Organisation Development Intervention in an NHS Surgery Pathway
Mayvin was brought in to design and deliver an away day to reset troubled relationships at this NHS Trust. Through a series of diagnostic conversations that created a safe space for everyone’s voice to be heard, we discovered that the issues were more complex than first presented and this highly successful clinical pathway was overworked to breaking point.
The Organisation Development work of helping the system was achieved as much through the diagnostic phase as by the away day itself.
By helping to foster open, authentic conversations we enabled people to build trust in each other and an understanding of other people’s perspectives and experiences. This resulted in greater cohesion in the team, improved communication, team-working and collective problem-solving.
Mayvin was asked to help design and deliver an away day for an NHS Hospital Foundation Trust. There was a fraught history of disciplinary cases, grievances, counter-grievances and broken relationships in one specific surgical team. It was recognised that this posed a risk to patient care if issues were not successfully resolved.
Senior sponsors hoped that an away day would help to reset relationships and encourage people to ‘behave better’, with the issue being described as a binary conflict between ‘overbearing surgeons’ and ‘scared nurses’.
Mayvin’s approach was to work to better understand what was really going on for people, resisting the presenting narrative. We avoided a quick solution and instead approached this as a systemic issue, rather than just a personal one.
BUILDING RELATIONSHIPS THROUGH DIAGNOSTIC CONVERSATIONS
To do this, we sought to listen to everybody in the system, including the sponsors. Through a series of one to one and small group conversations, we worked with over 30 people to map how the surgical pathway really works, what its real structure is compared to the formal organogram. Importantly, this also helped to identify what people didn’t know about each other.
It became clear that behavioural issues were more complex than initially set out and were greatly aggravated by the pressure of work. In addition, cross-cultural issues exacerbated misunderstandings. People were suffering from a limited view of high performance that focused on numbers of cases treated but did not include other measures such as staff wellbeing, training, resilience, and long-term capacity building.
Through the diagnostic conversations, we fostered a quality of genuineness and authenticity from everyone involved, seeking to gain everyone’s trust. In this way, we purposely used these conversations not just to gather data but as an important intervention in itself. It enabled us to give people the space to understand their own stories while telling them to us.
We also paid attention to the parallel process — what is happening for us and between us as OD practitioners – as information about the system.
CREATING A SAFE SPACE
At the away day, with 50+ people in attendance, we created a safe space for everybody’s voice to be heard. The strong relationships we had developed through the diagnostic conversations meant participants felt able to trust us, enabling them to trust each other. This meant people were able to understand why someone may be behaving in a certain way, rather than relying on assumptions and misattributions.
This was an extensive piece of work that enabled people to understand each other’s perspectives, ease frustrations and find a collective solution.
At the beginning, there was apprehension about what was expected from people, and whether it would be confidential. As the programme progressed and we built trust, people became more open in voicing their own experiences.
Since Mayvin’s work, the culture in theatres has changed, with nursing, surgical and administrative teams working more cohesively. In particular, people are more aware of how words and actions may be interpreted by others and team-working has greatly improved.
Our work has helped to break down barriers to communication between all staff groups. Comments from the evaluation included: “In my opinion more of these should be taken as a group at least once a year to help team building and collective problem-solving. If you are part of the solution then nothing is a problem.”