Building Trust Across Complex Systems Our supporters NHS

Building Trust Across Complex Systems Our supporters

NHS Employers Strategic Workforce Forum Professor Veronica Hope Hailey University Vice President and Dean of the School of Management University of Bath

Dutch saying “Trust comes on foot but leaves on horseback. ”

Drivers of trustworthiness (Mayer et al, 1995; Dietz and Den Hartog, 2006)

Vanguards – cross boundary working for an integrated and collaborative response

Partnership

Methodology – data collected from 20 out of the 50 Vanguards Four stages: 1. Review of existing international research across all sectors 2. Three in depth case studies using documentary evidence, interviews and focus groups: Royal Free: Acute Care Collaboration Stockport Together: Multi-Speciality Community Providers Somerset Symphony Programme: Primary and Acute Care 3. Quantitative Survey: 52 item survey across all Vanguards 4. Workshop: Case Study Vanguards, NHS England, NHS Employers.

What are the barriers? • Competition in the system – competition in the culture – competitive mindsets within individuals. • Perceptions of motives of 3 rd parties, legislators and regulators • Organisational Reputation – “the shadow of the past” has great bearing on disposition to trust at the beginning of a partnership. • Profound differences in organisational cultures and mindsets • Individual Leaders and their Anxieties

What enabled trust? Recommendations?

The Symphony Programme Yeovil Hospital Trust

3 stage process – agreement driven trust knowledge driven trust , collaborative trust Adapted from Pomponi et al, 2015

Stage 1 – Agreement Driven Trust • Desired outcome – written agreement • Activities required to reach that outcome: • Team formation and composition important – clinicians and also those with ability and experience of working across boundaries. • Evidence Based Decision Making – using data that clinicians respect • Sharing information to move towards “cognitive closeness”. • Adaptive leadership • Consistency of behaviour – particularly if history of distrust • Leadership development programmes – investing in support • And investing time, time…. .

Time – trust comes on foot and leaves on horseback

Stage 2 – Knowledge based Trust • Desired outcome – original “written objectives” for the collaboration start to be seen as “aligned goals” for all and decision making speeds up. • Activities to generate that outcome: • Sharing key information and sharing knowledge. • Speaking honestly • Deepening understanding of the concerns of others. • Documenting and sharing successes to all levels and stakeholders. • From cognitive understanding to shared ownership of problems

Stage 3 – Collaboration driven trust • Desired outcome – written formal agreements less important than trusting personal relationships • Activities required to deliver that outcome: • Talk honesty about trade offs and dilemmas that exist between the needs of the partnership and the needs of your own organisation. • Do not over promise. Failing to deliver is worse than being modest in one’s desired outcomes.

Further recommendations • Don’t neglect the internal trust relationships • Maintaining the trust of broader stakeholders • Investment in leadership development programmes or individual support • Huge investment needed in personal time and energy • Wider NHS system has to change its metrics.

Checklist for leaders: Ability . • Don’t make assumptions that your partners know your competence • Deploy your best experts and demonstrate expertise • Use data analytics, logic and evidence based decision making to make the case for change • Mobilise resources and remove blockages to demonstrate ability to deliver quick wins Benevolence • Helping others out in difficult circumstances – going beyond contract to demonstrate your support and concern for your partners. • Knowing the needs of our partners demonstrates benevolence • Investing your time and energy demonstrates your commitment to others Integrity • Agreeing a shared vision • Being honest and open about the difficult choices and trade offs needed between needs of partners and their individual organisations. There are real moral dilemmas revealed in the survey data. Predictability • Frequency of contact and proximity breeds familiarity; physical, tangible symbols of collaboration reinforces trust – shared working hubs, tea funds, following through on promises; sticking to commitments on regularity of meetings.

Veronica Hope Hailey Vice-President and Dean of the School of Management University of Bath v. hope. hailey@bath. ac. uk Professor of Management Studies twitter. com/bathsofm Voted One of the Most Influential HR Thinkers in 2012 – 2017

Table conversations Our supporters

Dynamics of Complex Systems Paul Taylor-Pitt @NHSE_Paul. T

Resources: www. nhsemployers. org/OD Linked. In: NHS Organisational Development Twitter: @NHSE_Do. OD www. nhsemployers. org/od

Consider the dynamics of complex systems • • The changing nature of change Recognising complex systems How to work with complexity Challenges (and opportunities) for leaders

The changing nature of change

“I was very explicit about…the nature of how hard the change process was going to be” Trustworthy Collaboration, p. 50

Recognising complex systems

“You end up just collaborating; you don’t do any work” Trustworthy Collaboration, p. 45

Recognising complexity 1 2 How close are we to agreement? How close are we to certainty?

(Ralph Stacey)

How to work in complexity

“You’ve got to nurture it… …and that takes time” Trustworthy Collaboration, p. 51

(Ralph Stacey)

(Ralph Stacey)

(Ralph Stacey)

1. 2. 3. 4. 5. Slow down. Even driving at normal speeds in fog can be very dangerous Do not use full beam. Do not attempt to navigate using the fog lights of the car in front, as these can give a false sense of security Stay focused. Driving in fog is not a time for multi-tasking. If you really cannot see, you should consider stopping

1. 2. 3. 4. 5. Slow down. Even working at normal speeds in complex systems can be very dangerous Do not use full beam. Do not attempt to navigate using the outcomes of organisations in front, as these can give a false sense of security Stay focused. Working in a complex system is not a time for multi-tasking. If you really cannot see, you should consider stopping

(Ralph Stacey)

Challenges and Opportunities for Leaders

Challenges for leaders In complex systems… …but (and) • Embrace unpredictability • Operate far from equilibrium • Let go of previous practices • Dismantle hierarchies, boundaries, secrecy and competition • Surrender your need for control and stability. • People seek out and expect certainty • People are tired of change. • Efficiency is found in the status quo.

“My vulnerability right now is not knowing enough” Trustworthy Collaboration, p. 45

Opportunities to Think Complexly 1. Engage and expand the whole system. Who else should be involved? 2. Continually prove yourself wrong, find flaws in your thinking and test every alternative. 3. Use the little understanding you have to ask influential questions 4. Embrace your lack of control. Be emancipated by it. 5. Reject cause-effect, command control. 6. Increase your tolerance for ambigiuty 7. Recognise that the system has unlimited human potential. 8. Trust is your greatest asset. *Compiled from Ciliers (2002), Ray (2013), Richardson (2008), Bechtold (1997), Cheung-Judge (2017), Wheatley (1999)

Think… • How could Stacey’s Landscape map generate conversations that will increase mutual understanding of your context? • What is your tolerance for ambiguity and how can you increase it? • How’s your driving?

Q&A Our supporters

Now available to download Includes case studies from • Royal Free London • Stockport Together • Somerset Symphony Programme www. nhsemployers. org/buildingtrust