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Working patterns in the NHS during Covid

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In this podcast episode, Liz Maddocks Brown offers us a fascinating insight into working patterns within the NHS during Covid.
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This is the first in a series of 3 interviews with managers over mindfully moving towards new patterns of working

In this episode, Director Sarah Fraser chats with Liz Maddocks Brown, a Senior programme Manager for the NHS who offers us a fascinating insight into working patterns within the NHS during Covid. And what they might look like going forward.

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Suria Lonsdale 0:00
Hello, and welcome to the Mayvin podcast. Over the last few months, we've been exploring with the Mayvin community how we can mindfully move towards new patterns of working. As we adapt towards a post pandemic world, organisations and individuals are attempting to make sense of the emerging context and take decisions on how to design their future working practices. Mayvin is facilitating an inquiry with our community to understand how those involved in or influencing the design decisions can support the development of the most beneficial new working patterns. Over the summer, we've had conversations with three colleagues from the Mayvin community to find out more about what is happening in their world right now. In the first podcast, we hear from Liz Maddocks-Brown, talking to Mayvin, Director Sarah Fraser, who offers us a fascinating insight into working with the NHS during COVID. This considers how the balance of power may have shifted between the leader and the individual, but that this works, where there is trust, and where intrinsic motivation can flourish. Let's hand over to Sarah and Liz now to here more. We hope you enjoy listening.

Sarah Fraser 1:17
Liz tell us a bit about your role, your work, working contexts, and then talk about the working patterns.

Liz Maddocks-Brown 1:25
Okay, well lovely, and great to be able to have the conversation with you. So my role. I work for NHS England, NHS Improvement, which are two facets of the health and care system that have recently merged in the last 18 months. And what's interesting about that relationship is that NHS England was predominantly a commissioning organisation. And NHS improvement had a role to assure standards of performance and quality, a role, not the ultimate role, because there are the monitoring bodies that kind of wrap their arms around that. And I work within the improvement directorate under the leadership of Hugh McCaughey, who is the director. And I've been working in improvement now since 2007, when I started to work at the NHS Institute for Innovation and Improvement. But prior to that, my background is in OD learning, training and development. So I'm very interested in the people aspects, the human aspects of organisation, the dynamics, the psychology, and the well being of organisations and individuals and work within it. So my role currently, I work partly well significantly in it in a team called NHS Horizons, which is a fabulous team and led by Helen Bevan and Kathryn Perera. And their ambition is to really help the NHS think of new ways of tackling wicked problems, and particularly brokering relationships across the system to make impactful change and transformation happen and stick. The other, the other side of the team is one, which focuses more on the science and delivery of improvement methodology. So you've got kind of two ends, not two ends, but two very complementary facets of improvement, the innovation, the relationship, the stakeholder engagement and management, and brokerage across the system for change and improvement, and then a team that looks more at improvement methodology science and how that is applied to some of the challenges within the health care system.

Sarah Fraser 4:17
And it sounds like there's the theory of change is around the brokering of relationships across across the NHS to enable us to enable change to enable innovation, right is that

Liz Maddocks-Brown 4:31
I think that's, that is a key part of it. So relationships are particularly are a major consideration of the Horizons team and a passion and then helping people by using facilitation approaches and techniques and design to think differently creatively and innovatively and allowing people to go into the spaces to almost to think the unthinkable and from that create breakthrough solutions to intractable problems. So that I think is the real art of the Horizons team. And the nature of the team enables that to happen. So, so that's a really energising team to be part of.

Sarah Fraser 5:24
Yeah, it sounds, yes, I can imagine quite exciting. And and what roles do you play within that, at the moment, within the Horizons team, probably variable, that there are several changes.

Liz Maddocks-Brown 5:40
Yeah, my main role is to help develop and manage a network of improvement directors. So we are we have established over the last 18 months, a growing network of, it's called the Improvement Directors Network strangely. But a growing network of the most senior lead in organisations, who have a remit and a passion and a desire to really drive forward improvement, as the way in which an organisation considers and delivers its business. So through an improvement methodology, or mindset, approach and lens. So that's my major piece of work with horizons. And because of my background in OD training, learning and development, I'm a very willing, willing, willing pair of hands for other events that the team are leading forward. So they do some great work with the people Directorate. And during the COVID crisis did some really great work with healthcare systems that were just trying to keep their head above water. So it felt very purposeful, and, and worthwhile. And also bringing in new systems like video consultation. So really at the edge of, you know, some of the, the chaos and the new practice and approaches that, that the NHS was grappling with, at a time when they were also absolutely immersed in operational delivery, still helping people to think about how do we keep our heads, heads up, brains and gear about how we do different and new things whilst dealing with a very, very poorly people?

Sarah Fraser 7:38
A crisis. Yeah. Lots of different ways. Okay, but just tell me, so how is the last year been for you?

Liz Maddocks-Brown 7:50
For me, personally, yeah, no, I've thoroughly, not withstanding the pain and suffering that's been going on around Covid. In terms of my work, I've really enjoyed the last 18 months. And you know, when you look back over your career, when one looks back over their career, there are different episodes, which you think we're flipping awful, and periods and phases that you think have been great, and you've really learned and you've, it's the difference between surviving and thriving. So I would say that the last 18 months has been a thriving year personally, from a professional perspective, because there's a stimulus and the opportunity to get involved in things that I felt have really mattered and can make a difference. And to work with a team as well that are different to the you know, that work beyond the boundaries and the hierarchy. Work in a different way. In other teams, I could tell you what, I could I could make a guess at what banding people are, in this team, I can tell you, because it would seem to me that if you have a talent and enthusiasm, some energy to do something. You are an equal player. So it's been a really

Sarah Fraser 9:13
The permission is there.

Liz Maddocks-Brown 9:15
Yeah, yeah. It's been an energising experience for me.

Sarah Fraser 9:22
So then I'm going to, I'm curious there, how has how has, how have you and that team worked together, even if we talk more broadly, at some point about you, you're influencing other parts of the system? How has your system worked and what are your patterns of working and yeah, tell me about that?

Liz Maddocks-Brown 9:42
Yeah, so it's, so it's the team, I would say is, is very what's the word is it I would say if you were looking from the outside in it's very agile, it's very responsive. And, and as a result of that, the energy and the emotions can fluctuate. So it's, it's, it's a bit like the. Be a bit overdramatic to say it's like the fire brigade that turns up at the fire, you know is a bit overdramatic, but in a parallel, the team are ready, often mobilised at short notice to tackle or to engage in supporting system challenges that have been emerging. So what does the team do? Well, one of its strengths as it went into this was that it was very technically enabled. So technology was not new. And technology was the way that the team had had, and does/ did deliver a lot of it's, a lot of its office work. So that that was good. And as a result of that the team had been able to connect well, using technology. So they are used to interacting, they're used to having quality conversations. And the team pays a lot of attention to its well being. So every week, we have a well being survey. And we have huddles, a weekly huddle, where we discuss the results of that we have team times where we come together and explore what's going on, we have a model called trust partners, where a number of us in the team are available for anybody to pick up the phone at any time and have a conversation. So, so there are lots of things that the team does to attend to its people, and its health and well being. Yeah, it's not all perfect, and people get tired, people get a bit burnt out, people get a bit grumpy. Because, because of the pace and the nature of the work. And what I've seen over the last year, particularly, is a greater openness emerging around these things. And for example, recently, we had a bit of a jumbled session, and something popped up on it called toxic positivity. So yeah, we started to explore that as a team. And and we're still exploring it. So things emerge, then, then they're taken seriously. We still got a long way to go to really fathom that one and other things. But, but, but there is a there is a commitment, I think a good intent to, if things are flagged as an issue to unpack them and explore them.

Sarah Fraser 13:09
Toxic positivity? Yes, I like. I like that. As in, it's, I've seen it I work a lot in the not for profit sector, including in the past quite a few health related charities. And yes, toxic positivity means something to me in that context anyway, maybe, maybe nuances. But yes, how do you go against it? If you're not, you're not in that mode or zone. So what what you've said about the team is a sense that the there isn't a very sort of clear hierarchy as an it's not felt in the relationships in the way that you work. But you mentioned before we, we started on the call that that something that stuck with you from the previous Mayvin session was around the role of leaders and their responsibility in managing people in new working patterns. So I don't know if it's helpful to sort of reflect on how maybe new working patterns, if you want to talk more broadly, but I'm really interested to explore that. What you're what you're seeing and you're in the wider system as well, that you're working to.

Liz Maddocks-Brown 14:31
So I think in the NHS there's a theory, McGregor's motivational theory Theory X Theory Y. And I can't exactly remember which way the X and the Y work but I know that one extreme is that all people are good. They get out of bed every morning to do a good job they can be trusted, and as a result, they need to be nurtured and light touch managed. And then you've got the opposite theory Y. And I think over time, because of the NHS open, public responsibility, open book policy, accountability that needs to be very transparent at all times, we've become the I think that, (this is Liz Maddox-Browns view of the world) people can't be trusted, people don't always come to work to do the best they can do. Ergo, we need to create lots of policies, we need to create lots of rules. And we need to make sure that people adhere to those rules without exception. So that we can be absolutely assured that we are making best use of all public money. And I think this is where it comes from. So I can get it, I don't think there's been a tyrant somewhere that's, that's egotistical. But I think, you know, because of the nature of the work that we do, and our level of public accountability, it's become a kind of, and because they have people have made some errors, and done some things that haven't landed, the approach to that has been more rules, more policy, more procedure. So so what I've seen during the pandemic is a relaxing of that. Because people, where people have said in the past, you know, I really like to work from home, can I have more flexible hours? No, your jobs, nine to five, you come into the office, and you sit at that desk, whether you've got something to do or not. So now, and meetings, you know, you must attend in person. So there's been a big a big, a big flick, I think of that switch to necessarily, for people to be given greater, to be trusted, have greater autonomy and to be empowered to do their own things we've seen in loads of industries, so not unique. So I think that for me has been the big is the bit that I'm most curious about going back into a world of normality. Although working for NHS England, we are now still not. We know that the mandate at the moment is that no face to face meetings until at least the New Year, no return to offices. So there's no need for people to travel. No need for people to group, no people need for people to be getting together and travelling. So.

Sarah Fraser 17:43
So, yeah, with people.

Liz Maddocks-Brown 17:46
I think people welcome that actually. The majority of people welcome it, there will be some folks that miss the camaraderie and for certain reasons may be able to flex that for, you know, personal health and well being issues. So yeah, and is receptive to that. I don't I don't know where that's happening. But I'm sure people will be taken care of if that's if that's something that they need. So. So yeah, I'm curious as to where you know, where that pendulum swing where we'll get back to

Sarah Fraser 18:28
Do you have a theory for NHS England, of where, where it might fit? And what that might? Because it's what what you're sort of suggesting is like, it's, it's what that might mean, in terms of a leader, a manager's role as well, you know, how much? Yes? How much command and control, do they use without being extreme? And how much can they maintain the level of personal responsibility? You know, with trust having built up, like, what's in the bank? Almost,

Liz Maddocks-Brown 19:10
I think it may, I think we'll end up with a hybrid approach. And I think people will be comfortable with that. And I think that's probably true of many industries and businesses. And there'll be lots of drivers for that as well. You know, we've got a big net zero target to, to consider. So, you know, not having people in huge monolithic buildings and having causing them to travel. You know, and all of the net zero savings that that will generate, I think will be a driver. I think the you know, the the balancing the books will be another big driver, obviously in healthcare, so not having to pay travel expenses. Yes. And a whole range of costs associated with people travelling round will be another driver. And I think also, people now have a stronger voice. So I'm really quite surprised at some of the people that were saying at the outset of the pandemic, oh I'm really going to struggle to work from home and now saying, oh I really don't know that I want to go back into an office, thank you. I've got it. I've got everything I need here. I'm doing well, I'm delivering on my deliverables. So I'm actually enjoying life. And I feel I've got a better work life balance. So I think the workforce has a much stronger voice and is being listened to around this as well. So I think it'll be more of a hybrid model. And we'll just we'll just have to see. And certainly in the work that I'm involved in, which was, which also features running large scale events, and bringing groups of people together to have quality conversations and spend days together, you know, we've demonstrated we can do that now. Virtually. Right. Yeah. And do it and do it pretty well. So you know, it's always good to have them to mix it up a bit. But I think I think it will be, it will be a different, the new different rather than back to normal? You know what I mean?

Sarah Fraser 21:20
Yeah, I do. And that really ties with with some other conversations I've been having. And and some of the articles I've been reading, you know, that a new normal has got to emerge, there isn't going to be a going back, but what's the getting clear on what's the purpose of coming together? What's the benefit to that group of people, what's the benefit to, to the organisation. But even in your role, because obviously, it's part that's similar to my world, I'm used to normally facilitating teams, facilitating groups, large group events. And previously, you know, my mantra, it's always better to be in person, you know, there is the opportunity for connection in a different way, people are more aware of how each other are sensitive to each other, you have more difficult conversations. So I'm really, really interested, you know, how are you going into sort of the rest of the year into next year, thinking about what you would be your how you want to work when you're doing when you're facilitating, you know, when when would you push to say, actually, this will be better in person? And when would you say, I don't know, if you have a sense of that yet. Maybe that's a bit too far off, knowing that people are not going to be in the office.

Liz Maddocks-Brown 22:38
It's a really, really good question, Sarah, because I would I now have developed a consciousness around Is this really necessary? is so so previously Yeah, you know, we would have travelled, nationally, that was part of the role or requirement of the role. If we were running a large event, we probably go the night before, so team of us would travel the night before and stay at some cost. We had, you know, we moved into premier inns and travel lodges, that kind of thing. So we, you know, there's been a shift gearing down into accommodation costs, which was absolutely right. And but even so, you have to question and then your your delegates would need to travel possibly stay the night before. So so what what what is it? What would be so important that that kind of ask would be made when we've run some really great and impactful events online using teams and zoom and, and other methods? So I don't really know the answer to that. And it's something that I've said out loud. You know, what, so what would be the criteria? What would make an event so important that it could be run, that it would need to be run in person?

Sarah Fraser 24:07
So what if we explore it this way? What do you think? Is there anything you you feel like you've noticeably lost or a group or the people who have lost from it being online or being virtual?

Liz Maddocks-Brown 24:25
I think so if I use the example of the network's the directors network I mean, there's there's losses and there's gains tha. The loss I think are the opportunistic networking, connecting relationship building.

Sarah Fraser 24:52
In between bits, in between,

Liz Maddocks-Brown 24:54
in between bits that so all of those things where you see someone and you go I've been meaning to, you know, tapping somebody on the shoulder and which then and making that firm commitment to follow something through. Or let's just go for a drink when you finish or when you do fancy go for coffee or whatever. So I think, for me, particularly the work majors on network building, which is a relational building, opportunity, those are the bits that have been more impacted on I wouldn't say totally impacted on but more impacted upon. So I suppose what would make an event, it's a really good way of going into that. Sarah so what would make it an event, if it was more about the serendipitous opportunity to connect with others, the opportunistic networking, that kind of discursive opening up conversation, and I suppose thinking about what's on the agenda for health and care with developing integrated care systems. It's mainly probably that would be most purposeful. So if there was a region, because region's need to be so dependent and interdependent, you know, the different organisational players and agencies in order to deliver great, great care along a pathway that would probably be the most purposeful case for bringing people together

Sarah Fraser 26:30
For bringing. Yes, yes. To allow those urgent conversations to happen and are people to connect without? If yes, is something what it's like to allow people to connect without an agenda? Yeah, it's a question they're trying to answer. Yes. problem they're literally trying to solve, but allow them to connect and see what what comes. Yeah.

Liz Maddocks-Brown 26:55
And that can be done to a certain extent online, and I'm sure somewhere, there is some software or programme or something that I'm still not aware of, but people are developing madly now. I mean, as technology is just accelerated, hasn't it, you know, virtual meeting spaces. So there may be somebody out there that might listen to this and say, Good, God Liz, you're so behind the times, there's a programme or a piece of software or something that can do this. And, and that would be brilliant, wouldn't it to know about that? So that you could then say what actually, does it need to?

Sarah Fraser 27:33
Maybe we'll get someone to respond to this and they'll point us in the right direction? That'd be great. Yes, what kind of action researchers supposed to do? Yes. But yeah, there was there was one article over the Harvard Business Review article I read a couple of days ago, which was, was touching on, yes, what's most efficient, and what's most effective, you know, whether you're meeting face to face, whether it's even hybridised, somewhere in the room somewhere online, you know, make that work, or whether it's virtual, but then the two other things they brought in? Well, one was camaraderie, you know, how important is it for that, and the other being mental health, which I assume is often high on your agenda as well, when you're advising others, other teams.

Liz Maddocks-Brown 28:31
I think mental health is an interesting one. And I think what we've seen during the COVID crisis is a sort of a real acceleration and overwhelm of people suffering with mental health issues. And it would be interesting to try and unpack some of that, because there was a point at which the whole world was locked down. So you were locked down socially. So your social and emotional needs were not being met, your physical not meet needs were not being met. And then your, you know, your work related, so everything was being impacted upon. And for some people, their, their, their environment, circumstances were really dreadful. And so they really, really suffered. So so. So as the world opens up, some people are saying, Actually, my mental health and my work life balance is much better now that I'm working from home. But the other things now I've got my social support, my emotional support, I can go to the gym, I can go for a swim. So all of that world now is better. All of that helps me to balance my mental health or to attend to my mental health needs. But actually work that makes the work situation. Okay. But it's when you've got 100% of things that have been closed down, maybe? And I don't, I don't know, because I know, it's maybe it's 100% of things that are closed down that created a lot of these issues. And we know, we know, for instance, that, you know, holidays and Christmas time, so the biggest cause of separation and conflict in families, aren't they? Because people are cram, people, you know, absolutely put together intensively and that's what we've had. So who knows what the some of the underlying issues have been for, for many people as well.

Sarah Fraser 30:46
So yeah, it's interesting, it makes me think that I think, I wonder, as we, as we maybe have more opportunity to facilitate, and work with teams, you know, even face to face, or as we, as things are opening up more whether we will need to, you know, even in that role of supporting people in organisations, allow space for them, to, to share what the impact has been over the past year, you know, pandemic on on them as a person. Yeah, and how that then has influenced them at work. But without, yes, without feeling safe and not too exposing. But you know, allowing for that, if people knew that would be useful, which is going to require quite a lot of sensitivity and, and trust amongst a team. But that may be important it kind of in making sense of how things have been and how people want to move forward. Because, yes, that's going to drive people's motivations in terms of how they want their working patterns to be going forward. How much they want to work at home, you know, the practicalities around it as well.

Liz Maddocks-Brown 32:04
Yeah. And people have had different, have had experienced something that they didn't know they didn't, it was sort of the unknown unknowns, wasn't it? And so many people I've met, now I meet where you're coming up with. And so what I've decided I'm going to retire, or I'm going to change my career, or we're going to move or so I think you're absolutely right, Sarah and thinking in the round, how have people what have people's discoveries been about themselves? And where has the experience taking them to?

Sarah Fraser 32:45
So many boundaries have been crossed? That actually, yes, that it is potentially changed a lot. But I think from it, you know, think about an employer's perspective in terms of you know, right. Literally, how do we manage people going forward in terms of their working patterns? It's, there's got to be some formalities around that. And it's going to be there's going to be significant personal stuff behind each each person's story. But there's something you said earlier about, you know, the individuals preferences or needs are certainly coming, you know, much more at the surface and have much more power is that the right way of putting it? I'm aware we are we are, we have run, we have run out of time, running out of time, we have run out of time. So, we should come to a conclusion of lots of interesting bits of conversation. Thank you. Good. Well, what do you think? Yes? What are you taking forward? I suppose, I think maybe in your work and your role you take you forward in terms of supporting influencing people as they develop new new patterns, and it sounds like a little bit further into the future into the new year. But what do you think you're taking forward into that?

Liz Maddocks-Brown 34:09
I think for me, I think there is there is real value in people thinking about their lives in the round. And that may be to do with my age and my stage in my career. I do get so I will be taking forward, a sense of balance and perspective. Because that's important for me, going forward. And I think probably greater flexibility and tolerance are things that that I need to be more mindful of and being open to probably what I mean by that is being open to different ways of doing things and people's personal needs in the way that they do deliver their work or the way that they work the way that they engage with other members of the team. So for me, it's it's been a it's been a real lesson in learning to think, being prepared to think differently and let go of some of my own mindsets, and paradigms about how the working world should be based on my own experience and what I now find helpful energising and, and what I've learned from others, so that's my ambition. Yeah.

Sarah Fraser 35:57
Noticing and yeah, responding to others as well. Nice. Thank you. Thanks so much for contributing to the research further.

Suria Lonsdale 36:08
Thank you so much for listening. And thank you once more to Liz for her contribution and insights. Next week, we'll be posting episode number two, where Steve O'Donoghue Director of Corporate Services at the trade remedies authority invites us to explore an imagined approach to developing guiding principles and practices to support staff in developing new working patterns. And finally, don't forget to subscribe to our channel to ensure you catch all future episodes. If you'd like to get involved in our mindfully events. Our next virtual group inquiry is on Friday the 17th of September 2021 from 12pm to 1:30pm. So please get in touch to confirm your attendance. Our contact details are on our website

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