Why is the NHS a failing system?

Sometimes I’m unsure about the contribution I make when working with organisations that are going through change. I drew this image of how I felt last week about working in an apparently failing system.

Recently I've talked to several people about our public sector systems and heard about their first-hand experiences, and the what they see in this picture.

What do you see in this picture?

What is your experience?

Here are a few responses that people have kindly shared;

“I see this huge pipeful of energy about to explode... And disconnection.. Both in those trying to keep it together and the one who is curled up, in pain, in doubt and in helplessness. I feel reassured seeing this image knowing that we are talking about this futility and disconnection....”

“Do we stop trying to cover the gaps with plasters and rip them off.... come at it with a new approach, fresh eyes?”

“There's still a few more plasters left in the box. All is not quite lost.”

“We seem to be facing failure on a global scale and it's easy to feel like the kneeling figure on the right (I often do...) And... it's important to process these feelings, to acknowledge them and bring them to the surface such that we can join in grief and despair.”

“I see people who are noticing and not turning a blind eye. People using whatever resource they have (big or small) to stem the flow. People drawing attention to the issue, calling for help or action. And just on the periphery are more people combining resource, talent, skill in order to rebuild the system (with environmentally friendly materials, of course). Big effort takes longer to mobilise and co-ordinate but it needs those brave few to triage until the rest arrive.”

Visual Thinking through the Ages

The clash of egos

This picture was inspired by a recent conversation with a client. They were describing the behaviour of two people in a meeting. They were facing off against each other on opposing views on what needed to change, and which was best for the organisation. This my interpretation of the metaphors they used.

When change is scary it’s natural to want to stay safe, stick to your point of view and not listen to others. Change can brings up feelings of anxiety, which I often try to deny, avoid or defend against with my ego armour. My ego wants to be certain and right and on its own familiar ground. When we are under threat, its job is to keep us safe from harm. But to adapt to change we need to risk letting go of what we are sure about, and move towards something new. If we’re going to lead change, and genuinely serve people, there’s no place for unconscious ego if it’s getting in the way. We need to be willing to drop the defences and to go first into the unknown...

How do you see this happing in your organisation? How do you work with it?

The Top Table

When an organisation is going through a potentially uncertain period of change there can be a tendency for a distance to arise between leadership and staff. Decision-making in such volatile environments can be fraught with disagreements and ambiguities, with leaders finding themselves debating more and more on which course of action to take. Sometimes there is just too much input to consider and the temptation is to limit the options and control the situation.

From the point of view of those not sitting in the decision-making circle it can feel difficult to influence or even be heard by the top table - leading to widespread frustration. A communication void further exacerbates the situation, with people filling it with rumour and speculation about what is going on “up there”.

The onus is on the leadership to be aware of this dynamic in times of uncertainty and do what it can to include, involve and listen to employees’ concerns and perspectives. Getting a broader viewpoint on a problem is rarely a bad thing and often the solution lies with those who do the work.

Why You Can’t Afford to Ignore the Role of Relationships When Doing Business Transformation

In today’s business context the only certainty there is, is that everything will be uncertain! To be able to deal with the complex and ambiguous nature of the challenges we face we will be more reliant than ever on the quality of the relationships and conversations that we have in organisations. More often than not these are overlooked when a strategy is being considered and generally termed to be the ‘soft stuff’ while in our experience this is actually the hardest part of any programme to deliver.

Building relationships is at the heart of any successful culture change and central to improving performance in every organisation. Businesses today cannot afford to overlook the importance of relationship building when delivering transformation and culture change programmes.

We use Visual Dialogue, Creativity and Narrative to build relationships across organisations. By creating safe spaces for people to make sense of difficult relational issues, we help co-create practical tools to start building the better relationships that underpin successful culture change.

How will we run this?

People embarking on a project together can be equally invested in achieving a successful outcome yet be out of step if they lack a shared understanding of their respective capabilities, or have different expectations of each other.

Establishing clear and aligned roles - either as individuals, as teams or as whole organisations - can help to harness complimentary strengths that will make the partnership greater than the sum of it’s parts, bringing value and a sense of purpose to the collaboration.

This builds a stronger relationship based on having not just a shared goal - but also a shared approach to reach it.

How can we stop HiPPOs turning into elephants?

Have you come across a HiPPO in a recent meeting? This acronym stands for ‘The Highest Paid Person’s Opinion’. This refers to the impact of rank or hierarchy in a meeting where people will often fall silent, deferring, for various reasons, to the opinion of the person with the most power and highest salary. 

HiPPOs can get in the way of good decision-making. Having a HiPPO in the room can dominate a meeting as it often carries a lot more weight than other voices. People may feel too scared to challenge a dominant opinion, even though they may fundamentally disagree with it, while others may pay lip service and be eager to please and toe the line. The owner of the dominant voice runs the risk of believing they alone have the best ideas and miss the opportunity of hearing the valuable insights or ideas that come from different voices in the room. A leader may be aware of the impact they have on others but it’s not easy to create a culture where people feel its safe to question a HiPPO without fear of reprisal.

The interesting thing for me is that HiPPOs only exist because of the relationships in the room, with everyone in a sort of collusion in keeping them present. It seems to me that it is vitally important for everyone to be aware of the impact they have on others and how one reacts in silencing oneself in these dynamics.

Taking ownership of the parts we play in creating HiPPOs is the only way to stop them turning into elephants.

Was there a HiPPO in the room today? What was the part you played in keeping it alive?

So, you think you're collaborative?

We like to believe we’re collaborative - yet it’s all too easy to lose sight of other people you should be having more collaborative relationships with. Do you know how they feel about it? Are you really listening to your people?

Power relationships can make it almost impossible to speak up to someone in charge. As a leader, if you’re not hearing feedback then you're missing an opportunity to learn and demonstrate the new behaviours you want to see in the culture. Just by saying you’re going to be collaborative doesn’t mean you will be, and there may be no one with the courage to hold you accountable. How collaborative do those working around you really think you are?

Are you really listening?

We believe change happens though conversations. Conversations require listening, which can lead to learning, mutual understanding and better relationships.

Hearing from different perspectives disrupts usual assumptions and encourages collaborative, creative thinking, which can lead to more considered solutions. Honest, candid dialogue can counter scepticism and resistance, building engagement and earning respect.

Listening requires being present, and it is all too easy to be distracted by background thoughts and considerations that may be running through our heads. Not least of these are issues concerning ego; that the direction of the conversation will be a reflection on our personal abilities, and therefore status. To demonstrate our abilities we want to make intelligent, ‘high value’ contributions, but it’s difficult to process lots of new information quickly so we tend to seize upon the things we can respond to confidently. If we try to anticipate where the conversation is going in order to prepare our response then we stop being curious - about the areas where we feel weak in order to capitalise on the parts where we feel strong. We can attempt to dominate the conversation so that there’s less new information to process and we can feel more in control, but by listening less we learn less.

Great conversations can be insightful and productive - and they require people to be curious and really listen to each other.

Why isn't our new strategy taking off?

We often hear leaders’ frustration that the frontline don’t get the new strategy. And we hear from those people that they are being asked to implement a new change strategy they don’t understand, don’t feel connected to, or don’t believe in. 

However brilliant a strategy looks in Powerpoint, it may not be worth much if it’s created at the top and cascaded down onto the people who will be delivering it. The one-way nature of traditional "comms" can create alienation, confusion and lack of meaning if it doesn't encourage the dialogue necessary for people to make sense of and fully understand the changes being asked of them.

This separation between strategy development and its implementation is often cited as a major cause of failed change programmes. The frontline should be involved in the strategy development process. Listening to what they have to say and taking their ideas, concerns and objections seriously can go a long way to creating a genuinely shared narrative that everyone can feel part of and committed to.