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This blog is a copy of an article written for GP Online. The full copy can be found here
Are there times when the concept of professionalism can be dangerous? I think that unexamined approaches to professionalism can be harmful to ourselves and to our patients. We need to be looking at professionalism in context, and questioning whether the system we work in supports professionalism, or militates against it.
I clearly remember my sense of desperation when a practice manager reminded me that I’m a professional as I saw yet more home visits being added to the end of my already overloaded list, without me having any say in the matter. Professionalism can mean going the extra mile for patient care. But that concept of professionalism is only sustainable when there is some slack in the system, so that whilst at times you expend more, at other times you recuperate. With every minute in General Practice counting in an endless stream of intense activity, it can seem that our sense of professional duty is being systematically strained to breaking point.
I’m in good company. Last year the RCGP published ‘Patient safety implications of general practice workload’1, and questioned whether professionalism really means that we keep meeting the ever-increasing workload. Can we truly be empathic and clear-minded, delivering safe, high quality care when we are frazzled, with a rumbling stomach, and a full bladder?
A definition of professionalism from the Royal College of Physicians places trust at the centre of professionalism:
“Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.” RCP, 20052
Patients should be able to trust they are in good hands, and that they will receive the very best care we can offer them. The RCP report describes how contemporary concepts of professionalism place more emphasis on the collective systems and cultures we co-create through leadership, team-work, education, appraisal and research. The practice of medicine is situated within a complex organisation, with financial and political pressures bearing down upon it. There are discrepancies in the apportioning of accountability for good healthcare, so that it remains easier to place the blame for poor care at the feet of an individual practitioner than it is to hold the entire structure of healthcare to account. All people shaping the healthcare system – from politicians, ministers, managers, commissioners to the public who use the service – need to embody a reciprocal duty to create the conditions in which healthcare professionals can best discharge their professional duties. There is an ethical duty to provide a context which does not damage the people working in it, but enables them to do their work well.
NHS England is renewing effort to create contexts in which we can work effectively, compassionately and professionally. Hopefully we can start building smarter, more sustainable work patterns. This will require us to further develop teams and alliances across different organisations. Collaborating effectively across the wider system in which we work will form an increasing component of our professional practice.
For our own well-being, we need to be mindful of the changing contexts in which we work, reflecting on whether our concept of professionalism needs adjusting to our current setting. Gone are the days of paternalistic, heroic professionalism in which the doctor could be relied on to respond to all woes day and night. Nowadays, the foundation stone of our professionalism is to ensure we are in a good state of mind and health ourselves, so that we are best able to engage fully with the patient before us, to communicate effectively, to make good decisions and to work well with colleagues. Professionalism can - at times - mean saying ‘no’ to more work when we are simply not up to it. It can also mean placing more emphasis on prevention, and on empowering patients to find their own resourcefulness in looking after their health.
© Contextualyse Ltd. 2016
1. RCGP (2015) Patient safety implications of general practice workload. London: Royal College of General Practitioners.
2. RCP (2005) Doctors in Society: Medical Professionalism in a Changing World. London: Royal College of Physicians
My latest article for GP online focuses on the inspiring learning from a coaching course I attended last week. The coaching perspective is that if we focus on what we want to achieve, and flesh out the image and describe it clearly with specific language, we are more likely to get there.
For example, if we focus on 'losing weight' we are focusing on a negative. Instead, we may boost our effectiveness by aiming for a desired end-point that we begin to imagine: to be slimmer, or weight 9 and a half stone, or feel more energetic.
Good luck with creating positive health-related outcomes, and moving towards them!
We hope to encourage and inspire you to find ways of improving the wellbeing of you and your team. Addressing issues upstream gives us a chance to prevent burnout, illness, and impaired productivity.
Drawing on an eclectic range of resources, including our clinical experience, psychological insights and our understanding of organisations, we want to help you find the wiggle room that will help you move from surviving towards thriving. By wiggle-room, we mean that space in which we have choice, and we can try things that may serve us a little better than our current status quo.
Wellbeing in the workplace is frequently couched in terms of the individual's ability to cope. Whilst some of the wiggle-room may well be at individual level, a lot of the possibility for improving wellbeing lies in the work culture, including management and leadership practices, and styles of communication.
Our workplace contexts are bigger than any one of us, and may challenge us to find different ways of understanding our agency. We co-create cultures, and so can each learn to be leaders who inspire, and role-model wellbeing at work.
We explore not only what an individual can do to enhance their own wellbeing, and how they may influence their team, but also think about organisational processes and culture.
The time is ripe to improve wellbeing at work. It is right up the agenda, with new governmental departments focused on enhancing working lives. And even beyond the work environment alone, policy-makers are now moving beyond framing their success only in terms of GDP, and are looking at far broader indicators of what makes a society a good one to live in and contribute to. Take a look at these wonderful graphical representations of international wellbeing comparisons:
So let's be part of a positive change to improve our wellbeing, that of our team and workplace community!
This is an adaptation of an article in GPonline magazine
“The primary goal…today is to promote opportunities for women and men to obtain decent and productive work, in conditions of freedom, equity, security and human dignity.”
– Juan Somavia, Director-General, International Labour Organisation (1999-2012)(1)
Can work be more than a means to earning a living? And what are the conditions that could turn work into a community of engaged, flourishing individuals, each contributing in their unique way to an endeavour they care about?
Whilst there is compelling evidence that unemployment is bad for health - associated as it is with increased mortality, more health conditions and poorer self-care - ‘bad work’ is actually even worse for physical and mental health than being unemployed.
As we spend on average of a third of our waking hours at work it is a key setting for improving our health and wellbeing. The type of work is important, and this is where the concept of ‘good work’ comes into play. The Work Foundation calls us as employers, employees, policy-makers and citizens, to have a vision for the kind of work we aspire to create (1).
The compelling argument is that good work leads to a win-win situation, benefiting customers, staff and employers (2).
· For the customer, good work delivers high quality goods and services, encouraging a positive perception of the organisation.
· For the employee, good work means meaningful, satisfying work, with opportunities for development and personal impact.
· Good work is related to productivity and efficiency, reducing staff absenteeism, presenteeism and turnover. Hence good work sustainably enhances the bottom line.
The business care for investing in employee wellbeing is impressive. Poor staff health is estimated to cost the UK economy around £100 billion a year (3), and the average cost of absenteeism to the employer is £595 per employee per year (4). The return on investment made on employee wellness programmes is between £2-10 for every £1 spent. And healthy employees are 3 times more productive than those in poor health.
But the argument goes beyond finances. Businesses are heeding the importance of business ethics, transparency and integrity, with greater attention being paid to their duty of care to their employees, and their contribution to society.
The attributes of good work are (1,5):
· Job security.
· Fair reward compared to effort input.
· Ability to influence the organisation.
· Discretion in how one carries out one’s work.
· Variety and interest.
· Opportunities to develop skills.
· Strong, inclusive workplace relationships.
· A healthy work environment.
Creating ‘good work’ requires sustainable cultural change, with careful thought given to communication, leadership and management practices. How does your organisation perform? Are how could you improve the wellbeing of your staff through attention to the work environment?
1. Bevan, S. (2012) Good Work, High Performance and Productivity. The Work Foundation.
2. Public Health England (2016) Work, worklessness and health – improving health and wealth outcomes.
3. (2009) Workplace health: long-term sickness absence and incapacity to work. NICE.
4. (2013) Absence Management. CIPD.
5. Coats, D. & Lekhi, R. (2008) Good work: Job Quality in a Changing Economy. The Work Foundation.
© Contextualyse Ltd. 2016
KEEPING AN ORGANISATION VIBRANT, EVEN IN TIMES OF CHANGE
None of us likes having no choice. The sense of things simply being done to us causes us to resist and resent, which wastes energy and vitality. So, how can organisational change projects harness the energy of creative collaboration? ‘Building and Aligning Energy for Change’ (1) addresses this question.
The energy of our teams and staff is a powerful resource in organisational life, perhaps even more valuable than time. It needs to be directed wisely, not squandered. Energy is harnessed when we align with the internal motivations that people bring to their workplace, co-creating a shared purpose.
Tapping into energy appropriately improves the capacity of a team to achieve its goals. If we think holistically about the energy of our teams: on physical, emotional, mental, social and spiritual levels, we can create a workplace that is full of vitality.
Drawing on internal motivations is far more energy efficient than working to externally dictated targets, rules and regulations. So bureaucratic approaches to work should be kept to the bare essentials.
Force Field Analysis
Kurt Lewin, writing in the 1940s, described his concept of a force field, in which the driving forces were those moving towards a particular change, and the resisting forces were those preventing the change.
In conversations with teams about planned change, taking note of the resistances we encounter gives us important data. What we learn might cause us to redesign aspects of the change initiative, as well as to discover how we might ease a transition.
What Kurt Lewin discovered was that rather than PUSHING through a change by increasing the driving forces – which would simply increase resistance (and resentment) – change happens more easily by minimising the resisting forces.
Analysing the forces that are for and against a change, helps us decide which is the easiest resisting force to minimise. By listening to our colleagues and teams, we might learn just that, helping us release their energy from resisting to aligning with the change.
1. Building and Aligning Energy for Change (2012) York Health Economics Consortium and Landmark Consulting.
© Contextualyse Ltd. 2016
HOW TO BUILD ORGANISATIONAL RESILIENCE
Understanding how to foster resilience in ourselves and our organisations is a key antidote to burnout, sickness leave and team dysfunction. Resilience is linked with an engage-approach mentality, in which our creativity and resources are fully alive.
What is resilience?
A common definition of resilience is that it is the ability to ‘bounce back’ from strain. In my view this definition is too tightly linked to the engineering origins of the word resilience. For humans we need a more organic, dynamic way of viewing resilience; one that pays attention to our psychological and social context. Resilience is about bouncing forwards; recovering and learning from difficulties to remain engaged and curious in life.
What are the features of a resilient organisation?
A resilient organisation will make systematic, proactive efforts to develop connected leadership, and to foster effective working relationships. A resilient organisation benefits from the collective knowledge and skills of its staff, because communication is open and flowing. This furthers engagement of staff who feel valued, and collaboratively able to shape the endeavour.
Accepting and adapting to complexity and uncertainty are significant aspects of resilience. There needs to be some ‘give’ in the system, and an avoidance of over-specification. On an organisational level the question is always how to create enough structure while allowing for flexibility.
By providing what staff need in the way of support, time and places to rest, eat, connect and process their work experiences the organisation lays in a store of energy and commitment it may need to draw on when the going gets tough.
How can an organisation improve its resilience?
Resilience is a dynamic process rooted in good connections with others, and with our values. It relies upon our ability to respond well to each unfolding moment, a skill that can be enhanced through mindfulness, acceptance and commitment training, and creating spaces for dialogue.
Contextualyse can help develop resilience through its work with organisations and individuals. Contact us if you would like to discuss how we might work with you.
©Contextualyse Ltd. 2016