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PROactive Management of Integrated

Services & Environments


Atul Gawande spoke about ‘The Idea of Wellbeing’ in the 4th Reith Lecture 2014:

‘If no one cares when someone takes the trouble to do things right, nothing changes. And the overwhelming message to the people who work at the frontlines of care around the world is that no one notices excellence and no one cares. That is the biggest source of burnout and discouragement for health care workers everywhere.

Celebrating excellence is vital to keep staff energised. The motivation for change cuts across five domains:  what’s in it for me; my patient; my team; my organisation and my society. Research shows that staff motivation differentiates equally into these five groups (Scott Keller and Carolyn Aiken: The Inconvenient Truth About Change Management). So if a change story can touch all five domains it can unleash tremendous energy throughout an organisation. However, we have found that change works best when frontline staff craft their own ideas and foster individual talent. Positive changes occur naturally as one taps into the collective consciousness, intelligence and imagination of the workforce.

Enablement involves creating an empowered environment in which staff can come up with ingenious ideas and exchange continuously evolving innovations.

Empower: create a culture of personal responsibility

Exchange: celebrate innovations by replicating

Evolve: re-innovation for continuous improvement

Empower: Power to empower lies within every individual. An automatic by-product of empathic exploration is the willingness to be open to the experiential journey ‘the other’. This could be in a patient-staff construct or between a senior and junior colleague. When it goes right, the other  becomes one with the self, both feeling empowered to work together to achieve common goals. In a clinical context this way of working enables patients to make rapid strides in their recovery journey, encouraging hope and agency together with a strong sense of being well supported. In an organisational context it starts to break down the barriers of hierarchy and encourages leadership at all levels. If we encourage autonomy organisationally we find that, rather than waiting for permission or decision-making by committee, everyone is able to act in the best interest of the patient and bring about the changes we all seek. In complex healthcare systems leadership often fears potential chaos from such a degree of autonomy but the reality is quite different. With freedom staff embrace responsibility too:  they not only act appropriately but also think through risk at a much deeper level than if decision making happens elsewhere. The wisdom they bring offers far more than any top-down risk assessment paperwork could achieve. On the PROMISE journey we have found that trust in the power of human relationship is vital and puts the soul back into the art of mental health care.

Exchange: It is essential to capture and collate the ideas and innovations, the successes and failures. This may be via a virtual exchange or in a physical format. Identifying barriers and reflecting on what might have been done differently is an important part of the process. Organising all the change initiatives into key themes will allow for easy and rapid sharing and replication. Ensuring that due credit is given to the innovator or innovating team will result in an ever-growing bank which continues to push the frontiers. However, it is in the replication of success that the true benefits lie. Acknowledgement of excellence comes when others adopt an idea, thus boosting the confidence of the initiating individual or team. The self-belief this generates at the frontline is the key to creating the pathfinders of tomorrow.

Evolve:  Early adopters of an innovation can refine an idea and adapt it to their particular service.  This creates ownership as what gets implemented is a re-innovation, a newer version. In the pursuit of excellence knowing when and how to reinvent the wheel is the trick. The wheel’s evolutionary journey did not start with pneumatic tyres or with cart wheels. From sliced up tree trunks to modern day wheels is a journey of continuous improvement. This is a fundamental concept to grasp as there is always room for improvement, and when these innovations get synthesised into recovery pathways, patient benefits are immense. It is also important to acknowledge that some innovations will lead to a dead end, but a learning organisation embraces these as well to shape its future. With this approach the roadmap will never be static. Staff and patients working together will continually redefine the frontiers of humane care. Success breeds success and celebrating new standards and the achievements of the pathfinders will result in ideas and innovations springing from all sectors and levels of the organisation. This will further bolster the culture of leadership at all levels. There is a need to track the ideas as they rapidly develop and change during replication but it is important to resist the temptation to do version control. The role of leadership is to provide the support and framework within which evolution can take place. What works will dictate which version remains on the knowledge exchange as the established path for the organisation.

The Enable phase empowers frontline staff to step outside their traditional role, perhaps as a nurse or a health care assistant on a ward. Once they can look afresh at the patient journey many new ideas will emerge which, in the right crucible, will soon become effective innovations in practice.

 Enable: Ingenuity to Innovation

PROCESS - Organizational Change Model