Healthy Leadership (620) One Model to Rule Them All

When you join an organisation you agree to be similar. I realise a great deal of our conversation is of different at the moment but the better conversation is, as is often the case, an AND conversation. ‘I am both different / unique AND similar / connected - all at the same time.

You have joined the organisation, you were selected because something about you was different to the others who applied, your difference is important.

You have joined the organisation, you were selected because something about you aligned to the organisations task (purpose) and that you will be able to work with the shared objectives and shared values of the organisation, your similar is important.

For many years, and in this weekly note, I have been careful with a phrase I have used about people in organisations. My personal version of referring to people emerged as the tension between expressions such as ‘blame culture’ drove fear into people and the alternative ‘no blame culture’ created anxiety over accountability. Improved terminology is used and we refer to ideas such as ‘Just Culture’ and consider ‘Safety II’ as our approach. We assume good but ensure we are open to reality - I use the phrase ‘on balance the majority of people in the organisation are good’.

I appreciate the clumsiness of good and bad and its simplistic nature. As a mental model to keep my mind from disappearing down unwanted rabbit holes it helps me. It matches my views of community both local and global. It also keeps me curious and open to ‘other’ possibilities. Your organisation is, to some extent, a representation of our society. It has good people, it has exceptional and generous people, it has selfless people, it has kindness throughout. It has struggling people just as our community does and everything possible should be done to help, support and elevate them. It may also have some ‘not so good’ people in the same way our world does. The organisation is, in part, a reflection of society and how you think about people matters.

The ’Pick of the Week’ (see below) is a model that has been in existence for some time but just recently I have noticed that its fundamental principle is appearing in much of the work I am engaged in and curious about – Safety II, Civility, Kindness, Inclusion. leadership and Just Culture have an echo to the principles of the Vanderbilt Model if not a direct connection. The model is often represented as a Pyramid so let’s move up the model (it is a bottom up approach) with the principle of ‘on balance the majority of people in the organisation are good’ This is my refection on the Vanderbilt Model.

Start (how we ‘think’ about people) : The majority of the people in our organisation (team) are professional and ‘good’. We assume best intent and that good people become better people and professionals with supportive and helpful feedback. The actions we take are concerned with creating a learning and improving culture. This culture should be awash with feedback – not positive or negative but regular, specific, supportive and followed up. Don’t wait just for the negative events feedback on all moments and feedback against those shared aims, objectives, standards, values and behaviours.

NOTE – if feedback can be in real time that can often be helpful but think about the moment. If the real time feedback is behavioural make it first person and own it. Avoid labels DON’T SAY ‘you are being stubborn’ as this labels a person and will, more than likely, illicit a defensive response, an attack or denial. DO SAY ‘I am experiencing this moment as being stuck’ make it about what you absolutely know (your experience and their impact) not about what you don’t (their character or intent - a mystery to you). I would appreciate it if you didn’t swear, I am not sure that I understand, I am feeling uncomfortable in this moment, I am experiencing some frustration and I wonder what’s going on for you?… create a combination of language that works with your experience and be curious about what is happening for them. Don’t manipulate this moment, be kind, speak in the first person.

A single act / moment occurs. This can be referred to as ‘unprofessional’ but be careful, who wants to be called unprofessional? While unprofessional avoids other labels such as bully, rude etc it can still be distressing. If you use such terms make sure that it is from your experience ‘I’ and not an accusation or a label, such as ‘you’, which condemns. You may feel comfortable to explore this moment or it maybe that an ‘informal’ conversation with a third party may help everyone involved – ‘cup of coffee’ moment. The purpose of this opportunity is to explore the individuals insight into their behaviour and impact. There may well be underlying issues, lack of awareness or just and ignorance of the moment and language. Stick to ‘on balance the majority of people in the organisation are good’ and so this is a good person with perhaps unconscious acts. One such moment does not turn a good person bad – good people do ‘not so good’ things occasionally but remain good people.

NOTE : There are exceptions indicated by the term ‘mandated’ and ‘egregious’. Mandated may be a clinician who makes a drug error and it is mandated they complete an incident form. An example of Egregious might be ‘if I walked down the corridor and hit you’ this may be a safety issue or even a police issue of assault. This are rare moments in the life of the organisation not the common. Your leadership will examine context and the person may also benefit from being listened to and a ‘cup of coffee’.

Recurrent Issues (a pattern) – Remember that the numbers are with you as ‘on balance the majority of people in the organisation are good’ yet a pattern is emerging. This may still be unconscious or as yet not owned by the individual. The next level of ‘awareness intervention’ may be undertaken by a third party if required, someone with the skill to address the behaviour but remain in a learning and development space. There may be reasons for the emergence of the pattern, they may have influencing personal circumstances, lack of knowledge, a failure to offer feedback earlier so the ‘habit’ forms and is stuck etc. The issue is not avoided, ducked or glossed over but learning, growth and change is the ambition rather than formal moments. As well as seeking learning and removing the ‘disciplinary’ element the moment may still have an enduring effect on relationships and trust – ending the pattern may only be part of the process and healing relationships may also be required.

Definite Pattern Exists – a formal or ‘authority intervention’ is now required. Clarity on the process is essential by all involved and skilled colleagues are helpful in facilitating what can be extremely challenging moments. Here there are clear and tangible outcomes in which the issue is identified, documented and with a shared understanding of what is taking place. An action plan is agreed with outcomes/outputs than can be measured or assessed. We may have training / coaching at this moment but our mindset remains in being helpful and supportive. People should also be made aware of future consequences but other interventions may be required that help with knowledge, understanding and behavioural change. All is not lost, people can change – believe that because ‘on balance the majority of people in the organisation are good’.

Behaviour Persists – you have chosen the path in which you started with the notion that on balance the majority of people in the organisation are good’ but you cannot avoid what is now starring you in the face. Some people are not aligned to where you are, what is expected from the organisation and continue to behave is ways deemed ‘unprofessional’ but may be defined by other terminology as well. At this moment there is a failure to change in line with the previous action plan and we are moving towards formal and disciplinary processes. While this may indicate you have uncovered a rare ‘not good’ person in the organisation and you should take actions required that might not be all there is. You started with ‘on balance the majority of people in the organisation are good’ it may be that this good person needs a different organisation, environment and opportunity.

This is my practical working of a model that is appearing more and more. On the whole it fits with how it is being described, supported and recommended and also aligns with policy and respectful practice. It is hard to undertake because the leap from first unprofessional moment to ‘deploy consequences now’ is felt strongly and swiftly actioned. Hold that emotional moment in check and think your way to a better process. The vital element of this model is the understanding of patterns and awareness with graded interventions.

My ambition for this area of work is compassion and transparency. We find it easy, and perhaps satisfying, to go from single act of unwarranted behaviour to formal consequences – we want people punished. That approach places more people in that top area of the pyramid when there is, in reality, few. With so many there we now can’t see or tackle the few people and truly distressing moments. Poor behaviour by those who should have that behaviour formally addressed hides if we jump from the bottom to the top of the pyramid in one unconsidered leap.

This model follows what many other models and policies recommend and it can be the one model to rule them all in terms of improving organisational behaviours and cultures but we do need to develop the leadership ability to recognise its usefulness and to utilise it in uncomfortable moments.

‘on balance the majority of people in the organisation are good’

How do you think about the people of the organisation ?

What process – formal or informal – do you use when ‘moments’ occur?

Do you know how to facilitate discussions that offer feedback that is non labelling but helpful?

Can you manage your emotions when repeated patterns of challenging behaviour emerge?

Do you feel confident to take people / teams through the stages of the model?

Notice and be Curious

 Pick of the Week - Vanderbilt Model

This model for professionalism is not new but it seems to be appearing more - civility, justice, inclusion - could just be what I reading but I hope we are moving to such an approach - assumes majority good, does not ignore issues, offers accountability...

https://www.vumc.org/patient-professional-advocacy/promoting-professionalism-pyramid