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Psychology 4 Improvement: Aiming for 20% technical and 80% human

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Psychology 4 Improvement: Aiming for 20% technical and 80% human

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What do you get if you cross a mathematician, some improvers and a couple of psychologists?

Is this some kind of joke?

Nope, it's an improvement project called Psychology 4 Improvement (P4I), which has brought together a range of people interested in change in health care. This blog is about how our logo has changed, in line with how our understanding has shifted - of the project, and of each other.

Here's what we started with:

What do you see?

'Psychology 4 Improvement? It's all about brains, isn't it? And run charts?' Our early exchanges indicated that our work together would be something science-y, about experts and data. We'd see some linear progression from the beginning of the project through to some deliverables that we could measure at the end. Wouldn't we? I remember early on in our steering group a feeling of anxiety about having to demonstrate my competence, maybe a pressure to make some clever comments, or use the right jargon.

Even though our starting point was a shared understanding of Marjorie Godfrey's quote that "improvement in healthcare is 20% technical and 80% human", we in fact started with something that felt far more technical. Perhaps this is the play-it-safe, risk-averse culture we are immersed in, and it becomes the default place to start?

Perhaps this is the play-it-safe, risk-averse culture we are immersed in, and it becomes the default place to start?

Even early on, questions were sometimes raised about the logo; is it quite right? Is it a bit too individual rather than relational? But there was tentativeness - it felt best not to risk hurting anyone's feelings, better not say anything that might be too contentious. After all, we were all involved over-and-above our day jobs, and someone has taken the time to design this, so let's just go with it. Perhaps there wasn't the psychological safety to talk about this, or perhaps an alternative logo wasn't obvious as our work was forming.

We met every couple of months. There was a sense of our commitment to the project and each other despite the wider circumstances of the pandemic. There was something engaging and interesting about bringing together our differences. We supported each other in some 'random coffee trial' conversations, we found out more about each other, who we are, and what we're going through. Steering group meetings became noticeably light and fun, and yet there was also a sense of really moving. I'm not sure words like 'progressing' or 'being productive' are quite right. It was more like a richness and depth forming - preparing some fertile soil to grow who knows what. We were enjoying not only working together but also each other's company. We shared a Space for Listening, a sense of connection growing ever stronger as we shared and witnessed each other's vulnerability.

In more recent months, we have noticed a sense of belonging, a feeling of being able to say what we want - a warm, relational process, and a confidence that we can turn up and be ourselves and that we each have something to offer. We have reflected on our close relationships, and our collective strength as more than the sum of our individual parts. We are more than our individual brains, and the process together has not felt linear.

We wonder if this process we have experienced might reflect the wider journey the improvement community might need to embark or continue on. Bringing an understanding of psychology into improvement, realising that the work of improvement needs to be relational if it is to succeed is a key part of our group's work.

So, we decided to develop a new logo. A small number from the group created some options, and then we all fed back our thoughts. Here are the options we looked at:

What was noticeable was the quality of the conversation we were able to have about these images. It felt like an important conversation and also one that embodied a combination of fun, inclusion, creativity, and freedom to express an honest opinion.

And here's the final cut.

It has a combination of clean lines, and is also about people, shades of soft colours, space for discovery and story. There are still brains in there, but they are implied. We wanted something to represent us, and also our purpose; bringing together our rich diversity enabling us to work towards sharing and developing understanding. So we feel more legitimate now in using Godfrey's quote "20% technical and 80% human". We'd want to add to this quote that to us, the 'human' bit is about relationships, connecting in our shared passions, and valuing our differences -the multiple shades and colours we each bring.
Interested in finding out more about the project? Visit the team's project page or read their latest update blog.

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Psychology 4 Improvement: Aiming for 20% technical and 80% human | Q Community

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What do you get if you cross a mathematician, some improvers and a couple of psychologists? Is this some kind of joke? Nope, it's an improvement project called Psychology 4 Improvement (P4I), which has brought together a range of people interested in change in health care.

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Taking a psychologically informed approach to quality improvement

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Taking a psychologically informed approach to quality improvement

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What if you wanted to find out how to build an organisational-wide improvement approach that was grounded in evidence-based psychology? What resources and tools are out there for you to use? This was the question we decided to investigate in 2019.

It is well known that improvement in health and care is 20% technical and 80% human (as noted by Godfrey in Coaching interprofessional health care improvement teams). Yet in practice, quality improvement often does not reflect that balance.

When we started this project in 2019, there was no space devoted to considering improvement from a psychological or relational perspective. Given these factors, we saw an exciting opportunity to establish a co-produced, evidence-based mindset and skillset that foregrounded psychological factors in improvement.

From the start, Psychology for Improvement (P4I) grounded itself in 'co-production', drawing on the ideas and resources across our community, with expertise shared by both improvers and psychological practitioners. To help our work flourish, we established three specific goals:

1. To understand the emotional journey of an improver and support their wellbeing.

2. To disseminate a masterclass from Kate Hilton on the Psychology of Change which included sessions on intrinsic motivation, co-design, and working with power.

3. To create resources relating to psychological safety and its key relevance to improvement.

We developed the P4I Dynamic Model (below) to help visualise these goals.

Those involved have brought not only their technical skills but their creative and imaginative energy to the workshops and discussions, the last of which was held in March 2021.

The steering group rapidly evolved a way of working that privileged connection and relationship, prioritising working experientially over processes that can sometimes stifle creativity and innovation. We were aiming to model the way of working that we wanted Psychology 4 Improvement to promote.

Through the global lockdown and beyond, P4I has been on a transformational journey. We have been delighted by the huge response from the improvement community to this work.

Improvers are hungry to share tools and resources, to connect with each other around the relational and organisational challenges they face in their work and to do further research in this vital area of quality improvement. We are actively looking at ways that Q can continue to support this work, and we would love to hear from you.

If you're interested in working in this area, or would like to stay up to date with our work and resources, please join Q's Psychology for Improvement Special Interest Group.

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Taking a psychologically informed approach to quality improvement | Q Community

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What if you wanted to find out how to build an organisational-wide improvement approach that was grounded in evidence-based psychology? What resources and tools are out there for you to use? This was the question we decided to investigate in 2019.

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Understanding the psychology of change | Q Community

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Institute for Healthcare Improvement (IHI) Psychology of Change expert Kate Hilton joined the Q Exchange Psychology 4 Improvement (P4I) team on 31 March to share her knowledge in an interactive, co-produced session. An open-access recording of the event is now available to anyone interested in this…

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Building a body of knowledge around Psychology 4 Improvement 

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Building a body of knowledge around Psychology 4 Improvement 

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Earlier this year I took part in my first ever #QIHour tweet chat as part of the Psychology 4 improvement (P4I) Q Exchange 2019 project, which aims to help make improvement more effective by developing a body of curated knowledge, practical resources and networking events.
What does Psychology 4 Improvement mean to the QI Twittersphere?

The Psychology 4 Improvement (P4I) Q Exchange project aims to develop a community to lead, develop and role model the importance of psychology for improvement in delivering human-centred, sustainable improvement in health and care.

COVID-19 may have had an impact on how the project delivers its aims, but has also provided new opportunities for virtual interaction: in my case, to be part of a conversation about psychology for improvement across a large network of improvers from the comfort of my own sofa!

The tweet chat was kindly hosted by Lou Waters and the team at Gloucestershire Safety & Quality Improvement Academy (GSQIA), with the aim of incorporating the information captured into the Psychology for Improvement work.

Over the course of the hour we explored experiences and understanding, the feelings and psychological barriers we experience as we engage with improvement, and tools and techniques to support the psychological side.

I was blown away by the richness of ideas and experiences captured within just 60 minutes - and 280 characters! We saw 60 participants generating 555 tweets and over 900k Twitter impressions within the hour, reaching a total of 805 tweets and 121 participants in the 24 hours that followed.

Conducting a thematic analysis of over 800 tweets was a somewhat daunting task, but a great opportunity to revisit the contributions I had missed during the fast-paced tweet chat.

Findings from Twitter

It was widely recognised that psychology for improvement is fundamental to improvement success, with the key themes as:

Connecting people and building relationships

Understanding why change fails, in order to address challenges

Building the will for change

Understanding people and their values and motivations

Self-reflection and awareness of one's own motivations and feelings

The importance of understanding and talking openly about feelings was seen as key to being able to overcome difficult emotions and build psychological safety.

A wide range of emotions were reported at different points in the improvement journey. This ranged from excitement, enthusiasm and hope to anxiety, frustration and anger.

The importance of understanding and talking openly about feelings was seen as key to being able to overcome difficult emotions and build psychological safety.

The psychological barriers for improvement practice included fear of blame, failure, change, loss and the unknown. Other contributions discussed the ego and being inner rather than other focused. Change fatigue, and the need to have time to stop and reflect, was another recurring theme.

Psychological safety was frequently noted as one of the key conditions of change, created through:

Encouragement to contribute

Education and encouragement to be involved in QI

Openness, honesty and building trust

Good leadership behaviour

Fostering a culture that supports failure, learning and innovation

Sharing innovation

Celebrating success, learning and small wins

Listening and engagement

Understanding the mindset and power dynamics of those involved

Coaching skills

Embedding psychological safety into daily processes

A wide range of tools and techniques to support the psychological part of improvement were shared:

Social proof - spreading ideas through informal networks, key 'influencers' and enthusiasts

Building and mapping relationships and networks

Establishing ground rules for a QI session

Creating shared ownership and input through co-production

Asking questions, active listening and appreciative enquiry

Mind mapping and idea generation tools

Storytelling to build will and understanding

Measurement for improvement

Our expertise and passion as QI leads

And finally, ideas to help include more about psychology for improvement in your learning and improvement projects:

Sharing experiences and successes

Practical tools, training and resources

Building P4I into our environments

Mapping relational coordination

The full transcript, links and resources from the tweet chat is available, including all resources, articles and tools shared.

What struck me the most as I analysed the themes further, was the spectrum of emotions related to the challenges of change.

At first sight, the findings appear to map nicely to the existing evidence base around QI. However, what struck me the most as I analysed the themes further, was the spectrum of emotions related to the challenges of change. It was clear that different stages of the improvement journey prompted a wide range of feelings and behaviours. It was reassuring to see that improvers everywhere have faced similar struggles on the improvement rollercoaster!

How can we make navigating this journey easier for ourselves and the improvers we support?

Practical resources would be helpful, but to see these mapped to the different stages of that QI journey of emotions may feel more relational and tangible - while helping us understand we are not alone in some of the more challenging feelings.

We set out to explore the emotional journey of QI further in a follow-up P4I #QIHour tweet Chat and will be sharing more of what we've learned from the QI Twittersphere soon.

If you're interested in this work, check out our project page to be a part of the conversation.

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Building a body of knowledge around Psychology 4 Improvement | Q Community

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Earlier this year I took part in my first ever #QIHour tweet chat as part of the Psychology 4 improvement (P4I) Q Exchange 2019 project, which aims to help make improvement more effective by developing a body of curated knowledge, practical resources and networking events. What does Psychology 4 Improvement mean to the QI Twittersphere?

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Psychology 4 Improvement (P4I) Community of Practice: Update from our first meeting

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Psychology 4 Improvement (P4I) Community of Practice: Update from our first meeting

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Psychology 4 Improvement (P4I) - what's it all about?

We know that W. Edwards Deming talked about a profound knowledge of human behaviour being key to any endeavour that is about changing things, making things better for staff and service user's alike... but what does that actually mean?

It seems to me that the psychological environment within which improvement takes place is a key predictor to achieving aims

When I was trained as a quality improver, it struck me that the thinking at the time was that psychology of improvement was predominantly about motivation theory. Fundamentally important, but it struck me that there was more that psychology had to offer in support of improvement. The habits of an improver Health Foundation publication talks about improvers and uses words like creativity, influencing, learning, resilience; compounded by words like communication, coproduction, empathy, team-playing, optimism, tolerating uncertainty, comfortable with conflict and making connections. It seems to me that the psychological environment within which improvement takes place is a key predictor to achieving aims, and evidence bears this out. Concepts such as psychological safety, relationships, team dynamics, wellbeing, joy and whole lot more are the bedrock for great experiences of quality improvement.

So, are there ways we can support improvers to build this profound knowledge? This is what the Psychology 4 Improvement Q Exchange community are thinking about; aiming to build practical resources to be shared with the wider network, and to do this in a co-productive and inclusive way. This blog is a round-up of resources and ideas that were discussed at the first P4I Community of Practice get-together.

Our first Community of Practice meeting

At the first P4I Community of Practice Zoom call in April, replacing the planned get-together in Bristol, was attended by people from across the UK. We shared thoughts, ideas about what Psychology 4 Improvement means to the community and how we could take this work forward. Sessions included:

Kate Hilton: We were grateful to welcome Kate Hilton to the call, Kate authored the paper IHI Psychology of Change Framework and presented this framework whilst also hosting a discussion around its fundamental principles.

Anna Burhouse: Anna is a founder member of the Psychology 4 Improvement Q Exchange project and presented thoughts and research around psychology of improvement, plus hopes for the future of P4I work.

ABCi Team: ABCi are the P4I Q Exchange fund holding team. Benna Waites chaired this session where Matt Ploszajski presented an overview and update of the Q Exchange P4I work and Rachel Trask presented the Ψ4QI Framework that has been developed within Aneurin Bevan University Health Board.

Thinking Space: Benna Waites ran a Thinking Space session during the call, where all participants met each other and each had space to express their thoughts and experiences around psychology for improvement. This provided a rich seam of thoughts and ideas that will be used to shape the future of the P4I work.

It was great to catch-up with and meet new people who are passionate about developing this area of improvement theory and practice. As a result of the call, participants were surveyed in order to gain an initial view of the priorities and volunteers were invited to be part of the P4I Steering Group, who will lead the work.
If you are interested in contributing, taking part or listening in to what is happening around P4I please join the Psychology for Improvement Special Interest Group. Or if you want to have a chat about P4I please contact Rachel Trask. References
Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, Massachusetts: Institute for Healthcare Improvement; 2018. ( Available at ihi.org)

Lucas B with Nacer H. The habits of an improver: Thinking about learning for improvement in health care. London, UK: Health Foundation: 2015. ( available at health.org.uk)

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Psychology 4 Improvement (P4I) Community of Practice: Update from our first meeting | Q Community

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Psychology 4 Improvement (P4I) - what's it all about? We know that W. Edwards Deming talked about a profound knowledge of human behaviour being key to any endeavour that is about changing things, making things better for staff and service user's alike... but what does that actually mean?

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Experiencing, or being a part of, leading change can be an emotional journey.  Learn from others and create your own strategy.

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Join the Psychology for Improvement Special Interest Group

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Join the Psychology for Improvement Special Interest Group

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Share ideas and learn from others

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Join the next Q Liberating Structures user group meet-up: 3 March (1pm)

We will be trying 'Ecocycle Planning' together in our next meet-up. It enables us to 'Analyse the Full Portfolio of Activities and Relationships to Identify Obstacles and Opportunities for Progress' - in other words, a great tool for a team to step back and reflect together...

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Join the next Q Liberating Structures user group meet-up: 3 March (1pm) We will be trying 'Ecocycle Planning' together in our next meet-up. It enables us to 'Analyse the Full Portfolio of Activities and Relationships to Identify Obstacles and Opportunities for Progress' - in other words, a great tool for a team to step back and reflect together...

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What do people say about their emotional journey through QI?

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Learn about the P4I Project and its aims

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What is the challenge your project is going to address and how does it connect to your chosen theme?

A fundamental precept of improvement science is to understand & influence human behaviour (Deming). However improvement literature & training often focuses on its technical aspects, neglecting its psychological or 'people' factors, despite improvement in healthcare being "20% technical and 80% human" (Godfrey).

Human Factors has attempted to do this, but does not draw from the wider psychological theory base to support key improvement activities such as communicating and influencing staff, building the resilience of the improver and the staff teams they work with and overcoming organisational and cultural barriers.

By building a network and drawing on a range of multi-disciplinary expertise we hope to develop resources to make improvement activity more effective and help to overcome some of the challenges of scale and spread, resulting in systems that are more likely to sustain improvements.

What does your project aim to achieve?

This project aims to bring together the hitherto disparate worlds of psychology and improvement, crossing theoretical boundaries to make improvement more effective.

We want to connect people across organisations that are interested in the human side of improvement & form a Q special interest group. Over the course of a year we will co-produce:

>> A body of curated knowledge about the psychology of improvement;
>> Practical resources that use psychological concepts to support change & are free for people to use & evaluate;
>> 3 networking events across the UK to disseminate resources and spread impact.
The work will draw on the evidence base from Human Factors and Behavioural Economics, as well as the wider psychology research and theory base.

We are inspired by the IHI's 'Psychology of Change' paper (2018) which draws on the learning from Marshall Ganz about grass roots community organising, co-production and distributed leadership. The author, Kate Hilton, is supportive of our project.

How will the project be delivered?

We want to create a special interest group in Q and over the course of the next few weeks start to work up and craft our application to the Q Exchange. We would love you to join us on this exciting journey.

We are hoping to deliver this work using some of the distributed leadership & community organising techniques we are interested in. So we are looking for Q members who would not only join us out of interest, or show that they like this work, but who are also willing to undertake an operational role in the project and be in charge of a part of the budget to help us deliver our goals.

We will assign a proportion of the budget to the special interest group to enable members to take on specific tasks to help curate and disseminate knowledge, develop and test materials and plan and deliver the learning events.

We will use a commons stewardship approach to support a distributed leadership model, seeing our uniting purpose as the wish to create something useful for the Q community and beyond.

What and how is your project going to share learning throughout?

We will host a 4-6 weekly virtual meeting for active participants to share experiences, ideas, successes and failures to shape the learning resources, and this will be summarised as a written update for all Q members to enable the work to be influenced by a wider community of improvers and practitioners with psychological expertise.

We will continue to reach out to the Q Community throughout the duration of the programme to ask for support and input. We will let people know when we have created materials to test. We will ensure that all the resources we create are open access and encourage active feedback and evaluation via the Q twitter space.

We will hold three learning events to bring interested people together, to network and grow the community, to share knowledge and resources and to help improve and refine materials.

We are keen to write up our final learning and disseminate through a peer reviewed journal.

How you can contribute

We are a warm & friendly group of folk who are looking to find other people who are interested in this area. We are looking for people that want to take part in three distinct ways:

>> As a person with an active interest in this area who wants to keep in touch with how we are getting on and can sign post to resources, be a champion for the work and act as a critical friend

>> As a person with expertise and/or enthusiasm who would take a lead in helping to develop resources, thinking, materials etc

>> As a person who loves to plan, design & run learning events and be willing to help us or find us a free venue

We are also seeking your support at this early stage to tell us what you think of our idea and what we could improve. Please let us know if you'd like to join the group and help us make this happen or if you have ideas about how best to embrace co-production and ensure we ground this work in the best way possible

Plan timeline

30 Sep 2019

Set up P4I Special Interest Group on Q Community website

15 Dec 2019

Virtual meeting - plan virtual / site meetings for P4I team

31 Jan 2020

P4I team site meeting 1 - planning network/resource/events

31 Mar 2020

P4I virtual meeting - position update & support/events

15 May 2020

Draft P4I knowledge & practical resources developed

15 Jun 2020

P4I team site meeting 2 - finalise resource/event planning

30 Jun 2020

Knowledge bank/practical resources complete and signed off

1 Sep 2020

P4I virtual meeting - event planning (may need site meeting)

15 Dec 2020

3 national events delivered between Oct-Dec 2020

31 Mar 2021

Learning shared via Q Community & peer reviewed journal

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A fundamental precept of improvement science is to understand & influence human behaviour (Deming). However improvement literature & training often focuses on its technical aspects, neglecting its psychological or 'people' factors, despite improvement in healthcare being "20% technical and 80% human" (Godfrey). Human Factors has attempted to do this, but does not draw from the [...]

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What does psychology 4 improvement mean to the twittersphere?

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Earlier this year I took part in my first ever #QIHour tweet chat as part of the Psychology 4 improvement (P4I) Q Exchange 2019 project, which aims to help make improvement more effective by developing a body of curated knowledge, practical resources and networking events.
What does Psychology 4 Improvement mean to the QI Twittersphere?

The Psychology 4 Improvement (P4I) Q Exchange project aims to develop a community to lead, develop and role model the importance of psychology for improvement in delivering human-centred, sustainable improvement in health and care.

COVID-19 may have had an impact on how the project delivers its aims, but has also provided new opportunities for virtual interaction: in my case, to be part of a conversation about psychology for improvement across a large network of improvers from the comfort of my own sofa!

The tweet chat was kindly hosted by Lou Waters and the team at Gloucestershire Safety & Quality Improvement Academy (GSQIA), with the aim of incorporating the information captured into the Psychology for Improvement work.

Over the course of the hour we explored experiences and understanding, the feelings and psychological barriers we experience as we engage with improvement, and tools and techniques to support the psychological side.

I was blown away by the richness of ideas and experiences captured within just 60 minutes - and 280 characters! We saw 60 participants generating 555 tweets and over 900k Twitter impressions within the hour, reaching a total of 805 tweets and 121 participants in the 24 hours that followed.

Conducting a thematic analysis of over 800 tweets was a somewhat daunting task, but a great opportunity to revisit the contributions I had missed during the fast-paced tweet chat.

Findings from Twitter

It was widely recognised that psychology for improvement is fundamental to improvement success, with the key themes as:

Connecting people and building relationships

Understanding why change fails, in order to address challenges

Building the will for change

Understanding people and their values and motivations

Self-reflection and awareness of one's own motivations and feelings

The importance of understanding and talking openly about feelings was seen as key to being able to overcome difficult emotions and build psychological safety.

A wide range of emotions were reported at different points in the improvement journey. This ranged from excitement, enthusiasm and hope to anxiety, frustration and anger.

The importance of understanding and talking openly about feelings was seen as key to being able to overcome difficult emotions and build psychological safety.

The psychological barriers for improvement practice included fear of blame, failure, change, loss and the unknown. Other contributions discussed the ego and being inner rather than other focused. Change fatigue, and the need to have time to stop and reflect, was another recurring theme.

Psychological safety was frequently noted as one of the key conditions of change, created through:

Encouragement to contribute

Education and encouragement to be involved in QI

Openness, honesty and building trust

Good leadership behaviour

Fostering a culture that supports failure, learning and innovation

Sharing innovation

Celebrating success, learning and small wins

Listening and engagement

Understanding the mindset and power dynamics of those involved

Coaching skills

Embedding psychological safety into daily processes

A wide range of tools and techniques to support the psychological part of improvement were shared:

Social proof - spreading ideas through informal networks, key 'influencers' and enthusiasts

Building and mapping relationships and networks

Establishing ground rules for a QI session

Creating shared ownership and input through co-production

Asking questions, active listening and appreciative enquiry

Mind mapping and idea generation tools

Storytelling to build will and understanding

Measurement for improvement

Our expertise and passion as QI leads

And finally, ideas to help include more about psychology for improvement in your learning and improvement projects:

Sharing experiences and successes

Practical tools, training and resources

Building P4I into our environments

Mapping relational coordination

The full transcript, links and resources from the tweet chat is available, including all resources, articles and tools shared.

What struck me the most as I analysed the themes further, was the spectrum of emotions related to the challenges of change.

At first sight, the findings appear to map nicely to the existing evidence base around QI. However, what struck me the most as I analysed the themes further, was the spectrum of emotions related to the challenges of change. It was clear that different stages of the improvement journey prompted a wide range of feelings and behaviours. It was reassuring to see that improvers everywhere have faced similar struggles on the improvement rollercoaster!

How can we make navigating this journey easier for ourselves and the improvers we support?

Practical resources would be helpful, but to see these mapped to the different stages of that QI journey of emotions may feel more relational and tangible - while helping us understand we are not alone in some of the more challenging feelings.

We set out to explore the emotional journey of QI further in a follow-up P4I #QIHour tweet Chat and will be sharing more of what we've learned from the QI Twittersphere soon.

If you're interested in this work, check out our project page to be a part of the conversation.

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Building a body of knowledge around Psychology 4 Improvement | Q Community

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Earlier this year I took part in my first ever #QIHour tweet chat as part of the Psychology 4 improvement (P4I) Q Exchange 2019 project, which aims to help make improvement more effective by developing a body of curated knowledge, practical resources and networking events. What does Psychology 4 Improvement mean to the QI Twittersphere?

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Watch the Psychology of Change event run by Kate Hilton (author of the IHI White Paper) and co-produced with the P4I team, conveniently edited into sections for easy viewing

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Understanding the psychology of change | Q Community

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Institute for Healthcare Improvement (IHI) Psychology of Change expert Kate Hilton joined the Q Exchange Psychology 4 Improvement (P4I) team on 31 March to share her knowledge in an interactive, co-produced session. An open-access recording of the event is now available to anyone interested in this…

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Psychological Safety for Improvement  Presentation

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Psychological Safety for Improvement  Presentation

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This is a practical guide to help teams and leaders in their improvement work

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2021-12-18 -- PSY4I -- Psychological Safety

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https://q.health.org.uk/community/groups/psychology-for-improvement/document/?folder=21097

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Jen Morgan, Q's Head of Design and Collaboration, shares how this year's in-person Q community events will create space for you to connect with others and lead the change you would like to see through Open Space.

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Psychological Safety & QI  Reading & Resources List

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Psychological Safety & QI  Reading & Resources List

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Want to know more about Psychological Safety? Here are great resources from a quick 2 minute read, videos, podcasts or if you want to invest more time, papers, guidance and books

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The Slam Partners REACH© Coaching Framework enables people to have straightforward and healthier conversations that lead to positive actions.

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REACH Coaching Framework for Improvement_

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This is an invitation to take part in #SpacesForListening, one way to bring people together, and develop a sense of personal connection, in support of improvement work.

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Follow on Twitter @Psychology4I

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What has changed to make change happen so quickly?

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What has changed to make change happen so quickly?

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For the past few weeks I have been helping co-ordinate our COVID-19 response in our NHS organisation which has been a huge task and a real emotional rollercoaster. The pace and scale of change in our organisation over the past weeks has been astounding.

The pace and scale of change in our organisation over the past weeks has been astounding

In my organisation, a mental health trust, we are behaving and working differently with respect to change. Our services have been re-designed to face the challenge of staffing shortages, new physical health needs and mental health effects of the COVID-19 pandemic. It took us 10 days from conception to opening a 24 hour Mental Health Emergency Department, we reduced bed occupancy from over 100% to less than 85% (previously a pipe-dream) and introduced virtual clinics and home working. We are far from unique and up and down the country transformation of all types of services are happening. All of this happened without a single business case.

This has made me ask the question, "What has changed to make change to happen so quickly?"

Firstly, it is important to say that none of the changes have been perfect. It is not clear whether what's happened is offering a better experience for our communities and we do not know how safe the changes are. What is true, however, is that the resistance to change that seemed to burden those of us wanting to make change happen has all but vanished.

We have to acknowledge that much of the change is driven by fear and anxiety and it is not a sustainable situation

Often trying to get change to happen can feel like pushing against an immovable object and inertia can be a great demotivator.

Over the past weeks, I have experienced times of working with almost no resistance, like I was working in a gravity-free space, where a gentle force applied to change something accelerates quickly with the support from others. For anyone familiar with the work of Ralph Stacey and complex adaptive systems, the amplifiers of change ideas in networks have been very powerful and the inhibitory networks seem to be slumbering. I thought it was worth thinking about the shift in mind-set that has occurred.

John Kotter described the need to create a sense of urgency in order for transformation to happen. For many organisations, an existential crisis is needed. I think we can agree that we all share this sense of urgency and impending crisis. We have to acknowledge that much of the change is driven by fear and anxiety and it is not a sustainable situation. The risks of burn-out and psychological trauma are clear. Thankfully, awareness of staff wellbeing has been high on the agenda in many places.

Reflecting on some of these changes in my own work culture here are some thoughts:

1. The Burden of Assurance and Governance has reduced. Many involved in QI feel strongly that the balance between assurance and improvement is tilted heavily towards assurance which can often be a real hindrance to change and a culture heavy on assurance can stifle creativity and motivation. Over the past weeks' performance scrutiny, attendance at assurance meeting (which most people are loathe to attend and at least in my context do little to improve our system) and commissioner demands, which can cause discord, have disappeared. Released from some of the unnecessary scrutiny and burden people feel more confident and empowered to make change happen

2. Reversal of accountability. In Crossing the Quality Chasm (2001) Don Berwick and others described four levels of healthcare - from patient/community/microsystem/organisation/environment - and I remember him expressing the view that we needed to shift the direction of accountability towards the patient rather than up-the-chain of command within the organisation. I think in some ways this has happened. I have noticed many examples of senior leadership shifting from directing/demanding, to asking "how can I help?" and working to solve problems or overcome obstacles. As in point one, this creates psychological safety, a key ingredient in the psychology of change.

3. Shared purpose. There is an undeniable sense that we are in this together and people are working hard for each other and looking out for one another. I think the narrative around what is happening is so clear and undeniable and many people have reconnected with their own sense of purpose in what they do and why they do it. It also probably makes the fear and anxiety more manageable.

I am not trying to paint an overly positive picture. The pressures on our staff at all levels are enormous. But change is happening fast and people are being creative and innovative at a level I have never seen before. We would do well to try and understand some of the psychology behind this and how we can harness this in the future, hopefully not in the shadow of a horrible pandemic.
Find out more about Psychology 4 Improvement via the Q Exchange project page. You can also join the Psychology 4 Improvement Special Interest Group to stay up to date on the project's work.

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What has changed to make change happen so quickly? | Q Community

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For the past few weeks I have been helping co-ordinate our COVID-19 response in our NHS organisation which has been a huge task and a real emotional rollercoaster. The pace and scale of change in our organisation over the past weeks has been astounding.

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Learn about Compassion Circles

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Learn more about using Schwartz Rounds

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[These stories] ... tell us about the pressures of working in healthcare and the importance of sharing stories and emotions

Peter Wilkinson, Schwartz Round clinical lead
This film shows an edited version of a Schwartz Round taking place at Ashford and St Peter's Hospitals NHS Foundation Trust
Find out more

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Schwartz Rounds - Point of Care Foundation

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These stories] ... tell us about the pressures of working in healthcare and the importance of sharing stories and emotions Peter Wilkinson, Schwartz Round clinical lead This film shows an edited version of a Schwartz Round taking place at Ashford and St Peter's Hospitals NHS Foundation Trust Find out more

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Enabling voice through Liberating Structures

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Enabling voice through Liberating Structures

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Introduction

When you feel included and engaged, do you do a better job? Do you think teams in which people work well together produce much better results? Have you noticed the best ideas often come from unexpected sources? Do you want to work at the top of your intelligence and give the same opportunity to others?

If YES, we have found this is the kind of organization and community that people want to be part of. AND, Liberating Structures help make it happen.

So why is it that so many organizations of all stripes are filled with disengaged workers, dysfunctional groups and wasted ideas?

While there will always be some justification for blaming leaders (or professors and administrators in education), the more compelling and useful explanation is not that people involved are bad, stupid or incompetent, but rather that the practices they have all learned are neither adapted to today's realities nor designed to achieve the ideals listed above.

Unwittingly, the conventional structures used to organize how people routinely work together stifle inclusion and engagement.

Conventional structures are either too inhibiting (presentations, status reports and managed discussions) or too loose and disorganized (open discussions and brainstorms) to creatively engage people in shaping their own future. They frequently generate feelings of frustration and/or exclusion and fail to provide space for good ideas to emerge and germinate. This means that huge amounts of time and money are spent working the wrong way. More time and money are then spent trying to fix the unintended consequences.

Liberating Structures start with something so simple and essential as not to seem worth doing and end with something so powerful and profound that it hardly seems possible.

This website offers an alternative way to approach and design how people work together. It provides a menu of thirty-three Liberating Structures to replace or complement conventional practices.

Liberating Structures used routinely make it possible to build the kind of organization that everybody wants. They are designed to include everyone in shaping next steps.

Liberating Structures introduce tiny shifts in the way we meet, plan, decide and relate to one another. They put the innovative power once reserved for experts only in hands of everyone.

This alternative approach is both practical and feasible because Liberating Structures are quite simple and easy to learn. They can be used by everyone at every level, from the executive suite to the grassroots. No lengthy training courses or special talents are required. Mastery is simply a matter of practice. LS routinely unleash a vast reserve of contributions and latent innovations waiting to be discovered.

Every person interested in leading change-in schools, hospitals, foundations, agencies, and businesses-can use Liberating Structures to generate innovation and great results.

Liberating Structures are easy-to-learn microstructures that enhance relational coordination and trust. They quickly foster lively participation in groups of any size, making it possible to truly include and unleash everyone. Liberating Structures are a disruptive innovation that can replace more controlling or constraining approaches.

Click on any Liberating Structure below.

Leaders know that they would greatly increase productivity and innovation if only they could get everyone fully engaged. The challenge is how. Liberating Structures are novel, practical and no-nonsense methods to help you accomplish this goal with groups of any size.

Liberating Structures spark inventiveness by minimally structuring the way we interact while liberating content or subject matter. Very simple constraints unleash creative adaptability, generating better than expected results. Individual brilliance and collective wisdom are unbridled. Such a dramatic shift cannot be THAT simple, engaging, and powerful but it is. Read Getting Started if you are ready to liberate yourself.

By design, Liberating Structures distribute control so that participants can shape direction themselves as the action unfolds.

Learning Events

Immersion workshops are a great way to get started. Like a foreign language immersion course that temporarily relocates you away from a familiar culture, a LS immersion experience is a very effective way to learn. There are no presentations, facilitated discussions, status reports, brainstorming sessions, or open discussions. Only Liberating Strucutres arepracticed. Organizing a workshop for people in your working group can accelerate "fluency."

Check out News and Events for more immersion workshops and LS User Group meetings. Subscribe to LS News & get access to archives here.

Liberating Structures are immeasurably practical. Our world is increasingly complex, interdependent, and culturally diverse. Many of our most pressing challenges cut across geographic, cultural, and technical boundaries. Simple methods that help us work together productively are central to making progress.

Helpful Analogies
Like Wikipedia, LS create simple rules to guide and liberate everyone's contributions. Wikipedia's must-dos and must-not dos specify how anyone can write articles, edit content, reach consensus about the facts, and share with attribution. This structure makes it possible for a diverse community to generate and sustain accurate content that compares favorably with professionally edited encyclopedias. Like Wikipedia, LS is a disruptive innovation in regard to how we engage people in organizations.

Like improv jazz, LS sparks freedom that arises from shared understanding of simple rules. Great jazz comes from playing creatively within the context of melodic and harmonic structure. Like water in a river, LS takes the shape of the banks that it touches: adapting a similar pattern at every scale and in each local setting.

Below: watch this inspired video by Professor Arvind Singhal talking about liberating education and the role of changemakers. UnScripTED: Liberating Structures

Read this practical article "Tiny Tweaks That Help You Use LS" by Barry Overeem.

Simple Ways to Engage Everyone on Zoom: Learn Several Liberating Structures in 30 minutes from Media Changemakers on Vimeo.
Unscripted #2 Liberating Structures with Dr. Arvind Singhal from Media Changemakers on Vimeo.
Lisa Gill is a fabulous writer and top drawer interviewer. Her Leadersmorphosis series dives deeply into self organizing @ work. Put your ear to this interivew she conducts with Henri and Keith.

Below, enjoy scenes from the LCJP Restorative Justice Summit. Liberating Structures were used to organize a three day event full of learning, designed to advance the Restorative Justice movement. Restorative Justice (RJ) aims to create communities in which people feel safe by carefully structuring opportunities for offenders to make amends and victims to regain their personal power. Restorative Justice practitioners found Liberating Structures to be highly structured, liberating better than expected results.

2012 CO RJ Summit Video from LCJP on Vimeo.

LS were used to design the Transformation of Nursing summit. Coalitions from all 50 states and DC came together to advance the cause.

For the United Nations ITC-ILO, Henri and Keith offered a Liberating Structures immersion workshop and follow-up consulting sessions. (The Centre is in Turin Italy.) The focus was how to organize for promoting decent work and sustainable development by not over-helping but rather facilitating networked self-organization.

Ten Principles

While the individual LS microstructures are powerful separately, they function as an interrelated set which can transform an entire organization. The LS repertoire is inspired by ten liberating principles.

When we decide we belong together, LS principles help to guide behavior and leadership actions. Detailed descriptions here.

The Surprising Power of Liberating Structures book! Preview and buy on Amazon. The color paperback ($49.95 USD), black&white ($19.95 USD) and e-book are now available on the Amazon website. Amazon offers deep discounts and free shipping to some customers.

The development team at Holisticon is happy to announce that the Liberating Structures App is now available in the Google Play and Apple App Stores. A deep bow to their creative genius. Happy downloading!

Audio: A very playful Brave New Work podcast with Aaron Dignan and Rodney Evans. On Liberating Structures with Lorenz Sell of Sutra and Keith. Lorenz asks the deepest questions about collective intelligence, generativity, and complexity science. (50 minutes) Coaching Zone Podcast with Keith and Dr. Krister Lowe. The focus is on how leaders and teams can develop more productive habits with LS. [45 minutes] Radio Interview with Meisha Rouser, organizational psychologist. The focus is on groups working at the top of their intelligence and imagination. And a third podcast interview with Amiel Handelsman that dips into specific LS microstructures and their use by groups to generate innovative cultures. [60 minutes].

Check out Falling Off the Horse while faciliating & leading with Liberating Structures. This article by Keith McCandless describes a personal path forward. It includes what is possible to stop doing when LS is integrated into your practice.

LS are inspired by complexity science. Listen to this entertaining RadioLab program on Emergence to learn about some of the underlying concept of complexity science.

LS User Groups (inventing and enlivening a new way to organize) Open Letter from a Grateful Student to All Educators
Rhapsody for Strings!

Below: early LS users and co-developers in Latin America, Europe, Canada and the USA.

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liberating structures, social invention.net, microstructures, disruptive innovation, behavior change, collaboration, social invention, diffusion of innovation, strategy, transformation, heuristics, complexity science, emergence

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P4I Psychological Safety Resources on Q Community Webpage

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P4I Psychological Safety Resources on Q Community Webpage

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Jen Morgan, Q's Head of Design and Collaboration, shares how this year's in-person Q community events will create space for you to connect with others and lead the change you would like to see through Open Space.

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Final report...almost, of the Psychology 4 Improvement Project

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Welcome to Psychology 4 Improvement 's (P4I) first blog! This blog intends to introduce you to a few of the founding members of this Q Exchange project and how their interest in this area, brought them together to form this piece of work.
Anna Burhouse, Director of Quality Development (South West - England)
When I look back, I realise that I have been really interested in thinking about people and culture since I was ten years old, when I was lucky enough to spend a year living in Copenhagen and became fascinated by why people did things differently. Fast forward through my life and you'll see that I studied Social Anthropology at university to deepen my thinking about culture and then spent eight years qualifying as a Consultant Child and Adolescent Psychotherapist exploring the impact of human behaviours and people's internal working models of the world.

Quite quickly I realised that only 20% of quality improvement is about the technical skills and knowledge needed to improve, and 80% is about people skills

I have worked in health and social care for over 30 years and remain perpetually curious about what makes people tick. In the early 2000's I also started to get interested in how to improve the NHS and learnt how to use quality improvement tools and methods. Quite quickly I realised that only 20% of quality improvement is about the technical skills and knowledge needed to improve, and 80% is about people skills. I recognised the fundamental importance of 'psychology' in W. Edwards Deming's Lens of Profound Knowledge and how few QI training resources in the UK at the time spent any time teaching the kind of skills needed to do this well. Since then I have been practising how to effectively combine the two skill sets in any quality improvement work I do and offering training and coaching in this field.

This has happily enabled me to meet a lot of like-minded and inspirational people, who also want to help other improvers build their knowledge and experience of people skills. One of these inspiring people is Kate Hilton from the IHI, who organised a 'Psychology of Change' development day in South London. At the end of the day, a small group of us pledged to work together to create a bid for the Q Exchange programme.

We have worked together for several months now and are delighted that the Q community voted to support this work. We hope to develop materials for the Q community, hold three engaging events and to stimulate a wider interest in this topic in the improvement arena.

My personal hope is that we can share the strong evidence base for the importance of collective compassionate leadership in improvement, think about improvement as a highly relational approach, signpost to creative ways to unleash intrinsic motivation, think about how best to share power and co-produce in healthcare and recognise the importance of individual and group reflection. I hope we can learn from others in the group, grow the number of people in our community of practice and encourage diversity of thought and share resources and thinking widely and generously with others.
Benna Waites, Joint Head of Psychology Counselling and Arts Therapies (South Wales)
I am a Consultant Clinical Psychologist and job share the role of Joint Head of Psychology, Counselling and Arts Therapies for Aneurin Bevan University Health Board. I was brought into ABCi, our organisation's QI team, part-time, to create a leadership programme that drew on the evidence base around sustaining compassionate care. There is much of that work that has relevance to Psychology for Improvement, such as psychological safety for example. Building relationships with colleagues in the improvement team, I was struck by how challenging the work of improvers is. I noticed that much of what seems to be difficult in QI is around engagement, ownership, and beliefs about the work, as well as the oft-cited challenges of time, resource and staffing issues. I became really interested in whether we had nailed the framing of the problem and whether improvers had all the skills and understanding they needed to what essentially seems to be much more of a relational challenge rather than a technical one.

I noticed that much of what seems to be difficult in QI is around engagement, ownership, and beliefs about the work

I met Anna at the Bristol Patient Safety Conference when she presented on Psychology for Improvement in 2019 and was delighted to hear that her thinking was so aligned with our own in ABCi. She connected us up with a wider group and together we developed the Psychology for Improvement project bid.

It's been fantastic through the process of the Q community bid to connect up with other people with similar interests both nationally and internationally and I'm looking forward to building a shared understanding of what knowledge and competencies might be helpful to add to the repertoire of existing quality improvement skills and knowledge.
Rachel Trask, ABCi Improvement lead (South Wales)
As Improvement Lead and an Improvement Advisor, I am responsible for building QI capability within our health board and supporting others to improve their services. Basically I am an 'improver' and have been so for the last 15 years or so. Over the years I have enjoyed working and had great conversations with, clinicians, managers, operational staff and strategic leads for QI across the country, all of whom are improvers like me. Over this time it has dawned on me that improvers had a specific set of struggles and that these weren't about how to set up a measurement strategy, create a driver diagram or learn from a PDSA. The things people were losing sleep over were: 'How do I create positive working relationships to engage, influence and empower others?'

It has dawned on me that improvers had a specific set of struggles and that these weren't about how to set up a measurement strategy

Issues about ownership of change, learning from failure, being safe to raise ideas and resilience in the face of increasingly pressurised organisational conditions are what improvers are facing every day. In ABCi, for the last 2 years or so, we have been reflecting on these struggles and how to build capacity, conditions and connections to support improvers in their work. However, for me, P4I starts but does not end with, the individual.

'The first step is transformation of the individual ... the individual transformed, will perceive new meaning to his life, to events, to numbers, to interactions between people.' Deming.
Lorraine Moutel, Patient Safety Lead (South West - England)
I am a nurse and work as a Quality Improvement, Patient Safety Lead at North Bristol Trust. Whilst working with colleagues on quality improvement projects, I have often found that it's relationships, trust and understanding that cement the work. Colleagues wanting to carry out improvement are often seeking permission and have concerns around being allowed. We have lots of tools to support quality improvement, but perhaps not enough emphasis on relationships and understanding.

So, after I found myself stranded at Paddington train station (because of an incident) following an event by the IHI on the Psychology of Change Framework, with Anna Burhouse, who I know well from her days at our local Academic Health Science Network, and Ashley Gould from Public Health Wales, a new acquaintance that day. We started to talk about psychological safety and the human/ technical side of change. Anna asked if myself and Ashley would be interested in presenting with her at an AHSN conference in September, which I thoroughly enjoyed, and later involved us in the bid.
Charlie Jones, Specialty Lead for Clinical Psychology (Medicine Division, North Bristol NHS Trust)
I'm a Consultant Clinical Psychologist with a passion for systemic and relational approaches to supporting the wellbeing of the NHS workforce. I'm a dad with two lively twin boys, Freddie and Noah.

We need to create enabling and sustainable conditions for safe, honest conversations, with deep listening

We know from our experiences of our own family lives that to sustainably give care, we need to feel cared for and supported ourselves. Similarly in healthcare, a big predictor of safe, compassionate care is the state of mind of the care-giver; the nurse, the doctor, the carer. How is the carer feeling? What's the quality of thinking? I'm passionate about finding a variety of ways to support the state of mind and emotions of the caregiver, and I see this as a key role for clinical psychologists within healthcare systems. We need to create enabling and sustainable conditions for safe, honest conversations, with deep listening. I think these relational and organisational conditions are at the heart of improvement: it's about people, about the so-called 'soft' stuff.

I was thrilled to attend the Psychology of Change event in London and meet in person Anna Burhouse and Kate Hilton, who I'd previously been in touch with online. It was an energising event and I met so many inspiring people. There was a shared buzzing energy to invest more of our efforts in the psychological side of improvement. It was then fantastic to have backing from the Health Foundation and the Q community to take this work forwards through the Q Exchange programme.
Watch this space and expect more blog posts from P4I as this piece of work evolves. Find out more about the project on our Q Exchange project page. If you're interested in becoming a member of the steering group for P4I, please email Samuel Thornton. You can also join the Psychology for Improvement Special Interest Group.

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P4I: Let's introduce ourselves - Blog #1 | Q Community

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Welcome to Psychology 4 Improvement 's (P4I) first blog! This blog intends to introduce you to a few of the founding members of this Q Exchange project and how their interest in this area, brought them together to form this piece of work.

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Building a Psychologically Safe workspace - Amy Edmondson

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Building a Psychologically Safe workspace - Amy Edmondson

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Amy Edmondson Ted Talk describing Psychological Safety

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Building a psychologically safe workplace | Amy Edmondson | TEDxHGSE