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Leading Change in a Tribal Environment

Dr. A.J. Cartwright, a Consultant Anaesthetist, explores the concept of "tribes" in healthcare, emphasizing the importance of communication and understanding within the NHS. This presentation discusses the various tribes present in the NHS, including doctors, nurses, and managerial roles. It highlights the challenges of a target-driven culture, which can undermine team cohesion and individual value. Drawing lessons from industry practices, it underlines the need for effective communication and involvement to foster a collaborative environment, ultimately aiming to enhance patient care and staff satisfaction.

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Leading Change in a Tribal Environment

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  1. Leading Change in a Tribal Environment Dr A J Cartwright Consultant Anaesthetist

  2. Introduction • What is a Tribe ? • How does this apply to the NHS ? • Lessons from Industry • Communication – The C Word • Lessons Learnt • Summary • Questions

  3. What is a Tribe ? • A unit of sociopolitical organisation consisting of a number of families, clans, or other groups who share a common ancestry and culture and among whom leadership is typically neither formalised nor permanent. • A group of people sharing an occupation, interest, or habit.

  4. What is a Tribe ? • Doctors, nurses, managers. • Surgeons, physicians, anaesthetists. • Medical, finance, IT. • IT literate, IT illiterate. • Husbands, wives and other family members.

  5. What is a Tribe ?

  6. What is a Tribe ? You are Here

  7. How does this apply to the NHS ? • 1.7m employees (March 2012). • Healthcare, research, HR, logistics, marketing, publicity, property management – all dependant on IT. • Healthcare : Primary care, outpatients, investigations, operations, palliative care, alternative therapy. • Each sub-area differs in language and acronyms, capacity to tolerate risk, boundaries and culture.

  8. How does this apply to the NHS ? • Multiple stakeholders. • Multiple influences. • Patient Care • Resources • Finance • Government Targets • Personal

  9. How does this apply to the NHS ? • Increasing pressure, target driven culture and a change process can erode tribe membership due to devaluing personal worth within the tribe. • NHS Staff Survey 2011 : • Just under a third of all staff (32%) were satisfied with the extent to which they felt that their trust values their work. • Only 26% said that communication between senior managers and staff is effective. • 14% of staff reported bullying or harassment from a colleague.

  10. Lessons from Industry 現地現物 (GenchiGenbutsu) Go and see for yourself to thoroughly understand the situation Ask ‘Why?’ five times

  11. Lessons from Industry • Involvement • Visioning • Communication • ‘Treating What Hurts’ • Addressing individual’s ability to accept change • Encouraging people to develop new relationships • Increase Social Capital

  12. Lessons from Industry • Involvement • Visioning • Communication • ‘Treating What Hurts’ • Addressing individual’s ability to accept change • Encouraging people to develop new relationships • Increase Social Capital

  13. Communication – The C Word • Multiple modes of communication. • One mode may not be enough. • Increasing technology and therefore availability. • Enable the receive button, not just the transmit button. • Find political allies, popular within each stakeholder group if possible, to help drive the message. • Use friendships.

  14. Lessons Learnt • Be aware of your own tribe and others’ perception of this. • Carrots work really well. • A stick is sometimes needed. • Do not assume that because you use email that everyone checks it even fortnightly. • Doctors already lead people well. • Management training is very useful to learn structure, lingo, acronyms, and gain credibility (you’re a member of our tribe), but leading can’t be taught. • Physicians are ideally placed to lead these sort of projects and should be instrumental in leading the digital revolution.

  15. Summary • Tribal attitudes are hard-wired into human behaviour and cannot be undone. • GenchiGenbutsu. • Communicate. • Increase Social Capital. • Use these to create new tribal boundaries to encompass your project goal.

  16. Questions anthony.cartwright@nhs.net @tonykildare

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