Presentation to HSJ Conference in London on 20th January, 2010 on Wellbeing and Performance in the NHS

1. Wellbeing and performance in the NHS –
an outcome of a Positive Work Culture
Derek Mowbray
derek.mowbray@orghealth.co.uk

2. Health and wellbeing – where to start
Influences on health and wellbeing
Genetics
Nutrition Behaviour
After Thomas McKeown in:
The Role of Medicine:
Dream, mirage or nemesis
NPHT. 1976

3. The ‘big idea’
People who feel well perform better than people who feel ill

4. Wellbeing and Performance
Just a Minute Performance Model
Wellbeing Performance
feeling well clear aims
being well and feeling well appropriate aims
being ill but feeling well clear timetable
being alert efficacious action
concentrating no deviation
motivated effective action
engaged no repetition
having energy efficient actions
no hesitation

5. Work improves our health and wellbeing
Working days a year
Holidays
Work Weekends
Work

6. Psychological distress

7. Defining psychological distress
Pressure – Strain - Stress
Stimulant (pressure)
Diversion (strain)
Impairment (stress)

8. The impact of stress at work
The Law
Individual and
misery Tribunals
HSE
Management Insurance
Standards premiums
Sickness
absence,
staff
turnover.

9. 40 Turnover of staff 2006, 2007
and 2008
31 30 ‘Top 100 Companies to Work For’
30
Source: Sunday Times March 2007, 2008 and 2009
25
23
22
2006
Number 20
of 17
2007
companies 15
15 14 14
13 2008
11 11
10
9 8 7
7
56
5 4 4
1 22
0-5 6-10 11-15 16-20 21-25 26-30 31-35 Over 35
Percentage of all staff turnover pa

10. Organisations are controlled communities
It is the manner in which they are
controlled that is important.

12. Costs of the ‘Iceberg Effect’ as a percentage of
total costs of psychological distress at work
32%
58% sickness absence
staff turnover
‘Iceberg effect’ reduced productivity at work
10%

13. High personal wellbeing Average personal wellbeing
Good business performance Poor business performance
Characteristics: Characteristics:
Clear purpose Ambiguous purpose
Commitment, Trust, Engagement Poor recruitment practices
Effective recruitment practices Average terms and conditions
Good terms and conditions Mismatched skills to jobs
Team working; staff involvement Laissez-faire management practices
Adaptive leadership and management Few company wellbeing programmes
Customer and staff focus Average company benefits
Low sickness absence Average sickness absence
Low staff turnover High staff turnover
Low costs/high profits High costs/ low profits
Poor personal wellbeing Poor personal wellbeing
Average business performance Poor business performance
Characteristics: Characteristics:
Clear purpose Ambiguous purpose
Average terms and conditions Poor terms and conditions
Limited alternative employment Lack of Commitment, Trust, Engagement
Transactional management Coercive, competitive and bullying culture
Incentive and bonus schemes High level of presenteeism
High levels of sickness absence High numbers of tribunals
High number of tribunals High levels of sickness absence
Limited wellbeing programmes High staff turnover
Average staff turnover High costs/Low profits
Very high costs/Minimal profits

15. Tackling the problem of psychological distress at
work
Prevention
Strategic framework
Next Prevent
Generation deterioration
Palliation Restoration

16. A Positive Work Culture
based on wellbeing and performance
Strategic framework Focus Purpose
Prevention Culture To promote a Positive Work Culture based
on wellbeing and performance
To manage threats to wellbeing and
performance
Prevent deterioration Self To prevent personal deterioration
in wellbeing and performance
Restoration Support services To restore people back to their normal level
of independent life and beyond
Palliation To support people with chronic
psychological distress
Next generation To prevent psychological distress
in support workers/carers © Derek Mowbray 2009

17. Wellbeing and Performance
strategy
Culture
Derek Mowbray 2009

18. Characteristics of a Positive Work Culture
•a clear, unambiguous purpose, expressed as a simple ‘big idea’, an idea which all the staff
relate to closely, and are proud to discuss with friends and colleagues.
•an atmosphere of confidence, where all the staff are interested in each other, support
each other, and project this confidence towards clients and customers.
•staff who behave respectfully towards each other, value each other’s views and
opinions, work in teams which are places of mutual support, where anything is
debated without a hint of humiliation, where the critique of individual and team
work is welcomed, discussed and where lessons are learnt and implemented.
•staff who ‘go the extra mile’ by providing unsolicited ideas, thoughts, stimulus
to each other, and where their interest in their customers offers something
more than is expected, beyond courtesy, and beyond service, offering
attentiveness and personal interest.
•challenges for their staff, that provide opportunities for personal
development through new experiences, and which treat everyone with
fairness and understanding.
•staff who are personally driven towards organisation and personal
success - intellectually, financially, socially and emotionally.

19. We all act
We are all actors
We act according to context
We are influenced by the cultural foundations
We act in ways expected of us (stereotypes)

20. We behave according to the meaning we place on specific situations

21. Trust, commitment and engagement
Building trust and commitment leads to engagement

22. Organisation Development
Organisation purpose
Organisation Organisation Organisation
architecture ‘rules’ ‘how to play the game’
Organisation
development
Derek Mowbray 1994

23. Factors that influence trust and commitment
Purpose
The ‘Big idea’
Manager – employee Architecture
relationship
Employee attitude Structure
Manager discretion
Employee discretion
Attentiveness
Rules of the game
Management encouragement Job
Leadership ability Recruitment
Performance appraisal Pay
Teamwork Challenge
Involvement Secure
Openness
Communication
Work life balance Career opportunity
Responsiveness
Citizenship
How to play Training and Behaviour
Procedures
the game development Policies

24. Personal attributes and Behaviours
behaviours
Attentiveness
Politeness
Personal attributes Courtesy
Personal communication
Attentiveness Body language
Trustworthiness Addressing needs
Empathetic Engagement
People Demonstrate wisdom
Intellectual flexibility Commitment
Leaders Assertive
Emotional intelligence Trust
Managers Intelligence with humour
Negotiation Resilience
Passion
Sharing Tolerance
Direction with committed
ambition Reliability
Address individual needs Honesty
Nurture Clarity
Fairness
Humility
Conflict resolution
Encourage contribution

25. Attentiveness
Intellectual
Encouragement
flexibility
Behaviours that inspire
commitment, trust and engagement
In others
Resolve
Reliability
conflicts

28. Return on Investment
Costs
Performance
Engagement
Inspiration and Innovation
Trust
Commitment

29. Further information
Draft Code of Conduct for Healthcare Management – www.ihm.org.uk
Brief guide to a Positive Work Culture – www.orghealth.co.uk
White papers on:
The Wellbeing and Performance Agenda
Prevention of stress at work
A Positive Work Culture – http://webcommunities.hse.gov.uk/