At the heart of the services achieving the Care Quality Commission’s (CQC’s) Good and Outstanding ratings are values that encourage creativity, innovation and continual improvement.
Care leaders know this and develop strategies to deliver high-quality, person-centred, and relationship-centred care. However, all too often this is undermined by an established culture that is still too task-focused, too risk-averse, too focused on pieces of paper rather than people.
We are all familiar with Peter Drucker’s saying, ‘Culture eats strategy for breakfast’. But changing the culture of an organisation is easier said than done. If you want to shift your culture so that the people in your organisation are open to change and able to continually improve, best practice suggests two key areas to focus on: developing the climate people work in, and developing yourself and the leaders around you.
Addressing the climate
There is a well-established link between the climate of an organisation (i.e. the observable habits that characterise life in an organisation, or a ‘snapshot’ of its culture, if you will) and the quality of services, wellbeing of employees, and the organisation’s overall success. If you focus on improving climate every day, over time improved habits become ‘the way we do things round here’ – your new culture.
Whilst culture is hard to alter, climate on the other hand is changeable, more easily observable, and more responsive to improvement efforts.
It has been suggested that, even when successful, cultural interventions can take nine years or more to implement and embed, while climate improvements can be implemented and measured within seconds. For example, we worked with a service manager who leads a heads of department meeting every day, where every individual sat in the same spot and followed the same agenda. The mood of the room was congenial and pleasant. Conflict was low, but so too was challenge and involvement. As one individual admitted, ‘I come fourth, just after activities, so I usually fall asleep until I hear the word “activities”.’ The leader was coached to shift climate, and one morning walked into the meeting room, asked everyone to shift three seats to the left and then began the regular agenda in a random order. The climate in the room shifted immediately: people energised, suggesting ideas, volunteering for action. By intentionally addressing the climate, the leader increased the group’s ability to improve.
Factors such as trust, openness, debate, playfulness and humour are vital to raise awareness and prompt reflection and action. You can use established measurement tools or you can use informal approaches through conversation.
A critical step for the leader when working on climate is to increase trust between people in the organisation. To do this, you need to first show trust and be open to feedback. If a manager takes a high-trust approach, concerns can be seen as a catalyst for continual improvement and held up as an example for further learning about the service. For example, one care home we worked with introduced an anonymous box for concerns and suggestions which anyone could post in to. These were pulled out and discussed at regular staff meetings, with a focus on how to create solutions. This process has the multiple benefits of increasing safety through anonymity, building trust by seeing concerns addressed, and increasing debate, which in turn reinforces a learning culture.
If you want more playfulness and humour (and it’s a key factor in reducing stress, building teamwork, and increasing creativity), you need to model the way. We often support leaders to use games as a significant tool in managers’ and head of department meetings, as well as handovers. As one Chief Executive we work with said, ‘I used to think games were for children, I now realise that they are a key ingredient for success in care.’
A climate which supports debate is a climate open to continual improvement. Increase formal and informal interactions between staff, particularly management and employees. Approaches such as eating lunch together make management more visible by attending events in your service. Close the office door (with you on the outside) and spend time ‘on the floor’ as a role-model and teacher.
Just as it is necessary to be intentional about developing the climate that people work in to prompt lasting and continual improvement, it is also necessary to be intentional about developing yourself and the leaders around you. Look outwards and inwards for opportunities to grow.
Exemplary leaders look to their teams, enabling others to find solutions to the collective challenges faced by all, and create the conditions for others to take the lead. Part of this is recognising failure as an opportunity to learn. You can encourage positive risk-taking by drawing out the learning rather than attaching blame. This is often a significant personal learning step for managers.
Looking at yourself as a leader, as a rule of thumb, self-awareness and interpersonal competencies (otherwise known as emotional intelligence or EQ) account for 80% of the factors that will determine your success as a leader, whereas technical or hard skills (IQ) contribute 20%. The more you can develop self-awareness, self-management, social awareness and relationship management, the more effective you will be as a leader.
It can also be useful to look at the many factors that influence performance and isolate a single factor to help you understand it better, even though they all work together in real-life situations. One factor we focus on with care leaders is style – how you prefer to perceive, react to, and deal with the world. This is particularly important while leading and problem-solving, which is at the heart of a culture of continual improvement. Your style influences how you work individually, as a team, and how you will approach the rest of your organisation.
One example of style that we see regularly is for a ‘people preference’. When making decisions, managers’ problem-solving style is often to consider first the effect a choice will have on people – on people’s feelings and the need to support harmony and positive relationships. When ‘people preference’ individuals who have come from a care worker background move into the service management role, they find themselves asked to make decisions based on the successful completion of tasks. In the interests of standards and quality issues, it’s necessary to look first at choices and decisions that are logical and can be justified objectively, using impersonal, rather than personal, judgments.
Of course, being able to address outcomes for the benefit of both people and task is possible, but when it comes to preference of style, when ‘people’ managers are asked to prioritise ‘task’ in their decision making, they can struggle, particularly if they aren’t aware of this preference. This results in managers spending a lot of their time out of alignment with their preferences – what psychologists call ‘coping’. ‘Coping’ takes energy and can reduce motivation. Leaders might want to reflect on the way their resource is used and find ways to enable managers to operate in line with their preferences.
One practical approach is for service managers with a ‘people preference’ style to spend 8.00am to 10.00am helping with breakfast, ensuring the start of the day is focused on people. As well as having a personal benefit (playing to a leader’s strengths), this also develops a climate which is more conducive to improvement, because the staff are talking over breakfast, gaining insight into their customers, discussing ideas, and building trust. Another approach is to have separate roles for general managers and clinical managers. Going even further, another solution could be to have a clinical manager, who is heavily task-focused, and a wellbeing manager, whose explicit role would be to focus on people.
‘Coping’ can also be reduced by learning. When managers have learnt to appreciate the different preferences, and therefore strengths, of their colleagues, they report significantly reduced stress, and value their colleagues more. This is particularly true when they have also invested in values-awareness and appreciate the similarity of their underlying values, even though their approaches are different. This suggests a significant benefit in leaders learning about interpersonal dynamics, and enabling their teams to do the same, to deliver increased productivity and continual improvement.
Develop yourself, the leaders around you, and your organisation’s climate and, to paraphrase Peter Drucker, your culture will serve you your strategic vision for lunch.
What do you do to change the climate in your service? What’s your approach to developing yourself and your staff? Let us know by commenting below where you can also leave feedback on this article.