I am spending time with different members of the NHS Horizons team, getting to know and learn from each of them. I know Helen has intentionally put together a diverse team, reflective of the most emergent skills to ensure mobilizing, inspiring, personalizing, demonstrating, equalizing, and virtualizing the way we drive meaningful change.

Helen has equally focused on the values of her team members to ensure that only those with aligned belief systems are part of the Horizons team. Beliefs that are focused on working in new power ways, in ways where people are committed to engaging everyone is solving our most complex improvement opportunities in health and social care, those that are highly capable but come at solving complex problems in a way that creates movements for change, those that are comfortable with ambiguity and those who connect with compassion, kindness and humility. All of this aligns deeply with my own values.

Helen and Claire Shields (thank you, Claire) have arranged an itinerary for me that gives me an opportunity to experience and learn with the whole team and travel to different parts of the UK for breadth and depth.

Today, I spent the day with Pardeep Bains and Sasha Karakusevic @karas01 (meet the Horizons team) who have convened the leadership, management and front line for the Continuing Health Care Teams (CHC’s) to discuss opportunities to engage the entire workforce along with patients and their families to solve the biggest improvement opportunities for their sector, as a collective. Prior to engaging like this, each CHC was functioning independently and as a result the regular range of frustrations (that we are all familiar with) were experienced by patients, their families and the staff.

In coming together, the goal of the collaborative was to get to know one another (this is where we need to start, I believe), choose common priorities and a way forward, together. Like every cross collaboration change effort the focus was first on building trust and a commitment to the process for that to happen. 

My favorite moment of the day was one of the CHC leads said, “I am going to make a t-shirt that says, “I WAS IN THE WAY AND NOW I AM THE WAY”. He admitted how his previous beliefs (old power, command and control) and behaviors stood in the way of meaningful progress. You could hear a pin drop in the room. 

We were in awe of his bravery. 

As Helen says, change must first start with each of us. This is how culture shifts, when people beliefs system and behaviors shift and match up.

The collaborative has been working together for two years now. Today's session was about creating the space for reflection on what’s working well and where to focus next. 

These discussions were powerful. They were reflective. The NHS Horizons team process respects that change only happens at the speed of trust and unless space is created to meaningfully connect and reflect then trust cannot be built. This is an important lesson for all of us, to create the space to reflect together. It’s hard to do because of ‘busyness’ and silos and old held beliefs that relationship building are the soft skills …. Soft skills are the core skills in complex adaptive systems because these are the skills that connect people, build trust, allow for the power of numbers and create shared purpose and movements for change. When people come together in shared purpose, magic happens. Here are some of the trusting conversations from today:

- A story was shared about a woman who had a personalized budget and chose to get a service dog. Having the dog had the unexpected impact of her requiring a lower personal budget from the CHC. One reason…the service dog could sense when she was going to have a hypoglycemic reaction and could preempt her to respond therefore avoiding crisis and an ED visit. As her service dog was aging she wanted to have a succession plan for a new service dog to be trained alongside her current service dog. The policy wouldn’t allow for it. Now with the collaborative and the support of NHS Horizons to create change agency within all staff, a member of the team advocated, and the policy was challenged. Staff felt empowered and those in leadership roles, removed policy barriers.

- A retiring head of one of the CHCs stood up and said that in his entire career, he has not seen this type of "person-centered collaboration across all of the CHC’s and he is so proud to be making a change in his career at a time when the teams have shared purpose for the first time";

- Another CHC team discussed how patient engagement had been difficult to establish because the forums were inaccessible to patients and caregivers (carers) and patients and families felt the experience was adversarial. The team at the CHC asked patients and caregivers to codesign the approach to engagement and the answers became clearer… location of discussions was moved to accessible locations, patients and caregivers began to co-create agendas. Small steps but a fundamental shift in culture from old power to new power #codesigned. A topic very close to my heart.

- Three staff talked about why they stopped speaking to clients/patients face to face. All three have a role to track complaints; and in reflection they said that they depersonalized the experience because they didn’t feel like they had permission to help. In the past, they tried to ‘help’ and made commitments to clients but then their choices were not supported by senior leadership so they couldn’t follow through on their promises… so they stopped talking to clients. What struck me was that they felt emotionally safe to share this today and what struck me even more, was that everyone in the room rallied to support them and make it a priority to fix. Very brave. Sasha and Pardeep have created a process and a space for these discussions to take place.

The collaborative has grown to connect more than 1000 people working in the CHC community. In the early stage the programme listened to people’s stories. The key themes that needed attention emerged quite quickly. Similar conclusions were reached from quantitative analysis.

As the community has grown the collaborative has contributed to each work stream and also created connections between teams who had never had access to each other.

Overall the programme is on track and the community is still growing.

How did I find my place today with new colleagues and in the middle of a process that has been well underway for two years? I did whatever needed to be done. Capturing key messages and relaying them back, continuously debriefing and checking in with Sasha and Pardeep, connecting with members of the collaborative, handing out and collecting of templates and markers and sharing my reflections. Observing a lot and feeling blessed to be invited in. Also, smiling with how easily I slipped into the team and how open everyone has been to having me join.

We started the day with a two hour drive to the CHC session in Gatwick, UK and I am on the train now heading two hours out by train to our next session for tomorrow in Huntingdon, UK.

Jet lag? No time for that….I'm working in shared purpose…not much gets in the way when I am inspired.