Care Support Pyramid - Healthy Leadership (X01) Four dimensions that, if attended to, will improve the working experience.
The WHO (World Health Organisation) suggest that patient safety will never be achieved in our hospitals if the safety of the those who work in healthcare is not addressed at the same time. Keep health workers safe to keep patients safe. Safety is a component of quality in healthcare and this link between achieving it for patients by delivering for the workforce offers a new opportunity and relationship between patients and staff.
Perhaps there is a similar relationship between the other dimensions of quality in healthcare. We will deliver safe, effective, timely, efficient, equitable and good experience healthcare to our community in parallel to delivering these same dimensions to our workforce. The relationship between patients and workforce is no longer a ranking of one first but a symbiotic connection in which each needs the other and both require attending to.
Our purpose?become ‘Quality healthcare for our community AND quality work experience for our colleagues’. Inexorably connected and one is not to be sacrificed for the other but rather progress on both is the organisational ambition.
Just as there are numerous reports into poor care and initiatives are enacted to respond to concerns we often see wrapped into these poor care experiences poor workforce experiences – toxic cultures, poor leadership, lack of engagement – these will be found in the summary pages of many of our darkest healthcare scandals.
Our Patients Matter AND Our People Matter – an AND position not an OR.
This appears obvious and has now been declared and across our varied environments work is underway to improve quality for our patients and our people. In fact so much work is going on in both areas I am lost, are you? I don’t really have sight of all the activity, I am unsure which is relevant to me, seems that new initiatives are launched before the last ones had an impact, numbers seem to win the day and it is unclear how this matters to my specific local area.
The gap between healthcare teams of perhaps 20 people to the decisions made by organisations of 5000 against the initiatives of a national agenda concerned 1.3 million is huge – decisions made appear to have little relevance. The Care Support Pyramid emerged out of a need to close that gap and engage local teams in ownership of the issues that they can influence as well as awareness of the larger work they may want to influence. It offers a consistent organisational approach while encouraging local ownership and action.
There is a great deal of evidence that offer us ways to improve the working experience. They cover a wealth of interventions, ideas and actions. The Care Support Pyramid has taken some of the historical ideas and very recent work to create a consistent set of dimensions that become a framework to help manage, communicate and share what can be an overwhelming area of activity.
A previous famous pyramid was that of Maslow who referred to the pyramid sections as a hierarchy in which you must achieve from the bottom up. Achieving physiological needs before any other can be enacted. The Care Support Pyramid shares such a concern but rather than a hierarchy in which the first need is required before all others each dimension should be active simultaneously. The pyramid design does help us consider impact and the largest section, the hygiene factors, plays a significant role in the working lives of all employees. Statistically only a small number of our colleagues will need help and support at the highest level of the pyramid.
The work from the British Psychological Society (BPS) that helped guide so many teams and organisations through the challenge of the Coronavirus pandemic contains more recent ideas and combined with the Compassionate Leadership concept, described by Michael West and the Kings Fund, a clear and supportive approach has been constructed. Healthy Leadership is a key component in the support and care of our colleagues.
While the BPS paper refers to the psychological needs of colleagues it has significant content that requires organisations to provide ‘consistent access to physical safety needs’, such as PPE (Personal Protective Equipment) and other physiological needs such as ‘sleep’ and so it alludes to the relationship between individual and organisation in creating climates that appreciate the importance of self-care.
The Care Support Pyramid is designed as a pyramid to indicate both the building blocks required to support colleagues and improve their experience but also to give a visual representation of impact. While at the top of the pyramid the referral and intervention processes need to be comprehensive and of a high standard they may not be required by all members of the team or organisation. The starting point of Hygiene Factors indicates the ability of issues in this domain to influence and impact all our colleagues. All dimensions should be active at the same time and the ‘jigsaw’ visual indicates reality that the dimensions do cross and interact.
Evidence also suggests that the relationships people have with colleagues in the team and their leaders / line manager is significant in their experience of work and so focusing on Healthy Leadership is vital. The topics covered in this dimension are wide ranging and comprehensive but influence culture, team dynamics, communication and teamwork.
Healthy Leadership suggests that moving away from command and control to a more coaching, compassionate and inclusive process will make a difference. These leadership ideas need to be visible, not so much the leadership walkabout (although valuable) but leadership principles that can be seen in decisions, actions, communication and change. Constructing a coaching culture that believes in the potential of people but is also supportive, available and humble.
The work on Compassionate Leadership sits strongly in this approach as Healthy Leadership creates space for the team to establish autonomy and have more ownership and control. With that collective and collaborative position the voice of the team is heard and acted upon.
Colleagues also need the opportunity to stay well and so having a culture and the opportunity to engage in Being Well and Wellbeing activity is vital. Self-Care will vary and be unique across people and teams. Local leadership and the organisation can influence it through workload, expectations, behaviours and providing practical assistance. Team practice and culture matter hugely and being a team that truly believes ‘it’s OK not to be OK’ is harder than it may appear. Suffering stress or anxiety should not be seen as weak or an inability to cope and responding to emotional and psychological challenges with as much care and consideration as physical ones is essential.
There will be times when any one of us will need extra help and support and so having excellent and exceptional Referral and Intervention services is crucial. Knowing that help and support is available for those periods of time they may be required provides people with confidence that they will be cared for.
The Care Support Pyramid reflects the evidence of improving care for our community through the simultaneous focus on our colleagues. In busy times those caring moments for colleagues are delayed. Putting off till tomorrow development opportunities, 1:1 meetings, feedback, wellbeing conversations all because we are busy today has become common not rare. It is creating a problem in the here and now. We can no longer put these events off till tomorrows because all those tomorrows have finally caught up with us and our workforce needs the Care Support Pyramid to run in tandem with the care of our community. That is in small teams, large organisations and collectively across healthcare.
How to use the Care Support Pyramid
?The four domains can remain common to the organisation as a whole but local actions should be constructed and communicated around them. Evidence from individuals, the team, ‘Staff Survey’, friends and family, meetings, reviews, debriefs, incidents all contribute to creating the work that the Care Support Pyramid dimensions should support. Keeping the dimensions consistent enables lessons and ideas to be collated and shared across teams and throughout the organisation but making actions local provides context, control, ownership and clear visibility of change.
The Care Support Pyramid is a potential response to ‘what’s the point nothing ever changes around here’
Each dimension can therefore have local actions under each of the headings and a well communicated and regularly reviewed process can be undertaken.
EXAMPLE / CASE STUDY
In the NHS a national Staff Survey is conducted in the Autumn and the results are shared in the Spring. The organisation prepares its action plan and services and divisions are dispatched to respond. The connectivity between a huge effort can be lost. The organisations complete response could be framed with the Care Support Pyramid. Individual teams can take local action using the dimensions of the Care Support Pyramid and then sharing across teams has a framework and consistency while remaining locally owned with specific actions that matter to distinct areas and teams – people own the process and they see the change. The Care Support Pyramid could also take data and evidence from other sources and in Healthy Teams and with Healthy Leadership the issues will appear and be known before a national survey uncovers them.
Actions….
Take each section and work in your team to identify the areas that would improve the dimension. They may be totally in control of the local team or part of a wider initiative but the opportunity, the information, the actions and the change are brought into local domains.
Work through the teams, update the sections on a regular basis, make the action visible both through the Care Support Pyramid as a display and the real change that people see.
Make team meetings a place where the dimensions of the Care Support Pyramid are discussed. Update, engage, share and own.
Relentless attention to working conditions: the environment, rest areas, refreshments, flexible working, transport, benefits, resources, communication, technology, policies and processes. Pride in getting the basics right.
A blank area. Ready to have a local team name to identify. Include actions local and organisational. Share contacts, updates and encourage others to become involved
An example of the type of actions that could be include. Perhaps add contact numbers, help line, names, updates etc – make it local, owned, accurate and updated
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Building effective teams: be active, compassionate, visible and?inclusive. Healthy leadership creates collaborative networks, a sense of purpose, belonging and promotes autonomy. Coaching people’s potential.
A blank area. Ready to have a local team name to identify. Include actions local and organisational. Share contacts, updates and encourage others to become involved
An example of the type of actions that could be include. Perhaps add contact numbers, help line, names, updates etc – make it local, owned, accurate and updated
Being at our Best : establishing a culture that supports the wellbeing of self and colleagues as essential to success. A wide range of supportive initiatives from exercise, hobbies and family to mindfulness, online services, helplines and apps, Caring for our People
A blank area. Ready to have a local team name to identify. Include actions local and organisational. Share contacts, updates and encourage others to become involved
领英推荐
An example of the type of actions that could be include. Perhaps add contact numbers, help line, names, updates etc – make it local, owned, accurate and updated
Here to Help : Active services such as Health at Work and EAP (Employee Assist Programme), Employee Relations, reflective team events, staff networks, wellbeing training, mental health first aid, speak up guardians and more. Support if needed.
A blank area. Ready to have a local team name to identify. Include actions local and organisational. Share contacts, updates and encourage others to become involved
An example of the type of actions that could be include. Perhaps add contact numbers, help line, names, updates etc – make it local, owned, accurate and updated
The work could be individual posters in local areas or collective work. Updated on a regular basis with changes and actions shared.
An alternative way to display the actions and improvements….
Of course there are other ways to achieve what the Care Support Pyramid offers…
Evidence based actions and processes
Consistency across organisations
Locally owned actions and control
Visible change and improvement
Teamwork and collective action on local issues
… but the Care Support Pyramid is here, ready and freely available.
The Healthy Culture Team (2022) (Steve Andrews)
If you would like copies of this article, images used, posters to create your own Care Support Pyramid response and other resources then just email [email protected] and we will forward them on
MORE INFORMATION
The Care Support Pyramid is part of the Healthy Culture programme and contain further work and interventions. Don’t hesitate to get in touch if you would like to know more.
If you would like references, images, posters, videos and further content then please email [email protected]
This process uses evidence form many sources and so is useable across sectors and environment. Good luck in taking care and supporting your people.
VIDEO (watch this) https://www.youtube.com/watch?v=weihQNO5nb8&t=2s
Supportive Information
Kings Fund – Caring to Change – Compassionate Leadership https://www.kingsfund.org.uk/publications/caring-change?gclid=Cj0KCQjw-uH6BRDQARIsAI3I-UfOizj4vZY1hJ8UP5c3BMBkg3R2REFvMR_Drvn08z6Fu-4ECGIZqAUaArFDEALw_wcB
Kings Fund – Myths on Compassionate Leadership
Kings Fund – Compassionate Leadership (COVID19)
British Psychological Society – psychological needs of healthcare staff
HBR – High performing teams need psychological safety
HBR – The leaders as Coach
Active Listening
The importance of understanding why
HBR – the relationship between purpose, vision and principles
HBR – clarity (lack of it is the biggest leadership mistake)
Joy at Work
Thank you, good luck and 'look after your people'