What would the Health and Social Care Workplace Look Like

if People Really Mattered?

A partnership publication by

Oasis School of Human Relations and

the Health and Social Care Academy

1 7 Principles to Shape the Workplace of Tomorrow, Oasis Press, 2015

The publication of thought-provoking research on the workplace

of tomorrow1 has provided us with an opportunity to explore

together what the seven principles to shape the workplace of

tomorrow could mean in the field of health and social care and

how they can contribute to transformational change.

We are delighted that Audrey Birt has written this stimulating

think piece and we hope it inspires and engages you.

Cathy Neligan, Director of Communications and Research, Oasis School of Human Relations

Shelley Gray, Health and Social Care Academy Strategic Lead

‘Compassion is the radicalism of our time.’ Dalai Lama

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The contextThe need to transform health and social care is a regular call from media, from

politicians, from experts in the field and indeed from people who use support and

services. However, in a recent Commonwealth Fund publication2 comparing healthcare

systems internationally, the UK ranked first overall on healthcare quality, access,

efficiency and equity, and was considerably cheaper. Even as health and social care

staff deliver remarkably well by those criteria, still we challenge them to change, to

do better and to care more. And all this is in the face of growing demand, changing

demographics and a population with more complex and increasing needs.

It’s a paradox facing society and one which is not being tackled at a community level.

Rather, in general the expectation is that downstream services will fix it. Working in the

face of such paradox means the workplace of health and social care is facing a unique

and overwhelming challenge.

In this think piece we seek to explore the seven principles to shape the workplace

of tomorrow identified in the Oasis research and to see how they might help people

working in the sector to be brave enough to take the first steps into creating the future

of health and social care where people really matter.

The background The ongoing research into the workplace of tomorrow by the Oasis School sets out to:

• discover through dialogue the changing nature of the workplace

• identify what development is required for the future

• provide opportunities for stimulating, engaging and catalysing individuals and

organisations towards actions and ideas for shaping the future

• share the findings with a wider audience.

This recent research publication has emerged in tandem with the development and

launch of the Health and Social Care Academy in Scotland (the Academy) in May 2014.

2 International Health Care Systems, ed Mossialos, Wenzl, Osborn and Anderson, LSE/The Commonwealth Fund http://www.commonwealthfund.org/~/media/files/publications/fund-report/2015/jan/1802_mossialos_intl_profiles_2014_v7.pdf

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Why the research into the workplace matters

‘We often think of the workplace as somewhere we go to do our

job. But the workplace is more than that. It has the potential to

be a place where you can improve your health. It can be a place to

promote health – both physical and mental – and a place where you

can improve well-being.’ Dame Carol Black

The workplace has a critical and unique role for people. It is where most of us spend

most of our lives and where we shape our livelihoods. What we know, how we use it,

what we believe in, how we want to organise ourselves and, above all, the nature and

quality of our relationships, will underpin the autonomy and connectivity that frames

our workplace.

Oasis and the Academy both see the workplace, whatever its setting, as a crucible and

a servant for creating life-affirming activity. The Oasis research aimed to learn from people

across all walks of life, from business to third sector, from arts to technology, from public

to emergent, representing a dynamic cross-section of backgrounds, ages, contexts and

ways of looking at the world of work. The research question was:

‘What are the requirements of the workplace of tomorrow if people and planet really matter?’

The 7 Principles to Shape the Workplace of Tomorrow document represents the

distillation and the emergent thinking from these learning conversations.3

Academy and Oasis shared question Exploring our shared question: The Academy and Oasis recognise the synergies between

their organisations, including their emphasis on relationship values, and have come

together to understand more fully what those seven principles could mean to health

and social care if people really mattered. Whilst both are committed to planetary

sustainability, to stimulate the most spirited conversations, we have agreed to focus

on people within this document. Through this think piece we aim to stimulate further

discussion and enable transformational conversations to take place.

3 http://www.oasishumanrelations.org.uk/content/uploads/2015/01/7-Principles-to-Shape-the-Workplace-of-Tomorrow.pdf

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Connect people with their passion, their purpose and their planet

7 principles to shape the workplace of

tomorrowApproach complexity with inquiry

Pattern hope to help the future emerge

Trust more; control lessDevelop relational innovations

Create authentic organisationsFrom leadership to leaderful

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The 7 Principles to Shape the Future of Health and Social Care where People Really Matter

Connect people with their passion and their purpose

‘Everyone has his own specific vocation or mission in life; everyone

must carry out a concrete assignment that demands fulfilment.

Therein he cannot be replaced, nor can his life be repeated.

Thus, everyone’s task is unique as is his specific opportunity to

implement it.’ Viktor E. Frankl, Man’s Search for Meaning

How difficult can it be to engage the hearts and minds of those who have chosen

a caring profession as their career path? While the daily role of caring can bring challenges,

it also has huge potential for giving working life reward and meaning. And yet some

parts of the health and care system are facing significant challenges. From the care

worker paid minimum wage on a zero hours contract to the partner in a GP practice,

there are challenges with recruitment and retention, a clear sign of a need for change.

Most commonly we hear from people who are unable to provide the kind of care they

wish to because of the constraints of the approach and the sheer tidal wave of need.

The system is creating a dissonance between those seeking to serve and those they care

for, which manifests itself too often in complaints about attitudes and in particular a lack

of care and compassion.

Investing in people’s development, equipping people to work with uncertainty, building

their self-awareness and confidence and enabling them to make shifts throughout

the system could enable real change. We can only foster shared decision making,

self-management and compassion in the service if these are experienced by those who

provide the service. Engagement of health and social care teams in change will be

essential to achieve transformation; a lack of engagement will at best create stagnation

and at worst the kind of effects exposed by the Mid Staffordshire Inquiry. When we

invest in and enable the voices of all in the service, transformation towards a shared

vision will naturally follow.

What do we need to stop doing to enable people to connect with their passion and purpose?

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From leadership to leaderful

‘A leader is best when people barely know he exists, when his work

is done, his aim fulfilled, they will say; we did it ourselves.’ Lao Tzu

The future of health and social care will need leaderful environments and the

development of core skills to connect and to collaborate. These environments will need

to create the conditions for, in the words of one participant in the research, ‘emergent

self-governance’. Current leaders will need to move from a traditional hierarchy of

power to ceding power to enable all to take personal and shared responsibility for

change. At this time of integration of health and social care relational skills of leadership

will be core; leaders will need to foster a balance between the transactional skills of

leadership and the relational.

No one person or group can all have the answers, but by collectively using all the assets

of the workforce and the wider community, transformation can happen. Empathy, active

listening skills, inclusiveness, collaboration and a respect for all as true partners in the

process are the key ingredients to enable this shift. These shifts do not happen overnight

and they require a sustained commitment to a leaderful future.

What could we do now to bring out the best in all our people?

Creating authentic organisations

‘Honest disagreement is often a good sign of progress.’

Mahatma Gandhi

At the core of this is enabling difficult and honest conversations to take place. We

need to build in constructive feedback as the norm, to acknowledge the good and the

bad in the current reality and through that create the shared motivation for change.

We already understand that an open culture results in a safer system; the same is true

of effective organisations. This needs not only personal authenticity and awareness

but also authenticity and awareness within the organisation, where everyone has

a shared commitment to the outcome. In this way a person-centred culture within an

organisation will enable a person-centered service as illustrated below in the principles

of person-centered care.

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Principles developed for The Scottish Government National Person-Centred Team4

This is a symbiotic relationship and needs to have an authentic commitment at all levels

in the organisation as well as a culture that enables people to challenge any dissonance

they experience.

How can we commit to culture change at all levels?

Approach complexity with inquiry

‘In a time of drastic change it is the learners who inherit the future.

The learned usually find themselves equipped to live in a world

that no longer exists.’ Eric Hoffer

Experience shows us that existing processes in health and social care are frequently ill

fitted to the complexity of individual needs as well as the complexity of the system itself.

Compassion and kindness, to enable wellbeing

Flexible and empowering culture and system

Equality, mutuality and

individuality

People in relationship

Trust, respect and empathy

4 Image by clarejmills@gmail.com

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Our approach to date has tended to be to try harder to do more of the same. Instead,

this research tells us it is the perfect time to stand back and inquire into what we can

learn from the current reality, and to raise questions about the future state we want

to co-create. Each inquiry has to start with the right question. For some that question

might be at a whole system level, embracing the very paradoxes of health and well-being,

while for others that might be more focused on how to shift our specialist model to

a whole person, relational model of providing care and support.

The answer does not currently exist to the complex question of how to care for people

with multiple medical and social issues, to give one example, but potentially we do

have some steps along the route to change. On their own they will not be enough for

the transformation but will enable us to move away from the current horizon. To fully

embrace what the International Futures Forum would describe as the third horizon we

need to embed a culture of inquiry.

The current model has a tendency to punish those who admit to not having the

answers. What we need in the future is to reward those who are willing to question

the existing paradigm, willing to let go of knowing, and willing to bring their curiosity

to the questions they hold. From small teams to whole system health and social care,

inquiry approaches can release energy, innovation and potential, building the platforms

for connection and collaboration. Integration of health and social care is the ideal

opportunity to enact this approach.

What would your key questions be?

Prev

alen

ce

Time

First horizon –sustaininginnovation

Second horizon –disruptiveinnovation

Third horizon –transformative

innovation

H1

H2

H3

IFF Three Horizons Model: three forms of innovation

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Develop relational innovations

‘The most exciting breakthroughs of the 21st century will not occur

because of technology but because of an expanding concept of

what it means to be human.’ John Naisbitt

A paradox we all recognised in the Oasis research was that of technology as both

a connector and isolator. Interviewees understood the potential for global connection

to be transformational but also saw and felt the daily impact of social isolation and

loneliness. Circumstance compels us and provides us, with necessity a driver for more

technology-enabled solutions. But the core condition for those solutions needs to be to

connect people to people, so the technology becomes the conduit for connection and

not the replacement for it.

Technology has the potential to improve access to care and support but relational

innovations go beyond technology. They relate to individuals being enabled to shape their

own care, to self-manage and to shape and influence the future, e.g. through online

feedback mechanisms. The power of social media to share lived experience, and new

media such as blogging to enable a new kind of expertise, deepens empathy, improves

information and communication and challenges the hierarchies of knowledge and power.

Our future systems need to find how to embrace this as an enabler for transformation.

Technology can also work with others to enable the whole community to dream, co-create

and harness ideas. In this way it can allow a diverse engagement but we are social

beings with a deep-seated need to connect. Ultimately innovation in an interconnected

world will be through and out of relationship.

To what extent can we put people at the heart of technological development?

Trust more; control less

‘The best way to find out if you can trust somebody is to trust them.’

Ernest Hemingway

In a recent Academy masterclass delivered by Derek Feeley, the Executive Vice President

of the Institute for Healthcare Improvement and former DG of the NHS in Scotland

described his vision for the future of health and social care. He said that we now need

to move beyond power and control, beyond even the more recent phenomena in

healthcare of developing an approach of partners in care, and suggested that now the

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compelling need is to cede power. The Workplace of Tomorrow research by Oasis also

identified the need for this. To fully enable health and wellbeing power needs to be ceded

not just within the existing systems but also outwards to communities. The role of the

state is to get out of the way, as suggested by the Carnegie Enabling State model below.

The paradox of control and effectiveness highlights the dehumanisation and stifling of

creativity in health and social care. The dynamic of trusting more and controlling less is

a subtle relational dance that has to respond to context. The successful organisations

Oasis identified in the research were those that had moved to support leaderful

behaviours across the organisation. Their shared and compelling vision was fundamental

in encouraging employees to self-organise to reach objectives. Guiding principles and

shared values rather than controls or targets resulted in increased quality and productivity.

Again success requires commitment across all levels of an organisation but the result is

increased organisational and individual resilience. In work undertaken by Oasis within

North Star Housing Group (featured in an Academy Masterclass), which focused on

health and wellbeing audits and developing resilience, sick leave and stress-related illness

saw a significant reduction. Such shifts are a common consequence of this approach.

Active engagement of citizens, both staff and users of the service, means ownership of

change within and beyond the system into communities as well.

What would trusting more mean to you in your work?

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Pattern hope to help the future emerge

‘In order to carry a positive action we must develop here a positive

vision.’ Dalai Lama

In this work we heard time and time again about the need for hope. A sense of

hopelessness and powerlessness has an impact on the health of individuals and

organisations. In health and care organisations the impact of constant media attention

and criticism is disabling in the face of growing need. Disempowerment, disaffection

and despair are a potent combination in some, which is manifest through increased

sickness, high staff turnover and early retirement. The need to define a way forward

becomes compelling but the temptation to jump quickly for certainty is an inherent

danger. Makeshift solutions built on old foundations can perpetuate more of the same

and miss opportunities for sustainable transformation.

The first part of this journey of transformation is to move from talk of deficits to

assets. We need to build on our strengths as leaders, practitioners and partners in

care. Consequently this principle requires us to be bold about the future and embrace

uncertainty. This is counter-cultural in our current political and economic system, but

learning to live with uncertainty is one of the most important qualities needed for this

time of transition. People and organisations that can respond to serious challenge with

flexibility and in new and spontaneous ways are the ones most able to survive. So let’s

change those conversations to what we can do and focus on that. Let’s build into our

practice mechanisms that help us face up to the current challenges. And let’s help

people see a possible future to give them the courage and the hope to enable that

future to become reality one step at a time.

To what extent can we change our conversations to talk about what we can do?

And finally can we talk about love?

‘I think healthcare is more about love than about most other

things.’ Don Berwick

This research heard a resounding call for more humanity in the workplace and where

that was most compelling was in the context of health and social care. Could love

become a driver for policy, as one person framed it? When we talk of love in our

workplace culture many become embarrassed. If we frame ‘love’ as ‘deep empathy’

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then perhaps we can relate to the concept more fully. A person-centred and relational

system has deep empathy for those within it, creating a culture which can provide

the environment for these seven principles to build the new paradigm and the

transformational change we seek.

The aim of this think piece is to stimulate discussion, reflection and hope that we can collectively build a health and social care system where people really matter. We offer these principles as a stimulus to the process and recognise there are likely to be others that emerge. But what we do know is that for transformation to be achieved we need to:

‘Think big, act small and start now.’Audrey Birt, 2015 Academy Champion and Associate Director of Oasis in Scotland

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About the AcademyThe Academy is a response to the need for greater all sector thinking, development

and sharing of evidence and practice in relation to health and social care. It seeks to

engage with all stakeholders in health and social care and has a particular emphasis on

supporting the emerging health and social care partnerships to implement integration.

The Academy provides a focal point for driving transformative change and provides a

safe space for focus on relational and human aspects of change, rather than structural

or organisational. It is a uniquely cross-sectoral space, bringing together people who use

support and services with people at all levels from across national and local government,

health, social care, professional bodies, inspection and improvement organisations, and

third, academic and independent sectors. It seeks to create opportunities for dialogue and

collaboration among these groups and with Scottish citizens and society more widely.

The Academy’s activities broadly aim to support transforming, learning and connecting

(TLC) and reflect and promote the PATH principles:

• Person-centred – the priorities, expertise and lived experience of people will be the

lens through which all activity is undertaken

• Asset-based – all activity will reflect a belief in the assets, skills and capacity that we

all bring

• Transformative change – all activity will seek to drive fundamental positive change,

rather than only improving the existing model

• Human rights and equality – all activity will be inclusive and reflect a human rights

based approach

Academy Approach

The Academy is not a traditional ‘bricks and mortar’ learning institution. All activities,

learning, evidence and collaboration is underpinned by the equal inclusion of the voice

of lived experience in everything that we do. A key aim is to amplify the voice of lived

experience and enable its influence over policy, design and delivery of health and social

care integration.

Health and Social Care Academy 0141 404 0231 academy.alliance-scotland.org.uk

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About the Oasis School of Human RelationsThe Oasis School of Human Relations is a radical not-for-profit learning organisation

committed to inspiring and developing relationships for the 21st century.

The school focuses on learning and development, through educational programmes,

organisational health checks, one-to-one development, organisational development,

consultancy and research. We work out of a radical human relations approach and a

peer-based perspective.

Global pioneers in the application of Whole Person Learning, a form of transformative

learning that enables people to bring more of themselves to their lives, work and

communities, Oasis has a successful track record over 30 years in engaging with people

and organisations to make sense of their world, develop themselves and their future.

We apply a peer-based collaborative approach to develop and inspire responsible

practice and leadership across all sectors, equipping people and organisations with the

skills, strategies and attitudes they need to flourish.

As a partner of the Globally Responsible Leadership Initiative since 2004, Oasis has an

international reputation for its work and research.

Oasis School of Human Relations Hall Mews, Clifford Road, Boston Spa, West Yorkshire LS23 6DT 01937 541700 www.oasishumanrelations.org.uk

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academy.alliance-scotland.org.uk www.oasishumanrelations.org.uk