The Tavistock socio-technical systems tradition demonstrates that an imbalance in effort on tasks at the expense of relationships - or vice versa - can come at a high cost of productivity, staff morale or both. Here we spotlight one of our assignments for NHS Directors, which demonstrates how we are working at the heart of current challenges in the UK’s integrated care system.
The context
Health and care staff in the UK are under unprecedented pressure, with long waiting lists and staff shortages, and lengthy, intense working hours. Strong, productive relationships, often across organisational boundaries, are critical to tackle complex problems and implement change processes. But we find that staff often feel that focusing on relationships with colleagues is at the expense of ‘doing the work’ and relations between individuals and teams often deteriorate as a result.
The brief
We co-designed a systems and relational leadership development programme with a local systems leader from the NHS Leadership Academy, an intervention which lasted for six months with initial individual discussions, a ‘working note’ and regular group meetings across the period.
In the context of ever-increasing delays in the discharge of patients from hospitals back into the community, the programme focused on improving relationships between operational leads from three organisations jointly working on improvements to this pathway and helping them to work on responses to challenges as a system.
Key issues
On arrival, relationships were at best tense, or individualised, and staff focused on ‘their’ patients, rather than working together across the boundaries of their organisations (hospital, community therapies and social care support). We also included their leadership teams in aspects of the programme. Together, we worked on developing relationships whilst also honing specific aspects of the pathway.
Outcomes
What was different – and successful – is that we encouraged the group of participants to shape the content of the programme via their contributions, providing spaces to understand each other and the demands on different parts of the services involved. As Tavistock consultants, we provided a space for challenge and an opportunity to address conflict as it occurred in a non-threatening way.
A Tavistock Institute colleague undertook an evaluation which found that participants valued the different approach. Relationships became stronger and more honest, and participants were more able to practice constructive engagement with each other. They experienced the system at work in the room: how individual actions impacted on each other, working through the barriers of professional languages, and developing a better understanding of roles.
Whilst leaders participating in the programme were unanimous in their conviction that the relationship improvements were going to endure, there was also a sense in the system that sustaining results was likely to require ongoing nurturing, a challenge for their respective leaders as a group, and to other enlightened commissioners in the integrated care system.
