Wellbeing and performance in the NHS –an outcome of a Positive Work Culture

Derek Mowbray

derek.mowbray@orghealth.co.uk

Health and wellbeing – where to start

Nutrition

Genetics

Behaviour

Influences on health and wellbeing

After Thomas McKeown in:The Role of Medicine:

Dream, mirage or nemesisNPHT. 1976

The ‘big idea’

People who feel well perform better than people who feel ill

Wellbeingfeeling wellbeing well and feeling wellbeing ill but feeling wellbeing alertconcentratingmotivatedengagedhaving energy

Performanceclear aimsappropriate aimsclear timetableefficacious actionno deviationeffective actionno repetitionefficient actionsno hesitation

Wellbeing and Performance

Just a Minute Performance Model

Work improves our health and wellbeing

Working days a year

Holidays

Weekends

WorkWork

Psychological distress

Defining psychological distress

Pressure – Strain - Stress

Stimulant (pressure)

Diversion (strain)

Impairment (stress)

The impact of stress at work

Individualmisery

The Law and

Tribunals

Insurance premiums

Sickness absence,

staff

turnover.

HSE Management

Standards

5

10

15

20

25

30

0-5 6-10 11-15 16-20 21-25 26-30 Over 35

Numberof

companies

Percentage of all staff turnover pa

7

14

31

22

11

4

8

Turnover of staff 2006, 2007 and 2008

‘Top 100 Companies to Work For’Source: Sunday Times March 2007, 2008 and 2009

5

13

40

14

17

1

7

2006

2007

31-35

2

6

2008

42

9

11

23

30

15

Organisations are controlled communities

It is the manner in which they are controlled that is important.

Costs of the ‘Iceberg Effect’ as a percentage of total costs of psychological distress at work

sickness absence

staff turnover

reduced productivity at work

58%‘Iceberg effect’

32%

10%

High personal wellbeingGood business performance

Average personal wellbeingPoor business performance

Poor personal wellbeingAverage business performance

Poor personal wellbeingPoor business performance

Characteristics:Clear purposeCommitment, Trust, EngagementEffective recruitment practicesGood terms and conditionsTeam working; staff involvementAdaptive leadership and managementCustomer and staff focusLow sickness absenceLow staff turnoverLow costs/high profits

Characteristics:Ambiguous purposePoor recruitment practicesAverage terms and conditionsMismatched skills to jobsLaissez-faire management practicesFew company wellbeing programmesAverage company benefitsAverage sickness absenceHigh staff turnoverHigh costs/ low profits

Characteristics:Clear purposeAverage terms and conditionsLimited alternative employmentTransactional managementIncentive and bonus schemesHigh levels of sickness absenceHigh number of tribunalsLimited wellbeing programmesAverage staff turnoverVery high costs/Minimal profits

Characteristics:Ambiguous purposePoor terms and conditionsLack of Commitment, Trust, EngagementCoercive, competitive and bullying cultureHigh level of presenteeismHigh numbers of tribunalsHigh levels of sickness absenceHigh staff turnoverHigh costs/Low profits

Tackling the problem of psychological distress at work

Prevention

Prevent

deterioration

RestorationPalliation

Next

Generation

Strategic framework

A Positive Work Culturebased on wellbeing and performance

Culture

Self

Support services

To promote a Positive Work Culture based on wellbeing and performance

To manage threats to wellbeing and performance

To prevent personal deterioration in wellbeing and performance

To restore people back to their normal level of independent life and beyond

To support people with chronic psychological distress

To prevent psychological distressin support workers/carers

Prevention

Prevent deterioration

Restoration

Palliation

Next generation

Strategic framework Focus Purpose

© Derek Mowbray 2009

Wellbeing and Performancestrategy

Culture

Derek Mowbray 2009

•a clear, unambiguous purpose, expressed as a simple ‘big idea’, an idea which all the staff relate to closely, and are proud to discuss with friends and colleagues.

•an atmosphere of confidence, where all the staff are interested in each other, supporteach other, and project this confidence towards clients and customers.

•staff who behave respectfully towards each other, value each other’s views and opinions, work in teams which are places of mutual support, where anything is debated without a hint of humiliation, where the critique of individual and team work is welcomed, discussed and where lessons are learnt and implemented.

•staff who ‘go the extra mile’ by providing unsolicited ideas, thoughts, stimulus to each other, and where their interest in their customers offers something more than is expected, beyond courtesy, and beyond service, offering attentiveness and personal interest.

•challenges for their staff, that provide opportunities for personal development through new experiences, and which treat everyone with fairness and understanding.

•staff who are personally driven towards organisation and personal success - intellectually, financially, socially and emotionally.

Characteristics of a Positive Work Culture

We all act

We are all actors

We act according to context

We are influenced by the cultural foundations

We act in ways expected of us (stereotypes)

We behave according to the meaning we place on specific situations

Trust, commitment and engagement

Building trust and commitment leads to engagement

Organisation purpose

Organisationarchitecture

Organisation‘rules’

Organisation‘how to play the game’

Organisationdevelopment

Organisation Development

Derek Mowbray 1994

The ‘Big idea’

Purpose

Architecture

Rules of the game

How to playthe game

Structure

JobRecruitmentPayChallenge Secure

Teamwork InvolvementOpennessCommunication

Work life balanceResponsiveness

Training and development

Career opportunity

Management encouragement Leadership abilityPerformance appraisal

Manager – employeerelationshipEmployee attitudeManager discretionEmployee discretionAttentiveness

Factors that influence trust and commitment

CitizenshipBehaviourProceduresPolicies

Personal attributes andbehaviours

PeopleLeaders

Managers

Personal attributes

AttentivenessTrustworthiness

Demonstrate wisdomAssertive

Intelligence with humourPassion

Direction with committed ambition

Address individual needsNurture

Behaviours

AttentivenessPolitenessCourtesy

Personal communicationBody language

Addressing needsEmpathetic

Intellectual flexibilityEmotional intelligence

NegotiationSharing

ReliabilityHonesty

ClarityFairnessHumility

Conflict resolutionEncourage contribution

EngagementCommitment

TrustResilienceTolerance

Attentiveness

Intellectual flexibility

Reliability Resolve conflicts

Encouragement

Behaviours that inspirecommitment, trust and engagement

In others

Return on Investment

Costs

Performance

Engagement

Inspiration and Innovation

Trust

Commitment

Further information

Draft Code of Conduct for Healthcare Management – www.ihm.org.uk

Brief guide to a Positive Work Culture – www.orghealth.co.uk

White papers on: The Wellbeing and Performance AgendaPrevention of stress at workA Positive Work Culture – http://webcommunities.hse.gov.uk/