Assurance, Accountability and Ambition: the new Eskimo words for a healthy organisational culture

I have lost count of how many student assignments I have read on the subject of organisational culture that have included a line about the number of Eskimo (Inuit) words for snow. Some students will quote there are 50, others 100 or even 150. Sadly, its a bit of a myth. Yes, Eskimos do have a lot of words they use to describe snow, but likewise, geologists have a lot of words for rocks, just as we have a lot of words for ourselves: you, us, people, and we, for example. 

However, just because the Eskimo snow words story might be a myth, it doesn’t mean to say it’s not interesting. It is interesting in several ways. You might want to delve into the linguistics of the subject; if so, look here. 

But I’m more interested in the importance of the distinctions between the different words Eskimos use to describe snow. These are distinctions that 'package' information in a way that is both important and useful. In human interactions, if we ignore the significance of that packaging, we do so at our peril. I try and steer clear of politics in this blog, but just to illustrate this point, please have a look at the way in which Lord Geidt (the Prime Minister’s advisor on Ministerial interests) reported the outcomes of his investigations into possible breaches, by the Prime Minister and the Secretary of State for Health and Social Care, of the Ministerial code. In my mind, just like kindness, propriety always matters.

I digress, but perhaps not, let’s see. Organisational culture. Well I think what many of my students were trying to do in using the analogy of Eskimos having 50 words for snow was to somehow illustrate that culture is a multi-faceted phenomenon. In describing organisations, culture can be a rather nebulous concept. There are many Eskimo snow type words to describe it. At its deepest level, perhaps all we can say is that organisational culture is based upon values that arise from how we view: human nature – do we see people as being basically good or bad, enthusiastic or demotivated, proactive or reactive; likewise how the organisation defines itself in relation to others is important; the degree of emotions people are encouraged to express (often difficult in health care);  and whether the organisation is thought to be doing well or in need of improvement (the CQC view of the world).

Last week I had some wonderful conversations with my new colleagues. One of these was with a lady who had a wicked smile, an astute sense of the possible and a wealth of experience of how culture can inhibit or enhance people’s experiences. She told me a tale of a couple who had joined the NHS from India. They were two of the many nurses who have managed to come the UK to work despite the pandemic. This couple were very experienced, and highly knowledgeable nurses, who have been making a difference every day for some time now. They had been made to feel welcome, supported with housing, advice about schools for their children, and an orientation programme that helped them with shopping, food buying, where to worship and so on.

There was a but. What hadn’t been done so well, was to try and understand the culture the couple had come from and how this might play out in a different context, and whether there was anything that could be done to help them understand the difference. In conversation with them, my colleague found out that the couple had come from a culture where hard work and loyalty to an organisation was the way to progress your career and gain promotion. Apparently, there was little understanding that despite how hard you might work, it didn't always follow that someone would simply tap you on the shoulder and ask if you were interested in moving into a different role.  

I was saddened by this revelation. Throughout my career, I’ve always benefited from having a number of mentors who encouraged me to seek out new opportunities which allowed me to grow and prosper. I had to do the hard work, but I was also guided as to how that hard work might be recognised and what it might allow me to contemplate doing next. What I heard next made me even sadder.

My colleague told me that after offering advice to the couple on what they might consider in terms of moving their careers forward, the wife had come back with an idea for opening up opportunities for her to progress. She had found a leadership programme that she felt would better equip her to seek out new opportunities. Personally, I remain unconvinced that many leadership programmes actually are of benefit. I’m still firmly in the camp that leadership is better caught than taught. But I digress.

Now this couple worked in an extraordinary way. One worked days, the other nights. They were like ships that passed in the night. They worked this way to ensure their children were always cared for. I think such an arrangement, whilst understandable, would have been tough for the family. Such an arrangement would be tough for any family, but for a couple coming to a new country without a network of family or friends it would be extremely challenging.

Having found the course that might prove the catalyst to unlock her potential and improve her future prospects, she found she was thwarted. The reason? The couple would need to work slightly shorter shifts in order to undertake their childcare responsibilities and allow her to attend the leadership programme. Apparently, this was an impossible ask and her request was turned down. It appears there may be a new Eskimo type word to use in describing organisational culture – intransigence. Tesco, Sainsbury, Asda and all the other supermarkets have led the way on flexible working. 

Our people are the most important resource we have in terms of providing high quality health and care services. We need to nurture and look after them, not just in the here and now, but for the future too. I have three Eskimo words that best underpin my approach to achieving this – Assurance, Accountability, and above all else, Ambition. And if it does happen to snow today (and who knows with the weather we have been having recently), lets get out there and make our own sunshine!

You only get wrinkles where the smiles have been

Now then, who has found (and used) the Zoom tool that allows you to smooth your skin’s appearance? At the press of a button you might lose years in terms of your online appearance. Why would anyone be that vain to feel the need to use such a facility? But then as I think I might have mentioned before, I have been amused (tinged with just a little sadness) over those online pictures of people who, when you meet them in real life, you realise their photos were clearly taken 10 years or so before.

Apparently there really is a button on Zoom that allows you to make yourself look younger, more vibrant, and attractive. Really? The Covid lockdowns and our embracing of a virtual world of communication had some unexpected consequences. One of these made me smile last week. It was a report that suggested that men were more likely to press that button than ever before, and not only that, but seek to do something rather more drastic too. The British Association of Aesthetic Plastic Surgeons (BAAPs) last week reported that 30% of their members have seen a massive increase in consultations with men for what has been described as ‘tweakments’. The most popular tweakment is Botox, said to smooth out the wrinkles in your skin. Like many things, good and bad, the pandemic apparently is to blame.

Many of us have spent the past year staring at ourselves on the screen during Zoom and Teams meetings, and it seems that many men don’t like what they see. Now I have never pressed the youthful look button and wouldn’t have Botox injections, but I will admit to turning my laptop camera on to see what I look like before starting a meeting. I wonder how many of you, dear readers, do so too. However, these past three weeks I have been meeting real people in real life situations, and it’s been great.

I had forgotten how good it was to put a suit and shirt back on and best of all, being able to wear my clogs once more. You can do Zoom and Teams meetings barefoot. And I have the world’s greatest collection of different coloured clogs. Things are different now. Some of the Covid restrictions have been eased, and whilst social distancing and mask-wearing remain, I have been able to move into my new office and meet many of my new colleagues face to face. What a difference it makes to establishing, nurturing and maintaining effective relationships. I recently blogged about the importance of trust in building and sustaining relationships. For me, this is something that will be at the heart of my relationships with colleagues, stakeholders, patients and the communities they live in. Gaining this trust won’t happen overnight.

Interestingly for me, I also attended a webinar last week that looked at the future role of Non-Executive Directors and indeed, Trust Boards themselves. Building and sustaining effective relationships was a theme than ran through the discussion. In many Boards there can be a rift in the relationships between the Executive Director group and the Non-Executive Directors. It is an easy place for a Board to find itself in. Too often, the Executive Directors are not recognised as being part of the Board itself. A strange thing to say, but it’s true. They can be seen simply as a conduit of evidence that provides assurance. Yet, like the Non-Executive Directors, they too will have life experiences, knowledge and skills that the whole Board can benefit from, if they are encouraged and supported to do so. The whole Board needs to be bigger and better than the sum of its parts. Like many other teams and relationships, that means creating a safe environment for diverse views to be aired, where constructive challenge can happen and a space created for change to occur. This is not always easy, and again getting to this stage of a Board’s development won’t happen overnight.

My thinking is to start small and build from that; stop talking about the need for change, and make it happen. Which is what I have been doing over these past few weeks. The first tangible sign of change will be our June Board meeting, which once again will be held live, with colleagues sitting around an actual table and not a virtual one. Of course, for those not quite ready to do that we will still connect virtually, but most folk appear quite keen to get together in this way. Coming together will, I believe, be a brilliant way to contribute to our journey towards becoming an ‘outstanding’ organisation.   

I want, (and my Mum would tell me off for saying that) to have a Board that was intent on building relationships that give legitimacy and transparency to our decision-making; that ensures we effectively control the resources we have in working on our own, but also in an interdependent way with others; to add value to the culture and life of the wider organisation and to ensure that culture is ethical and values driven. It won’t happen overnight, but it will happen. 

Over these past three weeks I have found myself smiling at both the opportunities we can collectively create in making a difference every day. I know that smiles will leave wrinkles, but I won’t be having any Botox injections – I think in my case wrinkles add character, and I have to say, that’s enough. 

The nature of good mental health and wellbeing

Tomorrow sees the resumption of international travel. The UK government has released its list of places we can travel abroad to. There are 12 countries on the so-called Green List (where it’s possible to travel free from many Covid restrictions). Have you yet given any thought as to where you might want to go for your summer holiday? I’m thinking we might stay closer to home. Whilst the choice is limited, taking a decision will be based upon many factors – how much the holiday might cost, what weather you are looking to enjoy and the type of holiday that suits you.

I live near a beach but have never liked ‘beach holidays’. One of my best holidays was walking the Coast to Coast Walk, but of course, people have many different ideas as to what makes a good holiday. The German philosopher, Friedrich Nietzsche, one of the most influential modern thinkers, wrote his book, the Twilight of the Idols in just one week while on holiday in Sils Maria, Switzerland. His philosophy was (and for some still is) radical. The book was to serve as an introduction to his thinking and writing. The alternative title for his book was: How to Philosophise with a Hammer. I have to say I have found his work hard going at times, but some of his thoughts and words have stuck with me and have helped shape my appreciation of the world.

In this book, Nietzsche make the bold claim that ‘all truly great thoughts are conceived while walking’. Now I can’t claim to have many great thoughts while walking, but I would agree that walking helps me think. Indeed, I often conceive my weekly blogs while out walking. However, these days I sometimes make a note of my thoughts, as occasionally I forget the flow by the time I finish my walk! I walk every day and most weeks will clock up 40 – 50 miles. It’s my way of keeping active, both in body and mind.

Today is the last day of this year’s Mental Health Awareness Week. It is the UK raising awareness week of mental health and mental health problems and a call to finding ways to promote good mental health for all. Every year there is a theme and this year it is ‘Nature’. There is much evidence that comprehensively links taking exercise and improving one’s mental health. Research undertaken by the Mental Health Foundation noted that during the pandemic one of the top coping strategies was being in green spaces. Some 45% of the people asked, reported that it had been vital to their mental health and wellbeing.

That was certainly true for me during the first lockdown. Good weather and being able to spend much time outside in our garden was a brilliant way of dealing with the fear and anxiety of the unknown and the challenging pandemic restrictions. Sadly some 13% of people in England have no access to a garden, and getting outside for others, was simply too difficult. Undoubtedly, this will have contributed to greater feelings of isolation, loneliness and anxiety. Thankfully, many people up and down the land volunteered to ‘be there’ for and with others, perhaps doing shopping for people unable to leave their homes, or finding ways to simply check on neighbours and so on. Zoom church services saw congregations swell in numbers. The Mental Health Foundation noted that websites with webcams showing what was going on in zoos or in the countryside saw a 2,000% rise in logons.  

Despite the enforced isolation of the lockdowns, J and I were able to both enjoy our garden and get out for our daily ‘Boris Walk’. Although we kept to the ‘6 mile limit’ we were able to both walk to our beach and in the surrounding countryside. I think like many others, the quietness and stillness brought about by the lockdowns and travel restrictions absolutely meant I was more aware of my surroundings than perhaps I might have been in the everyday busyness of our lives.

It was a form of mindfulness that allowed for a much greater sense of being fully present, to be more aware of where I was and what I was doing, and perhaps more importantly, not to be overwhelmed by what was going on around me. Walking, and being able to do so outside in the countryside or on the beach helped protect and nurture my mental wellbeing. During a time when we couldn’t mix with our neighbours in the ways familiar to us, for me it promoted a sense of connection with my community. Of course, it didn’t mean I was happy every single day. Like many other folk, there were days that were tough, where it felt we would never again be living a normal life. But it did help both J and I become more resilient, and that was an important achievement.

Nietzsche argued that we should all try to gain three critical life skills: seeing (the ability to think before acting), thinking (best learnt in the way dancing has to be learned) and speaking and writing (being able to dance with the pen). Whatever the activity we choose, walking, running or even dancing, there is always something we can do to improve our wellbeing and protect our natural world too. Increasingly more people are growing an awareness of the damage we continue to do to our environment. Let’s all make our pens dance and raise a voice to ensure access to nature that is protected and cared for, is a mental health and social justice issue, as much as it is a sustainable environmental issue.

To trust is human, but learning to trust and be trusted is not easy

It was all about change last week. I updated my profile picture on all my social media sites. Recently I have been highly amused by meeting a number of people in real life whose profile pictures were obviously taken 10 or so years ago. When I looked at my own profile picture, I realised it was also many years out of date. Finally, my free bus pass arrived (very exciting). And after many years of active local and national politics, last Friday, J parked her political ambitions in the layby of life, and resigned her Councillor role and became @TheJaneWarne – but as Arnold Schwarzenegger once nearly said, ‘she will be back’. The most exciting change for me last week was starting my new role as Chair at Stockport NHS Foundation Trust (SFT). It was a busy week, more of which later.

First, today will be special as J and I are being treated to our first meal out together since the lockdown. It will be outside of course, so fingers crossed that we don’t have a repeat of the monsoon rain of yesterday. It is a birthday treat, and a gift from J’s two girls. We will also be eating at the wonderful Nutters restaurant. It was where we planned to hold our wedding reception before the pandemic shattered our plans. However, as Arnold Schwarzenegger might have once again nearly said, ‘we will be back’ for a celebration this September.

Later today we will be attending the Holy Communion service at St James. It has always been a meaningful place for us, but particularly so, as last year we finally got married there. It was a beautiful service, shared with a few special friends. This afternoon, no hymns will be sung. Lord Greenhalgh (Faith Minister in the Ministry of Housing, Communities and Local Government) recently told church leaders that it is unlikely that a return to singing hymns will happen before June. It’s such a shame, but understandable given the research on how airborne droplets help spread the Covid virus. Now although I don’t have much of a singing voice I do like hymns, and singing them always brings me joy.

Someone else who also has a thing about hymns was the ‘Godfather of English Hymnody’, Isaac Watts. He is credited with writing over 750 hymns, and although he died in 1748 many of his hymns are still sung every Sunday in churches up and down the country. As well as being a Christian Minister, hymn writer and theologian, Watts was also a logician. He applied a systematic approach to the analysis and validity of arguments. His book, Logic: The Right Use of Reason in the Inquiry After Truth was a standard textbook for nearly 200 years. Despite some of the language being perhaps unfamiliar these days, his work is still referenced in today’s textbooks on the same subject. If you are interested in better understanding how perceptions, judgement, reasoning, and disposition come together to help both make sense of the world and effectively articulate a view, you can still buy his book on Amazon.

Watts is also famous for his observations on life. I’m sure we have all heard the saying that ‘the Devil finds work for idle hands’ – Watts described it slightly more obscurely ‘In works of labour or of skill, I would be busy, too; For Satan finds some mischief still, for idle hands to do’. During the many conversations and discussions, I had last week with my new colleagues, one of Watts other famous quotes came to mind: ‘Learning to trust is one of life’s most difficult tasks’.

Like many of the relationships we might encounter during life, how these develop, are nurtured, and sustained will be dependent on the degree of trust that exists between all the people involved. Over my working life I have engaged in many different types of relationships which have all been shaped by the amount of trust shared. I have to say, because of my behaviours at certain times, some relationships have not always been successful. Some relationships were almost entirely transactional. Some were transformational. Many of my PhD students only really began to progress their studies once the trust between me as supervisor and them as student had been established. It never happened overnight, but once that trust was there, great things could happen.

The dynamics of trust are often delicately balanced. However, most of us will naturally respond to the presence of certain qualities in either an individual, a group or organisation. Such qualities will include: reliability and dependability - doing what you say you will do; transparency – all of us can become anxious around change and unknowns, so effective communication is critical as well as telling others how you might be feeling about a situation or issue; perhaps linked to this is fairness – being able to listen to both sides of an argument, and respecting the rights of others to express views that may be different from yours; openness (and maybe vulnerability) – being able to acknowledge one’s own mistakes and being able to apologise; competency – if you think an individual, or organisation is not capable of doing what they are supposed to do, it will be difficult to establish and nurture trust-based relationships; something perhaps seen in last week’s election; and finally, sincerity, congruency and authenticity – people are not stupid and can see when someone is being insincere or inauthentic, and when this happens people won’t believe anything that they are being told, and I’m sure we have all come across people who open their mouths and close their ears instead of the other way around, usually it’s the people who tell you all they want to do is to hear what you have to say!  

It’s these qualities that underpin the values we hold, and are demonstrated in the way we speak to each other, and in our behaviours towards each other. In a world that needs to become increasingly collaborative and interdependent, trust is the factor that will enable transformation to be realised and change to be successful. I have often (J would say incessantly) used the phrase ‘let me hold up a mirror’ when dealing with difficult conversations and situations. The aim is to enable the other person to reflect on how others might see them and the presence or otherwise of these qualities. As I take my first steps in building my relationships with my new colleagues at SFT and other stakeholders, I hope there will be someone along they way who will periodically hold up that mirror. And yes, in the words of Arnold Schwarzenegger, come Monday morning, ‘I’ll be back’.

7 Years in Wigan: My Life Before, During and After*

I have never been particularly interested in sport. I have never followed a football team, nor even been to a match. I had an intense dislike for PE at school and, apart from a brief period during my teens when I took up archery, have generally steered clear of sporting activities. That is until I was introduced to climbing by a colleague in 1984. Despite being slightly frightened of heights, I absolutely loved it. I practised on a climbing wall whenever I could and went out to climb every weekend. I thought about it as vertical ballet; all about balance, poise and above all, looking good! However, I can no longer squeeze my feet into my climbing shoes, Lycra looks daft on anyone over the age of 60 and arthritis in my hands meant I eventually had to stop climbing. I have taken up walking instead.

These days I do like a bit of a scramble in the hills. We are lucky to live close to both the Lake District and the Yorkshire Dales. Of course, combining climbing and walking is usually associated with mountaineering, and I still hang on to a wishful ambition of trekking and climbing in the Himalayas. It’s probably not going to happen now. During my climbing days I bought and avidly read every book on climbing and mountaineering I could find. 

Last week, I ordered a new copy of the classic book Seven Years in Tibet by Heinrich Harrer. It is a brilliant book and although the film of the book doesn’t do the story justice, it is still worth a look. You can find it on Netflix or Amazon, something J and I did one evening last week. It is a wonderful story, of adventure, exploration, learning about self, but most of all, about listening to others and trying to understand the way they experience the world.

Now you might be wondering what this has to do with health, nursing, education, or even the price of fish. Well Friday was the last day of my role as a Non-Executive Director at both Blackpool Teaching Hospitals and Wrightington, Wigan and Leigh (WWL) Teaching Hospitals. Yesterday was my first day as Chair of Stockport Foundation Trust. Whilst I had only been at Blackpool for just over a year (and what a year it has been) I was part of the WWL family for seven years. I have seen a lots of changes over that time, and have been involved in and led many of them. I like to think over  the years I made a difference. 

I came from a mental health background, so the workings of an acute hospital were somewhat alien to me. It took me several months just to learn what many of the abbreviations used actually meant. To this day I have an absolute dislike of abbreviations. During my time at WWL I was privileged to have worked alongside five Chief Nurses, two Medical Directors, two Chief Executives and many other Executive and Non-Executive Directors. They were/are a great bunch of people, and I gained so much from working with them.

In pre-pandemic times there were many opportunities to meet up, both from a business point of view but also socially. The annual Excellence Award night was always a great evening of celebration and fun, and of course, it was uplifting to hear about the many examples of improvements made to the care and treatment of patients and colleagues alike. I remember one notable evening when the compere (not a member of WWL staff) struggled throughout the whole evening with his attempts to pronounce many of the medical terms used. Defeated, he eventually gave up even attempting to pronounce the terms and used the audience to help him fill in the gaps.

There were sad times as well. We lost two Non-Executive Director colleagues in the same12 months. Both their deaths were unexpected, and their loss was felt by the whole Board for many months. In time we re-built the Board and were able to carry on the journey towards becoming an outstanding Trust. That journey involved many more people of course than just the Board. For many years we were the cleanest hospital in England, something I think which stood us in good stead as the pandemic hit us. We consistently met the national A&E targets and pre-pandemic, had our waiting lists down to single figures. All of this takes teamwork, a motivated and skilled group of colleagues, and excellent partnerships with other stakeholders. Wigan famously developed a unique model of public engagement, the ‘Wigan Deal’, to shape the way in which health and care services are provided, and importantly also addressing many of the social determinates of good health. The result has been nothing short of fantastic. There is a change in the way of working with people that has meant more power is given to patients and service users, a relationship that emphasises a ‘working with’ rather that a ‘doing to’ approach. A joined-up approach across all the various organisations that operate both in the public and voluntary sectors, with a shared purpose that underpins the combined contributions each organisation makes, is a critical requirement.

Achieving this can lead  to a different way of doing things that perhaps coalesces around four main areas: asset-based working, granting permission to innovate, investing in communities, and place-based working. If these areas sound familiar it is probably a consequence of the many discussions that have been ongoing since the UK Government published their White Paper in February this year. Unfortunately, the White Paper lacked an explicit description of what ‘place’ might mean. It does, however, seem clear to me that, like in Wigan, anchor organisations, such as NHS Acute Trusts, must work more closely with local people so as to nurture the resilience and strengths of individuals, families, and the communities they belong to. Such approaches are vital to building independence and greater self-reliance, reducing health inequalities, and promoting healthier life choices.

So, as I start my journey with my new family in Stockport, I don’t think I will have a mountain to climb in persuading my new colleagues to join me along the way. Just like Heinrich Harrer, we will take each day as it comes and keep on learning from the experiences of yesterday while keeping our eyes firmly on where we want to be.

*with apologies to Heinrich Harrer