Unnatural selection

A fundamental of Teal organisations is the pursuit of ‘evolutionary purpose’ – I wrote about this last week in my blog ‘Evolution two ways & Rio’.

I have been thinking this week about the whole concept of Natural Selection, or Evolution as proposed by Darwin and Wallace.

A few years ago, although I was aware of the concept, had read about the ways we have evolved – to the extent of internalising the idea that connects me to the universe, with, John Donne’s ‘No Man is an Island,’ through to Hemingway’s, ‘For Whom the Bell Tolls,’ – in that we are all part of the same complexity that is living.

I had largely parked these concepts as being of use in terms of my thinking about my place in society, how I relate to others, particularly my patients – I had integrated them into my lectures to medical students on the subject of older people – a blend of Humanism and practical science;

In the past two years however, Evolution has re-emerged as an important, relevant, component of not just my day to day working as a doctor, that is, in terms of my Evolutionary Purpose, seeking to improve the experience and quality of care we provide our patients in the hospital, but, in terms of my every action.

To untangle this a little more, when I find that ideas, or concepts, whether ancient or seemingly new converge, I am always hopeful that I have inched a little closer towards a better understanding of the world.

Evolution in terms of my place in society, work, life, family, is, I believe one of these concepts, and, this has only been evident to me through the writing of Laloux and others very recently.

Bruce Lee borrowed from the Taoist philosophers in describing his marital art, both in relation to his personal experience as well as the world in general – ‘hack away the unessentials’ – this is evolution, this is Lean, this is Kaizen.

And back to my own experience of Selection – natural or otherwise.

Our lives are spent making endless decisions that have an impact on ourselves as well as others – accelerating in my car will impact the life of someone crossing the road, the choice I make in a restaurant will affect the chef, serving staff as well as those sitting on the other side of the room, and, those interactions will ripple-out through the world; this isn’t anything new, whether we call it the Butterfly or Domino effect, it is well recognised.

Equally, the reality, that in order to maintain our sanity, we have to focus on that little bit of experience or life in front and behind of us, without getting too caught-up in the cosmos.

Selection, looking at the microcosm of health and social care, is fascinating.

Imagine the factors that determine whether the nurse who is administering your medicine is person A or B, or, whether the doctor who is explaining the procedure to determine whether you have cancer is right or wrong, sensitive or unfeeling, logical or emotional.

This can be drilled-down to an even more base-state – imagine, you are unconscious – perhaps after a road traffic accident*, or a heart attack or stroke and you arrive in hospital; a body with or without a name, an identify, family or friends.

*this is from personal experience after an ill-fated encounter between my bike and a Sheffield tram in 2005.

You are unconscious, the focus for the doctors and nurses is maintaining your physiology with particular attention to your brain and heart.

This is being at the mercy of others and probably, the system.

What factors determine whether the doctors, healthcare assistants, porters, lab technicians, receptionist are all working together as a team – collaborating, functioning as an entity that is greater than the sum of its parts, mutually contributing to your wellbeing, and what, determines whether the team is dysfunctional, antagonistic, caught-up in petty rivalries and competitions?

The process for recruitment in health and social care has been evolving over the generations, very often in directions that are counter-intuitive; this is driven by market forces; supply and demand for doctors and nurses in particular changes with time, the threshold as to who can enter nurse training and who is appointed rises and falls with the economy, social factors, numbers of university places and competition.

Hospital recruitment processes, are likely to be very similar to those within social care – currently, with the incremental growth in older people, the diminution of budget and resource, the pressures on those working in health and social care (H&SC), particularly those areas working within frailty and health and social complexity, are continuously increasing, making recruitment, retention and staff wellbeing ever more challenging.

In response to this, we need to determine what factors can both contribute to H&SC teams, what can make them more resilient, and, what can support them to work as teams that deliver optimal care (part of which in translation is, how can we make work not work, or make work fun?)

Part of the solution I believe is Teal.

Teal recruitment, moving forwards, is likely to be critical to the success and sustainability of teams working in H&SC.

What is Teal recruitment?

I am not aware that this has been specifically quantified within the literature, but we are learning;

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This week, on Tuesday, we, that is the Teal Partnership I support with Helen Sanderson, Greg Bamber and others, conducted the first recruitment day for our Teal Wellbeing Team, to be based in Lytham-St Annes.

The process for recruitment was to a degree labour intensive; the concept of an advert in the paper followed by paper short-listing based on CVs and formal interviews was not followed, for we knew that the work of our new recruits would be far more sophisticated, involving far greater delicacy and attention to the needs of those people we will support (our mothers, fathers, older brothers and sisters), than could be accomplished by the old ways.

The selection process started with the design of the advert which explained some of the ideas and concepts we were seeking to deliver – not home care, but well being, not dependence but autonomy, both for the team as well as those people we will support, and, not pigeonhole ‘timed-calls’ but individually crafted, relationships between those receiving and those delivering the support.

Following this process, telephone interviews were conducted explaining the role, what to expect and what not to expect, unravelling the understanding of the applicants as to their potential role and what might be expected of them; all, within a construct of Teal – self-managing teams, Evolutionary Purpose and whole-self.

The interview was not a 20-minute appointment with a panel, but a person-centred day, where those already working within the Partnership could talk to, interact with and learn about the hopes and aspirations of the applicants, could establish rapport and quantify their levels of commitment, emotional intelligence, empathy and compassion.

The day involved scenarios, group sessions and engagement, the involvement of potential users of the service (aka older people) was also fundamental, as were their opinions, thoughts and feelings (how fantastic would it be, were one of my patients to participate in future hospital interviews?) *

*This is not a new concept – it is called ‘co-creation’ – yet, within the formalities of NHS recruitment it hasn’t yet widely taken hold.

The day was one of personal development for the applicants as well as those running the recruitment – not considered an extra burden, but a fundamental, an enriching component to our roles.

Eating together, talking, using the up-front information provided by One-Page Profiles to support our getting-to-know one another, culminating in the applicants interviewing the recruitment team, facilitating clarification and questioning that would help to unravel any areas of uncertainty.

Not everyone was recruited and, our hope was that those people who have joined the team will start the journey to grow, learn about themselves and one another, share experiences, dreams and fears, contribute to the coalescence of what is good, that component of people stepping out of their individual preoccupations and concerns, into something bigger, more revealing and challenging , through self-management (aka self-mastery), bringing your whole person to work (with its inherent beauty and strength as well as frailty and vulnerability), and, evolutionary purpose, where those working in the team can be clear they are not working in silos, that a job is not just a set of routine processes repeated endlessly, but an opportunity to learn and grow continuously.

I’ll end with a dream (perhaps a wish), for the future of health and social care, where the talents, abilities, and, limitless possibilities of individuals can come together to maintain the system which is struggling, to add energy, momentum and passion to the roles we fulfil, not focusing on wage-packets or retirement dates, but on the good that can come of people sharing in the privilege of contributing to something greater than themselves.

I imagine if these principals had applied to me throughout my journey from childhood – entering school, college, university and training to be a physician, where would I be, how would I be influencing the system, what added opportunities would there have been for me to contribute? What might I have avoided, what might have happened to me if those I worked alongside has travelled through a similar trajectory of option and opportunity – allowing their whole selves to be revealed and allowed to influence the directions they took.

People doing what they love, where they love, with those who share the same love. Wow.

I am incredibly fortunate in relation to my current position – that is not to say the everyone loves everyone all the time, but, when I focus on my small world, which, for the journey of this blog to date, has been my work on Mallard Ward, those working alongside me do love what they do, and, through love, have established mastery and the ability to sustain that passion. By allowing this to grow, facilitating self-expression and encouraging everyone to contribute to the evolution of the ward (in my eyes, expanding patient safety and wellbeing), the possibilities are limitless.