to the solution enabling true insight to be found.

Where we create fear, which is often where the culture is grounded in criticism; this is where we get stuck – fearing the outcomes of change which prevents us from fully participating in the solutions.

When your team feel comfortable asking for help, sharing suggestions informally, or challenging the status quo without fear of negative social consequences, we are more likely to innovate quickly, unlock the benefits of diversity, and adapt well to change.

Leaders can build psychological safety by creating the right climate, mindsets, and behaviours within their teams. People should be able to be honest, authentic and trust created through a consistent, predictable and safe space for challenge and followership.

By empowering your team to be the best they can be and enabling them the freedom to define their own journey to a shared vision, we can create new ways of working and embed the insight from all.

Building a team is a common area where mistakes are made as we recruit or choose skills and pick the ‘doers’ rather than recognise the wider characteristics which are important for a happy and productive team.

We can always bring in individuals with specific skills and expertise later.

There are a number of models which consider the way that we work together.

Belbin Model: https://Belbin.com/

• Action-oriented roles
• People-oriented roles
• Thought-oriented roles

Debonos Thinking Hats: https://www.debono.com/

• Blue Hat: organisation and planning
• Green Hat: creative thinking
• Red Hat: feelings and instincts
• Yellow Hat: benefits and values
• Black Hat: risk assessment
• White Hat: information gathering

With my own summary of people having strengths in relation to:

• Exploration
• Connection
• Creativity
• Achievement
• Risk Spotting

We need all of these ways of thinking to be captured within our teams.

We need our explorers to look for the data, being interested in the world and giving us information for us to act on.

We need our creative thinkers to create solutions and think laterally to consider options.

We need our connectors to see the positives, to be able to engage with others and bring people together to collaborate with our vision.

We need our achievers, who can identify the processes we should follow, create our action plans and hold us to account.

We need our risk spotters to prevent us from making mistakes.

These models provide a useful framework for maximising our performance. By considering the strengths and weaknesses of each individual, we can organise our teams in a way that utilises everyone’s talents and fosters productive and creative collaboration.

These characteristics can be bought together to ensure we capture the different elements of managing a project or delivering a service however we can use it as a decision making tool to ensure we consider different perspectives. In Debonos hats, each thinking style is represented by a different hat: By “wearing” each of the Six Thinking Hats in turn, you can gain a rich understanding of the issues you face – and the best ways forward.

No project or challenge will be achieved through one way of thinking and only by recognising and celebrating our diversity of talent will we succeed.

From my experience, we need to deploy a team with shared values which allows working together from a shared sense of purpose. Where values are in tension, there will be a difference of professional opinion and conflict ensues.

Understanding the values of your team is critical as a foundation stone and together with a passion for your vision, are critical for success. They are not an afterthought.

Leaders must lean on their identified values to ensure that we achieve our aims and objectives. It allows a structure for how we behave, how we make decisions and how we develop our processes and policies.

Each team member will have their own values and also  will adopt the teams values to be successful. Ensuing that our team members can align to our core values is a priority.

As a leader, we must role model the values we have agreed.

Your values not only describe your character but reflect your uniqueness. They will show your strengths, your motivation and your purpose. Working to your values will provide energy to be happy and resilient. They will also identify what challenges you may experience when you are not being the best version of yourself.

• Understand what your purpose is – as this will drive your strength and energy and will enable you to meet your own ambitions.
• Understand what makes you happy – as this will allow you to recreate this feeling when things are not going to plan and can provide you with focus.
• Understand what is challenging and triggers you to feel defensive, anxious or irritated – as this enables you to develop strategies to avoid negative outcomes.

By sharing these with your team we can all work together and be able to create a positive working environment.

This allows:

• Leadership and followship
• A culture of inclusion and belonging
• Team relationships that are open
• Happiness and motivation

This link allows you to explore your common values – some overlap but others conflict so working with your team to identify your shared value set is at the beginning of your journey as a healthcare entrepreneur or completing a project of quality improvement.

https://sandsleadership.com/discover-personal-core-values/

You have thought through your wicked problem, brainstormed and explored the topic with a diversity of perspective and by analysing the data, you then need to identify your vision or a mission statement. Even a quality improvement project, needs a purpose.

This will need a creative thinker, so if this is not your own skill, find some-one who is a solution finder to explore your data and identify your vision together including your wider team.

A vision tends to guide a direction of travel rather than be a specific goal which will give you the ability to flex and bend to achieve success.

Our vision usually can be divided into the following groups:

• Achievers: Is your vision to be the biggest or the best at something.
• Explorers: Is your vision to know the most about a subject or create new knowledge. This can also be inventing or developing something new.
• Connectors: Is your vision to create a community and network to amplify voices and raise awareness.
• Self Expression: Is your vision to empower individuals to achieve something specific.

Once this has been identified – you can pull together the right team to succeed.

What are the next steps when you have an idea for a quality improvement project, a business case or an entrepreneurial opportunity? We can all be that person who changes things for the good.

I love this video that shows if children can come up with great ideas: we can too!

Many of us feel that we are not able to identify new solutions or turn an idea into action.

You may be interested to know the burden of a creative thinker is that we will fail if we try to do it alone.

The misconception of project management is that it is all about setting goals and identifying actions and everyone is busy completing their lists but we need to be much more thoughtful.

Every idea and project needs to consider who are the individuals and groups that are intrinsic to the solution. This is stakeholder mapping. We need to consider how we can connect and enable everyone to be heard.

These will be our champions and influencers of the future.

Our role as leader is to understand how we can hear wider viewpoints, empower talents and amplify self expression alongside noticing achievement in individuals, teams and wider systems. This is really important and often forgotten.

 We need to explore and understand the problem (market research).

When we have a challenge or are considering wider issues, our brains will look at the subject with our own lens of experience and we will believe we understand the problem (cognitive bias). My personal experience is we rarely fully understand.

Being able to use your senses to explore the problem will make a difference.

Focus in and what you will realise is that there is a lack of granularity. You need to dissect the problem from all angles – see it, feel it, move it around, touch it and listen.

When looking at the problem – consider it free from the system it exists within.

• The high numbers of young people who have committed suicide is not about waiting lists or IAPT but the reasons some-one does not want to be alive.
• The increasing numbers of those who die from overdose of addictive substances becomes about why people are addicted to substances and not how many detoxification services we have.
• Why our professionals are leaving our health and social care world as a career becomes about the individuals and their experiences of being in work and not a focus on recruiting more students.

Ensure you are listening to all the voices and be aware of the power people hold.

• I know people tell me what I want to hear because they want to show respect.
• Professionals especially doctors often limit conversation as we hold power through professional status and being considered experts in our field.
• Systems hold power so health, social care and the criminal justice system can often dominate conversations – this is through our own societal hierarchies and is not because they do not care.
• Individuals and wider groups must be heard and the body of lived experience should be visible and mechanisms in place to amplify those voices.

By creating neutral safe spaces, we can hear peoples truths and limit interpretation through our own lens of experience. Then we will ensure that we identify all the data that can inform our solution.

Use our data sets, they are huge and by utilising all the information available, we will be able to analyse and use as part of our creative thinking.

Finally, be kind with the time frame!

We should always give ourselves longer than we anticipate.

My personal experience is that although local improvements can be delivered in a few months, every project has to embed and if we are not careful your new idea will rapidly return to the previous status quo.

In addition to the exploration phase, project design and implementation, the team need to embed and champion the change and it will takes two or three years of constant reinforcement to ensure that your great idea becomes part of the fabric of our service.

In the next blogs, we will consider how we use critical thinking skills to come up with our new solutions, the team you will need to implement these changes and how we can have fun when tackling some difficult challenges.

I have always believed that we are learning every day and taken the opportunity to make small changes to my own practice if I notice that we should be doing something differently and encourage my teams to do the same. This requires us to be open to the concept that the world is not black and white, or that there is a right or wrong way and have seen how we place a defensive wall around ourselves if we do not adopt a flexible mindset.

By being open to new opportunities for change, both from local improvement outputs or national strategy, these form the foundation stones for change. These ideas, let us practice implementing change so we can all be change agents, champions and influencers of new thinking. These also provide the possibility of healthcare entrepreneurialism.

A wicked problem is another area of entrepreneurial opportunity.

They are a problem that’s difficult to solve—normally because of its complex and interconnected nature. Wicked problems lack clarity in both their aims and solutions and are subject to real-world constraints which hinder risk-free attempts to find a solution.

What are wicked problems in healthcare?

• Environmental challenges with a need for regenerative design
• Radicalisation and extreme perspectives from our social communication
• Complicated technology and integration including artificial intelligence
• Consumer led health and social care solutions with limited resources
• Poverty and Health Inequity
• Knowledge management in a rapidly evolving world
• Personalised medicine
• Patient and human subjects’ privacy and protection
• How to build trust in our health and social care systems
• How to have a workforce that is competent, confident and happy

In the beginning of my career, expert opinion and consensus view led the evidence base. We now analyse our data, initially retrospectively to make changes and create evidence based medicine and solutions and now have moved to real time data to visualise todays immediate crisis or success. This gives us lots to think about but rarely builds creative thinking or generates new solutions.

In our complex worlds, multiple stakeholders have different opinions, have different values and priorities and work within different organisational structures. Although we all want to be more collaborative, we cannot implement easily a new system approach in which we will be required to transform.

This is where the entrepreneur can try something new and experiment. They can understand the wider perspectives of the stakeholders especially if they do not belong to one group and they can demonstrate delivery which could be adopted by the wider community.

My own unique talent is to be able to look at new service design recognising that skills can be taught and develop governance systems and shared values to ensure safety and effectiveness. This can lead to an improving service where resources can be used more effectively but that quality improves.

In the 90’s, I was part of the advanced practice movement sharing the burden of diagnosis and treatment with new models of service design.

In the 00’s, I continued to identify models in healthcare moving from doctors towards a wider multidisciplinary team with improvements in capacity in these services but ensuring that they were caring, trauma informed and met high quality standards.

In the teens, I founded my own company based on these principles in forensic healthcare which has grown to be one of the largest providers of forensic services in England.

What next? We need to turn our attention to the workforce shortages and their experiences of distress. Those who use our services have complexity of needs and we have greater understanding of the impact that the failure to address the social determinants of health, alongside our own biases has led to widespread inequality. Mental health and understanding our behaviour whilst we experience a crisis of meaning are all wicked problems which provide opportunity.

So which wicked problem?

I do believe you need to have to have passion and understanding of the issues so my focus will always be towards making a difference to people, empowering individuals and using all our lived experiences to build better systems.

My new opportunities are:

Being able to make a difference to those who experience disadvantage and create a new workforce of those with lived experience harnessing their power and ambition to pull together the existing infrastructure to meet their goals – so The Maslow Foundation was born.

Being able to make a difference to health and social care and their crisis of staffing, with a model of psychological safety, ensuring safe spaces to nurture our talent and build confidence and competence, providing a space of trust, authenticity and consistency to feel safe to practice without shame and self doubt – hence Nurture Health and Care Ltd was born.

In these organisations we can:

• Frame the problem without worrying about the systems
• Identify the purpose asking for diversity of thought, in a neutral space ensuring our lived experience informs design
• Design solutions
• Experiment
• Scale what worked or learn from those things that did not go well
• Share our knowledge and create an open learning system to showcase our design

I loved this video as feel it solved a wicked problem and hope you create your own health and care incubators to nurture your ideas and implement through action.

I love being able to consider the wicked problems in the world of health and the wider world. I have the privilege of listening to amazing people, ‘taking a thought for a walk’ and considering their perspectives to try and co-create new solutions.

I would like to share one of the first challenges of a healthcare entrepreneur – what corporate structure do you utilise for your new venture?

• Charity
• Community Interest Company
• Partnership or Sole Trader
• Limited company

This is particularly challenging when you are a passionate advocate of the NHS and believe that care should be free at the point of access. My experience as a shareholder of a limited company, is that you may be perceived as being a corporate machine redirecting public monies to the greedy 1%. I also realise that as a charity or community interest company, you may be limited in the investment you can attract and that the charitable purpose can be its own burden.

So how do you decide?

How can you consider your ethical and moral responsibilities?

In considering your options, you must be brave and set out your vision:

• How large could this organisation become? Technology and private equity might be needed to ensure a safe financial foundation.
• Who will be your partners? Potential collaborators may be corporate organisations or the voluntary and community sector.
• Our thought leaders including doctors and other professionals and wider communities may believe that their intellectual property should lead to a financial reward. If we wish to retain our talent, do we need equity with other industry standards.

It is not possible to be a healthcare entrepreneur if you do not have a fit for purpose vehicle as a legal entity to be able to sell services or products.

As a founder of a charity ‘The Maslow Foundation’, a Community Interest Company ‘Urban Nest Housing Solutions’ and a limited company ‘Nurture Health and Care Ltd’, I have had to consider these elements recently. Collaboration provides another layer of complexity which our structures are not able to facilitate with ease.

The Maslow Foundation has the vision of social inclusion using the lived experience of the community for whom it serves. They should identify their own services and providing a workforce of lived experience practitioners who collaborate with the widest partners to create the evidence base for best practice. As a charity status, this allows the sharing of assets and transfer of leadership to those whose diversity of experience will exceed my own.

Nurture Health and Care Ltd, has been founded to nurture our workforce, so they can nurture others. As a workforce partner, it will require the use of digital technology, working collaboratively with industry leaders with the possible need to scale rapidly.

 I believe that limited companies and corporate structures are essential, and our supply chains are testament to that. These organisations must then be held to account so that we meet public scrutiny and are distributive and regenerative by design.

We should expect our organisations to be embedded with the principles of equality and justice. Instead of aiming to accumulate only economic forms of capital, it should explicitly value social, human and natural capital. In healthcare, we need all our energy and passion to be harnessed through collaboration to create the best services for all and to drive a thriving economy.

We should be celebrating the success of our organisations, our workforce and those who use our services expanding best practice and I look forward the lived experience of entrepreneurial spirit setting up their own visions and participating in the journey of improvement which may address the social determinants for health as well as create culture change for the NHS.

I share the ‘donut model of economics’ from Kate Raworth and aim for organisations that seek to thrive not chase the dream of never ending growth for shareholders working collaboratively with all our partners, both statutory and voluntary, community and social enterprise.