The evidence for staff wellbeing, performance and innovation

MICHAEL: So, Suzie I guess I’ve come to feel over the years that we tend to manage people as individuals a little too much. In a way, the important context for people at work, day to day, is the immediate team or ward or social care organisation. It’s the immediate team that they’re part of that shapes their work experience. We either think at the organisational level or the individual level and don’t really realise that actually, it’s the day to day experience of my team, the colleagues in my team, that determines how I feel at work. So, I think it’s really important to think about compassion at the team level.

SUZIE: Absolutely. I think it’s fundamental to how we show up at work and the relationships we have at work. I don’t think we place nearly enough emphasis on teams and teamwork and the importance of teams having time out to reflect on how they’re doing. Not only in terms of how they’re performing but also how their relationships are working. I’ve had the privilege of working in many health care teams, in many different settings in my career and there are noticeable differences in some of those teams.

I think there’s a lot to be said for making sure that teams have that proper time out, that proper time to reflect and also that we value what teamwork brings, both to the individual but also to the performance of the team and ultimately outcomes for patients, or whatever setting people are working in.

MICHAEL: Thinking about this at team level, we can think about team members behaving compassionately towards each other, being present, listening, understanding, empathising and helping. Something that I also think about compassion at the team level is to what extent does the team as a whole behave compassionately towards other teams, departments and directorates? Listening deeply, understanding the challenges that other teams and departments face. When we work in integrated care systems or place-based systems of care, with other organisations, the voluntary sector, community organisations, local authorities - are we listening, understanding, empathising and helping in our interactions with them? There’s also something about being aware of and listening to the team as a whole, so how does the team feel at the minute?

Is it under pressure? Are we losing sight of what our purpose is? So, beginning to think at a different level about teamworking. I mean, you’ve worked in so many different teams and at so many different levels, you must have a wealth of knowledge about how to do this really effectively.

SUZIE: Well, I think where I’ve been in teams where I’ve felt that I’m a really core member of the team, where I’ve felt a high level of performance and real job satisfaction, so where I’ve enjoyed those jobs the most, is where there is a real sense of compassion, support, a helping hand, problem-solving and a shared responsibility. I think there’s often too much emphasis on a team needing to be led by a single individual and I think what we’re seeing, particularly in health and care, is the value of that shared, distributed, collective leadership, to give it it’s term, around how the team operates as a whole, as well as what you bring individually to it.

Certainly, my experience of leading quality improvement in a large teaching community hospital saw some amazing innovations in teams who were really good at practicing that teamwork, who really valued being part of a team. But I’ve also experienced teams who were less so and less successful and did not enjoy their work as much. So, I think there’s a lot to be said for paying attention to that. Also, I’m afraid to say, that I have worked in some settings where I have witnessed some really toxic behaviours within teams and would say that people were in team by name but not actually in reality and as a result, you see the impact on both on individuals and that team.

So, burnout, bullying, harassment but you also see poorer outcomes for patients. So, I think there is fundamentally something really important about how we value and nurture teams and show up in teams as individuals, in order to do our best work. Both bringing the skills and experiences that we have but also being there, as you say, to listen, help, empathise and take action.

MICHAEL: It reminds me, I’ve had some really privileged experiences in working in teams over the years, in multi-disciplinary international research teams. You know, we’ve worked in teams together Suzie on some amazing, large projects. Something that I think is important to say is that the idea that having compassionate leadership in teams or compassion in teams is not some soft, cushion, scented candles approach to teamworking. It’s about being effective as a team so that there’s a clear vision, everyone’s work is aligned around that vision, people are integrating with each other to ensure the work is co-ordinated and there’s a strong sense of trust and motivation.

I guess what I’ve experienced is that it is diverse teams that are most, in my experience, creative and innovative and that’s what the research evidence shows as well. So, teams where we value the fact that people come from different professional backgrounds or from different disciplinary backgrounds or have different work/life experiences or are different in terms of age, gender, ethnicity, nationality, religion, socio-economic status, neurodiversity. Where you have positive climates and compassionate support and leadership, then those diverse teams massively outperform other teams in terms of effectiveness, productivity, innovation and the mental health of the staff.

The shared leadership point is really important because the research shows in every sector, where there’s shared leadership, even though you may have a named hierarchical leader, where the leadership shifts depending on who’s got the expertise for the task at hand, those teams are much more innovative and effective. I think we’ve got a lot to do in health and care services in building back teamworking much better because we estimate that probably less than half of people working in health and care, work in teams that have clear objectives and that regularly review their performance. That reflection time you referred to. So, I think there’s still an enormous amount of work to do to build teamworking back better.

SUZIE:I totally agree with you and I think with the increasing emphasis on collaboration and integration of services, the importance of actually helping people understand how to be an effective team member, in a scenario where you’re not actually spending a lot of time with someone, where you may be having to work across boundaries, the skill set of being curious, of being interested in other people, paying attention to relationships as you’re trying to integrate services is critical for integration. So, whilst we might think of the integration of services as a very structural, technical task it’s fundamentally about relationships. In order to build effective relationships, that requires compassion.

MICHAEL: There are two things I think we miss in good team working: one is taking the time and space to reflect and two is take time out to reorient ourselves in the team. What are we trying to achieve here? How are we going about it? What do we need to change to innovate, to adapt and to learn? All of the evidence we have is teams that do that, especially teams under pressure in health and care, community sector, voluntary sector, teams that do that are just far more productive and effective and innovative and mental health is better.

There’s almost an in-built resistance to taking the time and the space to meet on a regular basis, to review and reflect and yet it is what determines team performance. I guess the other thing is, the sense that we’re not compassionate enough about dealing with conflict. Chronic interpersonal conflict is a disaster for teams and my view is that it’s just deeply unprofessional if people let interpersonal conflict become chronic. But other types of conflict about what we should do in the team, about what the task is, how we should do it, who’s responsibility it is, those are inevitable consequences of trying to innovate and working effectively in teams.

By working through those conflicts in an open and transparent, courageous, ethical, compassionate way, we build psychological safety and what happens is we generate innovation. Other people’s mental health improves in those teams as well. I think those themes of reflection and managing conflict much better in teams is really important for us to address.

SUZIE: I absolutely agree with you and it’s certainly been my experience. I would often hear when I was a Service Improvement Director, teams saying ‘We haven’t got time to do this reflection, we haven’t got time to review how we’re doing’. Assuming you would need a block of a day. But actually building that review and reflection into a weekly rhythm and using a short amount of time to do a quick review of how things are going, to be able to give feedback, both to the team and to individuals is really important.

I would really like to emphasise the point about feedback, I think there is a huge absence of feedback in the health and care system, to individuals and to teams and as a result, poor behaviours can fester. So, often people avoid giving feedback to people that they think might be quite difficult or the feedback might be in itself quite difficult to give. As a result, we’re doing a disservice to each other because there is a way of giving people feedback about how they’re coming across, how they’ve shown up in a meeting, how they’re showing up in a team. I think there’s a way of doing it that is compassionate but can also lead to changed behaviours.

But so often, certainly in my experience of working with a whole range of professionals within the health and care system, people won’t be receiving feedback in their annual appraisal which is hopeless in terms of overall improvement and improved teamwork which can lead to improved outcomes.

MICHAEL: I absolutely agree with you, building in that review process, being able to have courageous conversations that actually examine some of the conflict that might exist, in what people are working on or interpersonal conflict, is essential.

Our compassion is ultimately for the communities and people that we serve, so if we don’t manage performance and manage performance difficulties or behaviour difficulties, then what we’re doing is undermining our ability to serve that core mission. Compassionate leadership is about having… from that motivation to help to serve our communities, it’s having the courage and the motivation then to address performance problems and behaviour problems within teams, in a compassionate way. I love, by the way, Amy Gallo’s Harvard Business Review book, ‘Dealing with Conflict’ which talks a lot about how to deal with conflict effectively.

It’s also really important because people think about teamworking…it’s understandable that we think about what goes on within the team because teamworking is what we’ve always done as a species but we don’t think enough about what goes on in our relationship with other teams. Are we being co-operative enough? Timely enough? Supportive enough? Or are we being difficult and obstructive? At least of equal importance is working compassionately to lead across boundaries, to ensure that our teams, departments, wards, directorates, organisations are working across boundaries in a supportive, co-operative, compassionate way with the other entities, organisations, teams that we have to deal with in the course of our work.

I feel these approaches are really important because the NHS and social care, voluntary sector organisations, local authorities - together these organisations have a huge influence in our society and if we can transform the cultures of teams and organisations across all of these settings, it will permeate out and affect our society more generally. For me, it’s been one of the big learning points from the pandemic.

SUZIE: One of the points that I’d add to that Michael, is my experience of having patient or citizens on the team. So, when we talk about teams in health and care, we particularly think about the professionals or the managers that are full-time employed or part-time employed, but actually once you put patients and citizens on the team, you change the dynamic and the rich source of data in order to do that review. I’ve seen some teams really transform in terms of their performance but also what they’ve been able to achieve because they’ve listened very deeply to feedback and the contribution that patients and communities can make.

I think we’ve seen some fantastic examples of that across the country but we need people to think very carefully to make sure that they are getting patients’ and citizens’ voices into teams directly. It’s not as hard as people think it is to do that.