Capturing the voices of leaders on the the AQuA LIT programme – June 2020 – A personal view by Rob Young, Writer. Illustrations by Matt Worden.

These are remarkable times. COVID-19 has ravaged our planet like a wildfire. It’s twin barbs of fear and infection have changed the way we live our lives forever, for those of us who still have one.  While it is easy to think of lockdown as “The World on Pause” for key workers, that is not the case. Their already formidable workload has rocketed as they brace themselves against the pandemic, forming a human chain to protect us all.  The pace of change is ferocious, its scale unprecedented and the human cost, both global and intimate, is humbling, tragic and raw.

As with all times of crisis, the human spirit shines through. Acts of kindness bloom like flowers in the wasteland. Sharp minds and tired bodies spring into life, finding new Mercurial ways to combat the crisis with astonishing speed and resilience. Every new challenge, and there have been many, has been met with a calm, clear head, breaking it down into core components to diminish, disseminate and dissolve. And yes, we have been anxious but that sharpens our resolve.

We adapt, survive, survive better. New roles, new teams, new leaders, all sharing the common goal of proactive, positive change. We have never learned so fast.

This is a sad and stressful time, but it is also one of great transformation. Health and care practitioners, leaders and managers find themselves liberated, as the firestorm of crisis burns away red tape. The fertile ground it leaves behind enriched with newfound experience. Trust is scattered like seeds and the roots grow quick and deep, so once this crisis is over, we will be stronger, taller, proud.

In June 2020, I attended a reconnections event for health and care leaders.  Initially scheduled as a celebration event at the end of an AQuA Leading Integrated Teams Programme to look back on what we had learned, it was re-imagined as a COVID crisis check-in.  As creativity is a core part of the leadership programme, participants took this in their stride and warmth exuded from the screen.  As an outsider, I found it interesting that in a confederation of leaders there was not one single ego.

What follows is the verbatim text of that meeting. Their words are so eloquent, there’s no need to paraphrase, translate or embellish.  All I have done is remove the names to keep things confidential and rearranged in order of theme to aid the narrative flow. What strikes me, every time I read it, is the positivity and the fact that feeling fragile boosts your empathy and that is a strength not a weakness. These are not ‘mythical health and social care heroes’, but real-life human beings doing the best that they can.

I have been a fan of the AQuA journey for many years now, but this time felt different – the distilled essence of leadership learning in the pot-boiler atmosphere of a global pandemic.  Stressful, of course, but also euphoric. 

We simply asked a set of questions and listened to their compelling reflections

What have you appreciated about your team during Covid?

It was described as a Tsunami that was coming towards us.

It hasn’t been easy for them, but it hasn’t been easy for anybody.

I’ve been off with the dreaded Covid, it’s been awful. You can understand how lonely it must be for people who are frail, elderly and on their own. It’s not been pleasant, it’s been… different.

My teams are all hospital-based, so we’ve got digital co-ordinators, end-of-life nurses and social workers. They’ve had change upon change.

With the onset of Covid, we had to rapidly transform the service and divert all of our appointments to telephone, so it involved about 250 clinicians. It’s been amazing. We virtually transformed the service overnight.

I don’t think we’ll ever have staff in the hospitals as we’ve had them before. Changes that once met with resistance have been given permission, enthusiasm and acceptance, which is fantastic.

The achievement of the clinicians has been unbelievable. People are working in community, they’re doing assessments from home, it really has tipped everything we’ve done on its head.

The ways we work are changing.

They’ve taken on front-line work with humility and that’s allowed them to experience what life is like for some of the services that they’re helping to transform. Also, what things are like for residents, the real nitty-gritty of what that’s like. What they’ve taken from all that, emotionally and personally, is being able to connect.  I found that really touching.

They’re resilient, kind and supportive of each other. They’ve got a WhatsApp group where they can connect. It’s been good as working from home, they haven’t got a colleague sat next to them to just run something by. I’m proud of the team and how they’ve pulled through it and are still pulling through.

There’s a lot of good and if we can secure the finance, going forward, it will stick.

It’s been good. It’s been challenging.

Reflecting on the way that you have worked during the Pandemic, what do you want to ‘hold on to’ as things unfold?

The messages I was getting back was that the teams had been quite isolated, so felt scared working in new environments, but they have done it, under difficult circumstances, so how can we continue to do that? And what I can learn from it?

Remote options and the use of technology has sky-rocketed in recent weeks. That is something we want to hold onto. I’m sure many of us will.

Using new IT systems like Microsoft Teams, I’ve been able to chair a lot of safeguarding meetings. In the past it’s been hard work synchronising timetables, booking a room, freeing up time, but now, it’s been so easy.

Because of digital and remote working, it’s given a lot of flexibility and new focus. It’s been really positive. People have got much more of a can-do attitude, to be innovative and creative.

If we took our sexual health services, for example, almost overnight we had a long-term transformation plan stretching across the next three years. In a very short period of time, there is telephone consultation, digital offer, postal contraception, ‘scoping of telemedicine’ type approaches in those services.

We’ve seen similar across other things, remote clinical sessions from health-visiting school nursing, more innovative ways for people to access things like breast-feeding support, anti-natal education, which seems to fit better with a lot of people’s availability and lifestyle.

The extension of that is the number of things that we are able to make work, successfully, such as working from home or working different patterns to support childcare commitments. Those flexibilities and digital transformations are really important to me.

Working from home has always needed permission from a manager but staff have been put in a position now where, unless you’re on some kind of duty rota, you’re working from home. The flexibility it’s given a lot of the staff, especially those who have children, has given them permission to work out their day for themselves.

They’ve also had to work on the wards, when they haven’t done that for a long time. Staff recognising that they’ve still got those skills. How we keep that up, keep staff multi-skilled and keep those skills up to date?

Something that Covid has forced is that teams have come together enabling us to view the whole system. We could do this before but Covid has forced quick decision-making and trials that would never have happened at this speed. Things that were on the horizon have just happened.

A lot came out of this. There has been a real freeing up. It has been very galvanising, enlightening for people who are on the front-line.

The main thing for me was that everyone pulled together to achieve a specific goal. Everybody had the same vision. A more integrated way of working. People felt empowered. They were being brought into the decision making, as opposed to a top-down approach.

It is a different kind of leadership than ‘command and control’.

There was less red tape, so they didn’t have to jump through a hundred hoops. It was a different kind of system than we had been in a few weeks ago. It has totally changed. How will the services now take things forward? It will be interesting to see how things unfold.

We need to hold onto the gains.

What key learning from the programme have you used during the Pandemic?

It’s been a good opportunity to clarify our purpose, roles and priorities and get those in place again. It’s going to be different, but the staff need to be reassured. They’re scared, it’s the uncertainty, it’s the change after change, so the psychological safety is really important. You’re looking after them and they’re looking to you.

Trust but that’s become more important. We discussed the fact that ‘a team is a group of people who trust each other’ and I’ve used that in my team.

The programme has reminded me of is the importance of networks, the value of being connected into things, on the likes of Twitter, think tanks and organisations like AQuA, who have been in helping me wade through all that. That’s been an important personal learning.

In the coming weeks, we start to do a lot more recovery planning, what are the minimum responses to keep this service ticking over? What might we need to step up, and step down, in terms of support as Test and Trace comes in?

We’ve started to see is the formation of new and different teams. It’s going to be key, for me, to take on a leadership role, with new teams and people coming in weekly. I’ll be looking back, digging into to the tools to help me through the process and help them gain some clarity.

We’ve touched on leadership roles and what tools we’ll need going forward from the AQuA programme. It’s a leadership role that will fit within any system. What we’ve learned we’ll be able to take forward. It’s being able to re-quantify some of the team objectives because it felt like, we’ve had to go back to basics and revisit the questions, what is our core business?

When people come up with new plans we’re asking, how can we help get you where you want?

My journey has been more personal. I’ve been reflecting, what’s worked well over the years? What hasn’t? I’ll learn from that and move forward, enabling people to make decisions as close to the patients as possible.

What are the leadership qualities that have been the most effective during the crisis?

Some of the team managers have struggled, emotionally, so it’s about giving them support, because they’ve been holding up their teams.

It’s almost like we’ve gone through a bereavement, we’ve had that initial shock, mass panic of, “What are we going to do?” then dealt with the different stages. We had the deep cleaning of the hospital, a couple of weeks deciding how we’d adopt the new legislation and guidance that was coming through and at every stage, there are staff wanting reassurance, being emotional and scared.

I saw the whites of Social Worker’s eyes being asked to go and see Covid positive patients. They were saying, “Well, we’re not going to go, are we?” and we replied, “Yes you will. At the moment, they’re ill but as the hospitals fill up, you will have to visit them”.

I understand that sometimes they want to come and just… vent, but other times, they’re frightened. You reassure them, “This is why we’re doing it, this is best practice” while setting them up that this is going to change again.

We’ve had to step up in our leadership role because we’ve had to be supportive with staff who are frightened and bewildered.

With PPE, in the first few weeks, the official guidance must have changed 4 or 5 times, “Is it a mask? Is it gloves and a pinny?” It was understandable that staff were frightened.

What this process has taught me is the importance of being able to hold hands and lead people to a different way of getting results.

You had to be a leader no matter what you were doing. It’s caused you, pretty much overnight, to rethink how you do what you do.

I could see elements of the collaborate and compassionate leadership coming together as we went through different stages.

Michael West was talking about Compassionate Leadership before all of this and I see that now. You’re seeing, hearing it, feeling it. For the good.

This has levelled the playing field

We’ve all been in the same boat.

We’re all in it together, a little bit uncertain but trying to stay as positive as possible.

There’s been no hierarchy about who knows the most and what we should do.

One of the leadership qualities that really stood out, is that you don’t need to know all the answers, just create the conditions where answers can come forward and help put those in place.

When you’ve got a team like mine, they’re doing the leadership by your side. It’s pushed them into a different space, which has been lovely to see. And the services have thrived.

It has also grounded people. I’ve found that many people have been looking too far ahead, asking what will this look like in the future? And we don’t know, we don’t have the answers, we’ve been learning as we go. We need to allow people time to reflect. We don’t know what that’s going to look like in the future and that’s OK.

You know good leadership when you see it.