The rumble of the grumble

We’ve all been there. We’re driving along. Maybe we are tired. Maybe something distracts us. Maybe we’re taking a bit of a risk. R-U-M-B-L-E!!!

You may be one of the countless people who owe their lives to an incredibly simple invention. The rumble-strip. I know that I am. A sudden noise and vibration alerts us to imminent danger. It jolts us back to attention and we take immediate action. We live to tell the tale. Or maybe we’d prefer not to tell anyone. Either way, disaster is averted and we learn our lesson.

“Rumble-strips” in healthcare

There are many equivalents to the rumble-strip in healthcare. Lights flash. Beeps change. Tools and communication devices vibrate. They send and endless array of signals and messages. What do they have in common? Well, most obvious is that they all typically indicate something has changed and action is required. But it’s also worth noting these examples are all patient-focused.

Clearly, we want patient safety. But what about the safety and well-being of the people who deliver the care? What about the doctors, nurses, managers and other professionals you work with? After all, burnout and breakdowns are all too common. When do we notice when things start to go wrong with healthcare workers? All too often, breakdowns and burnout are only noticed when things go badly wrong. It’s too late to take action. And when people breakdown and burnout it can be permanent. So where are the rumble-strips to alert us to those issues?

Could it be that grumbling is the rumbling that should grab our attention? Well, yes – and no!

Grumbling

A grumpy cat

It’s normal to grumble. In fact, psychologists believe that a bit of a grumble is good for us.

Sometimes it is just a safety valve. We need to let off steam about the things that frustrate us. This is particularly true when things are beyond our control. A good old grumble let’s us get it out of our system and move on. It also has a role in building and maintaining relationships. Sharing thoughts, feelings and opinions with others is an act of trust. It’s also a normal human approach to finding common ground with others. Common ground and trust helps us to form teams. Best of all, talking about our frustrations can be the first step in making something happen. It can be a catalyst for change.

So the grumble itself isn’t the danger signal rumble-strip noise.

Changing rumble of the grumble

Some roads we drive on are much noisier than others. But the humble rumble-strip even works on the noisiest roads. That’s because it alerts us to change by providing change. The sound changes. The feeling of the steering wheel changes. This same ‘alert-to-change by providing change’ idea is true of the various vibrations, bleeps and flashes mentioned earlier. The regular grumbles of the healthcare workplace are akin to the background noise on a very rough road. It’s change in the noise that should make us sit up and pay attention.

We make good use of a 5-aspect model of resilience on a number of our courses. Basically, we are at our strongest when we are positive, focused, flexible, organised and proactive. So, any negative change in any of these elements can be the early warning rumble that someone is struggling. And for resilient teams we need to consider both ourselves and those work with.

A few questions

Have you noticed any of the following changes in either in yourself or any of your colleagues recently?

  • An increase in negativity or general grumbling?
  • Grumbling about things at the ‘wrong time’? For example, grumbling to a patient.
  • Grumbling becoming increasingly fixated on one particular thing?
  • An increase in resistance to change or willingness to adapt?
  • A decline in levels of organisation, punctuality or complaining about ways of working?
  • An increase in negative reactionary behaviour or expressing lack of autonomy?

As mentioned, each and every one of us will have a good old grumble from time to time. It’s the changes in frequency, intensity or duration which should grab our attention. They can be the equivalents of the rumble-strips which have saved countless lives and careers through the years.

Finally, we must also look out for the change which is one of the most powerful, yet easily missed alarm signals of all. Silence.

Have noticed a change in anyone’s grumble levels recently?

Stephen McGuire – Director of Development

An alternative to achieving the plan?

A target in the sky

Focus. Clarity. Methodology. Discipline. Determination. Overcome the barriers. Success!

When we need to make improvement, what we need to change or create can often seem obvious. We need to clarify what we want to achieve. When that’s done, we must define how we are going to get from where we are now to where we want to be. Then we need to rise to the challenge. We have to get on with the tasks – along with the conflicting demands of everything else that is expected of us – if the planned change is to become real. But it can all go so wrong.

In fact it can go very wrong in many ways for numerous reasons. On our Practical Leadership & Management Course for Doctors we consider the problem with trying to achieve what we planned! Consider these two extremes: rigidity versus being too reactionary.

The problem with rigidity

Some of us find it easy to become fixed in our thinking. We start by considering the information and the options. Then we make our decision. “This is what we are going to achieve.” or “This is what we are going to create.” We then set about our task with determination and resilience.

But the medical world is a very dynamic place. New information comes to light. Resource availability changes. And when it comes to other people… don’t expect them to want the same thing this week that they did last week! Ignoring all these factors and sticking to the plan can easily mean that we end up with something that’s not fit for purpose.

The problem with being reactionary

Some of us respond in a very different way. We may have been equally diligent in defining what we going to change or create. Yet, with every new piece of information, with every shift in opinion, priorities or availability, we happily amend and re-define the plan. The problem here is that we can easily lose sight of what we were trying to achieve in the first place. Our project either loses momentum or we end up somewhere entirely different from the expectations. The original issue that we wanted to address persists. In some cases, it has got even worse.

Dido Harding’s tractors

What have tractors got to do with anything?

Dido Harding, Chair of NHS Improvement, recently described the mistake of applying a “Soviet style tractor production” approach to NHS workforce planning. It is entirely possible to calculate how many and what type of tractors a country needs for its agricultural purposes by this time next year. A bit of research, then you set about building exactly what you require. But how many “ologists” from each of the hundred or so sub-specialties do we need in any particular part of our country by 2027? Previous efforts at planning have resulted in problematic shortages in some areas with excess supply in others.

The solution

Clearly defined, fixed goals are ideal for projects with short time-scales. Examples include creating a regular team-meeting format, training for a new piece of equipment or a short research project.

However, long-term projects and programmes work best when they have agility built in from the start. They do create end-goals. But to avoid rigidity, these goals are defined just enough to begin the task and maintain focus. They deliberately keep options open with the shape of the end result given ever increasing clarity as the work progresses. In Harding’s workforce planning example, this means creating more generalists who can be deployed to increasingly more specific tasks as the need becomes more apparent over the coming years. The plan is still there but created with an attitude of conscious, disciplined flexibility.

What are you working on at the moment and how agile should you be in your planned outcome?

Stephen McGuire – Director of Development

Announcing FMLM Accreditation of our Leadership & Management Courses

FMLM Accreditation logo

We are delighted to announce that all of our full suite of leadership, management and team related courses are now accredited by the Faculty of Medical Leadership & Management.

FMLM is a body of all the medical royal colleges and faculties in the UK, and endorsed by the Academy of Medical Royal Colleges. Their primary objective is to raise the standard of patient care by improving medical leadership.

This accreditation is recognition of our courses’ quality and confirmation that the subject matter covered maps directly to their Leadership and Management Standards for Medical Professionals.

Here is a list of our courses which have been awarded this prestigious accreditation marque:

The above three one-day courses are available to book together as a 3-day option for a reduced fee.

Our courses run regularly at numerous locations around the UK. Our online courses can be accessed anywhere that you have an internet connection. Which course will you choose?

Ballet Dancing for Doctors Course

Ballet Dancing for Doctors

Have you ever wanted to learn ballet in the company of other doctors? What about origami then? Counting to ten in Japanese? How to draw cartoon characters? Would you like to learn how to play Chinese Poker? A card trick that could baffle your friends? How to strike the perfect yoga tree pose? Or would you like to learn how to juggle?

You might be thinking, “Ah, it’s 1st April today!” True. Yet all of this and more can happen on our two day Teach the Teacher Course for Doctors.

For a short time on this course, we step away from the medical world and explore other subjects. Anything goes. And you will find yourself teaching something that you know about. This gives you the opportunity to practise teaching something and experience other people teaching something. Yes, it can be a lot of fun. But more than that, it frees you and your fellow delegates to experiment. We then consider how the various styles and approaches of teaching can be brought back into your role as a doctor.

It’s a great way to improve your teaching. No previous ballet experience required!

Mind the Gap

Mind the gap warning beside railtrackDoctors are members of one of the most ancient professions. Such membership brings the expectation of professional attitudes and behaviour. But what does it mean to be professional?

Dictionary definitions include references to expertise, competence and skill. It is about maintaining a standard well beyond that of the amateur.  Further exploration of the general use of the term uncovers comments of appropriate appearance, demeanour, etiquette and of ethics. So far so good. However, the term ‘professionalism’ also has some different connotations for some people.

Problematic ‘Professionals’ and trust.

Autonomous. Self-regulating. Exclusive. Privileged. Elitist. These are a few of the less desirable behaviours that you come across. Some people use the badge of professionalism as a mask for protectionism. They are easily stung by criticism and are resistant to ‘interference’ from ‘others’. They feel threatened by managers, politicians or those jumped-up-healthcare-professionals-who-are-not-doctors encroaching on their territory.

True professionalism is a cornerstone of trust. Yet, over the past decade there has been an implosion of trust in our society. It’s most evident in the world of politics. We’ve seen that as trust declines, anti-establishment resistance grows. Many doctors feel threatened by a similar distrust and associated attitudes.  Some look back to the days when patients simply did what they were told with misty eyed nostalgia.  But medical practice has changed considerably over the years and so has the concept of true professionalism.

The gap.

There is increasingly a gap between what doctors are trained to do and the realities of modern practice.

That’s the headline of Advancing Medical Professionalism – a publication developed in consultation with healthcare professionals, patients and other stakeholders.  In-depth knowledge of the natural sciences combined with technical skill and manual dexterity are essential characteristics for being a good doctor. However, true excellence requires much more.

The report proposes seven key aspects of professional medical practice:

  • healer
  • patient partner
  • team worker
  • manager and leader
  • learner and teacher
  • advocate
  • innovator

It argues that such professionalism brings benefits for patients, teams, organisations and for doctors themselves.  Achieving true mastery of all seven aspects is a lifelong endeavour, so there is always room for improvement.  That aligns directly with our ideals at Oxford Medical Training.

What steps are you taking to advance your professionalism?

Stephen McGuire – Director of Development

An alternative to negative feedback?

Someone giving negative feedbackWe all take on many roles in our working lives. Our success is often dependent on an apparently straightforward but essential skill: giving quality feedback.

As proactive team members, we must interact with our peers and members of other teams. We also have to be able to raise issues with people in more senior positions. How else would they know what is causing us difficulties? And if they don’t know, then why should we expect them to do anything about it?

When we are leading or teaching others, we have to let people know if they are doing the right thing or not. How else would they know whether they are on track and making progress? And if they don’t know, then how does that make them feel?

So, an important skill. Yet many delegates on our courses are open about the fact that they really struggle with sharing feedback. This has been confirmed by our peer-reviewed research, based on self-assessment by over 200 doctors. 45% indicated that they were not effectively challenging or giving corrective feedback to fellow team members. Our ongoing follow-up study is suggesting this is an even greater issue for doctors when working in a leadership context.

Does it matter?

Well we could consider it to be just a cultural thing. People aren’t perfect. There’s only ever so much time available, so we have to prioritise. Patients are more important, so doctors just have to get on with it.

But – and it’s a big but – not speaking up about things which aren’t going well or causing problems leads to major questions of professionalism. Not speaking up allows behaviours which are causing difficulties to ourselves or others to persist. Stress, disconnection and burnout are waiting just along the line. And what about the Duty of Candour? Where does this start? Speaking up about things which aren’t right must be the frontline of action. Waiting to be open and honest with a patient when something has gone wrong is surely at odds with the true spirit of this ethical position.

So, what holds you back?

Many doctors have fallen into the thinking that ‘feedback’ is an annual event. There’s a reliance on anonymous comments via digital portals. But this can never replace face-to-face conversation about what is going well and what is not.

There can be many reasons for not speaking up and saying what needs to be said. Some people have a fear of repercussions or upsetting others. There’s also a culture of staying quiet and many doctors don’t actually know how to go about giving feedback. A good number of our course delegates say they feel comfortable with the idea of giving ‘positive’ feedback. However, this can often be the surprising driver of inhibition.

What’s the opposite to ‘positive’ feedback? ‘Negative’ feedback obviously. And who wants to be negative?

An alternative mindset

Rather than thinking of polar opposites, it helps to go back and consider the reasons for giving feedback. Sometimes we want to recognise effort, achievement or progress. Our aim is to reinforce what we want, encouraging the other person to continue in this direction. At other times we want them to change something and to initiate some improvement. So, how about this:

  • Rather than ‘positive’ think Recognition or Reinforcement Feedback
  • Rather than ‘negative’ think Change or Improvement Feedback

The feedback still needs to be delivered in a constructive manner that the receiver can take on board and use. So, a structured approach is still important. However, altering mindset and intent can significantly change the delivery and outcome.

What do you recognise as the most constructive aspects of your attitude to giving feedback.  How can you change and improve?

Stephen McGuire – Director of Development

Looking beyond Unconscious-Competence

In a recent blog post I used driving a car as an analogy. Sometimes we arrive at our destination but can’t actually remember navigating that major junction. Our internal autopilot, based on a combination of familiarity, habitual decision making and muscle memory, has ensured that we get there safely. It’s an example of what is commonly referred to as ‘unconscious competence’. Many use this term to indicate the highest level in the development of comprehension or of a skill. But is this really the highest level? If we believe in the idea that we can always improve then this would suggest there must be something more. But what? Well, let’s go back to the beginning.

A simple model of progression

You may have encountered the conscious/competence model on our Teach the Teacher Course for Doctors or elsewhere in your training. Here’s a diagram to illustrate the four clear steps:

Conscious competence pyramid

1: Unconscious-incompetence

This is where we don’t know what we don’t know. Ignorance is bliss – but unconscious-incompetents can pose a serious risk in many ways. When people are unaware of what could go wrong then disaster lurks just around the corner. Doctors working in teaching or leadership capacities who know the dangers are the ones who feel the pressure at this point. They are typically well versed in watching out for and managing such risks. We must choose the right time and right method to bring the issue to the learner’s attention, moving them to the next phase in a constructive manner.

2: Conscious-incompetence

Conscious-incompetence is often considered the most uncomfortable stage of the learner’s experience. Being aware that you don’t understand, can’t remember or are incapable of doing something that you want or need to do can be very stressful. Again, doctors who are teaching or leading others need to be aware of the multiple reactions to such stress and become skilled at guiding those in their charge to the next level.

3: Conscious-competence

This feels good for all concerned. It’s a safe and rewarding place to be. We get satisfaction from awareness of progress and confidence grows all round. But being conscious of absolutely everything that we are doing beyond the fleeting moment would be overwhelming. We need to concentrate and focus on the most demanding matters, so, as mentioned earlier, we have an internal autopilot which is designed to help us. It kicks in through repeated practise and experience as we progress to the in the fourth stage.

4: Unconscious-competence

Unconscious-competence would seem like the place to be – at the pinnacle of the pyramid. We can just get on with complicated matters with minimal effort. But what’s next?

What’s the next stage?

There have been numerous efforts to propose a fifth stage of development.  Here’s the one that I find simplest and most useful which is based on a different diagrammatic representation of the model. To explain it, let’s return to the driving analogy.

Conscious-competence cycle

On the day we sit our driving test we are definitely functioning in conscious-competence mode. We’re hyper-aware of everything we are doing. Once we get the good news that we’ve passed and gain our full licence we increasingly function in the unconscious-competence mode. We learn to listen to the music and chat to friends as we drive. The more familiar we become with the task, the more smoothly we drive and manoeuver the car. And what happens next?

Many of us start to go over the speed limit on a regular basis. We forget what some of those road-signs that we knew for the test mean. We start to function by expecting other drivers to do what we expect them to do. We’re less likely to notice that we cut across another driver as we change lanes. BANG!

The longer we spend in unconscious-competence the more likely we are to develop bad habits; to forget less commonly used facts and information; to fail to adopt and adapt new concepts into our practise. All too often, the next stage is actually a return to unconscious-incompetence.

An alternative?

An alternative approach is to regularly and deliberately return to conscious-competence. To revisit, remind, refresh and reset. This is one of the key reasons for ongoing CPD activity. The frequency of new discoveries and advancements in the technical aspects of a doctor’s knowledge far outstrips advancements in the social scientific matters: teaching; leadership; management; patient or team communication. Yet it is essential to regularly return to these topics to stimulate conscious-competence.

How effectively do you revisit, remind, refresh and reset yourself?

Stephen McGuire – Director of Development

Compliance or Utilisation: Where are you?

A big tick to indicate complianceIt’s now 10 years since the WHO surgical checklist was introduced to the NHS. Ara Darzi was one of the doctors involved in the implementation. He should be proud of the countless lives saved and impairments prevented through the use of such a simple tool. Similar checklists are now widespread across healthcare. Their associated actions are very familiar to countless doctors and other clinicians. So familiar, in fact, that they are often just part of the routine. It’s a bit like getting in the car or walking to get to work.  It’s easy to go through the steps without really thinking. When we arrive at work we often can’t remember negotiating that busy junction. But we know we’re safe, don’t we? We know this because, thankfully, nothing happened and everyone is OK. Yet, unfortunately, NHS Improvement’s data shows that so-called ‘never events’ still happen every single day across the UK.

Ticking boxes

Lord Darzi recently described how,

“Some surgeons scoffed at the idea that such basic checks could make a difference. Some objected that it was a box-ticking exercise. Staff complained it was poorly worded, time-consuming, inappropriate or redundant.”

‘Ticking the box’ is a common human behaviour. We’re most guilty when we become over-familiar with a routine, where we don’t understand the reasons or when we don’t really believe in a task. There are plenty of other examples of where tick-box attitudes have become common for some doctors. One is with the appraisal/revalidation process. Another is the practice of shift-handovers.

A shift in handovers?

A few years back, the discussions at our Advanced Team Communication Skills Courses suggested shift handovers no longer needed attention. The problem had been identified. Royal Colleges had published guidance and toolkits. Organisations had created and launched processes. Sorted. Time to focus attention on other matters then.

In recent times, though, there are indications that this simple process is slipping in some quarters. I’m meeting course delegates who openly admit that they don’t turn up to handover meetings. Some are locums and some are not. No one challenges them about this. So it’s become acceptable that they are not there. Others admit that they don’t listen. They are there when the meeting happens – it’s the routine afterall – but their mind is elsewhere. They’re ticking the box. One doctor told me that, to his bemusement, the department he had just joined now conduct the process via recorded voice messages.  A good solution to short attention spans and big time pressures? Or are these indications that the handover is at risk of losing its way? There was no way for him to ask questions about anything that was unclear. The risks should be obvious…

Compliance or Utilisation?

Let’s go back to Lord Darzi. Here are his thoughts on the purpose for the checklist processes which were derived from the approach taken in aviation.

“The object of the checklist is not to eliminate thought but to stimulate it, by assisting professionals with the myriad routine tasks they must carry out, freeing them to do what they are trained to do – deliver skilled care”.

During our Healthy Teams in Healthcare Study, we asked doctors how they communicated with others regarding team processes. We asked, “How clearly can you describe the reasons for working this way?” 28.7% of the 202 doctors who participated responded either “Not enough” or “Not at all”.  Even more notable was the fact that 36.6% stated that they didn’t discuss improvement of team processes either enough or at all. Were they avoiding the processes, ignoring them or mechanically going through the motions?

There aren’t enough hours in the day to waste time on doing things that serve little or no purpose. So doctors should, indeed must, challenge any activities which waste time and effort. Such challenge, when done well, should lead directly to systems improvements. This may be due to the generation of new and fresh ideas. At other times, however, the improvement arises because the doctor raising the challenge discovers the true thinking behind the system. In doing so, they may realise that there is true value. They are then likely to move from the mechanical compliance of a tick-box mentality into genuine utilisation. The improvements arise because they take ownership for the system.

Where are the mechanical compliance and tick-box moments in your current practice? What are you doing about it?

Stephen McGuire – Director of Development

Perception or reality: the best driver of change?

Do you want to change something? Well, start with ‘why’. People will follow you because they believe.  So, if you can explain ‘why’ you want to change something and people believe your message then you’re more likely to get them on board. That’s the message shared by Simon Sinek in one of TED’s most popular talks of all time.  We need to meet people where they are and start from there.  Working with beliefs boosts motivation and motivation kick-starts change.  It also helps to sustain efforts when the going gets tough.  We regularly explore these concepts during our Essentials of Medical Leadership & Management course.

Our perceptions are closely related to our beliefs. But how do we know if our perceptions match up with reality?  Well, if they are such a key driver for change, does it really matter?

A Case Study in Reality

A recent NHS case study from Brighton’s Seven Dials Medical Practice is worth considering. The GP’s who worked there were considering the number of ‘inappropriate’ appointments made by patients. These were the cases where the service could have been provided by another healthcare professional, such as a practice nurse or pharmacist. Their estimate was that these probably represented around 20% of their appointments. However, their analysis revealed the true figure to be closer to just 8%.

It would have been easy for the disparity between initial perception and significantly lower reality to have dulled their motivation. However, putting the reality into context created a new perception. The 8% represented 31 appointments. That is the equivalent of two full GP sessions a week being spent on inappropriate appointments for the practice. Resolving this inefficiency then became the focus of their attention.

Through a combination of staff training, a better system to promote consistency and improved communication, the practice successfully converted the equivalent of two full GP sessions a week from inappropriate to appropriate appointments. This meant more availability for patients with shorter waiting times. At the same time, there was an increase in patient awareness of the services available to them from other healthcare professionals plus an increase in the consistency of approach by the reception team.

Perception AND Reality

This is a great example of the initial perception being far removed from the reality. Our gut feel and hunches are useful indicators for telling us where to look, but they can be misleading. There was every chance that, rather than the inappropriate appointments being lower than the GP’s believed, the numbers could have turned out higher once measured. Establishing reality can confirm a hunch, dispel a myth or even reveal a new truth. This is an important element of any well conducted review or good audit process.

Clarifying reality should reveal what has gone well and where things have or are going wrong. All too often we jump directly from here to deciding what to do differently.  But first we must establish the reasons behind the issues and define how we will know that we’ve made a worthwhile, sustainable change. These are the skills that we focus on during our Practical Leadership & Management Course for Doctors. We also explore how to take such information, put it in context and present it in a motivational manner. After all, if the people you are trying to lead don’t believe in ‘why’ or that the change is unachievable, then you are likely to fall at the very first hurdle.

So which is the best driver of change?

Perception and reality are both relevant.  They need to match up and this is the basis of what we at Oxford Medical call Evidence Based Medical Leadership.

Stephen McGuire – Director of Development

 

What can you see in the NHS crystal ball?

Gazing a the crystal ballCast your mind back 10 years to January 2009. How accurately would you have been able to predict the world as it is today?

Who could have thought that Michael Jackson would leave the planet within six months? Or we would then lose David Bowie, Prince and George Michael during a single year in 2016? That this annus horribilis of celebrity deaths would occur just a few months after Queen Elizabeth became the longest reigning monarch in UK history and still going strong? Could you have entertained the idea of Dr Who being a woman? In January 2009 Gareth Southgate was really struggling as manager of Middlesborough football. He was heading for relegation and the sack. Would you have predicted that by 2019 he would be the most successful England manager of recent times? How many people would have laughed at the thought of Donald Trump as President of the USA – even though this was foreseen by Bart Simpson? Could you have imagined your worried patient making an appointment to discuss their smartwatch data? And what else has changed in your life over the past 10 years?

We can’t predict the future. Today, the current political events related to Brexit mean we find it hard to predict what our situation will be this time next week, never mind in January 2029.

So, why bother with a 10 year plan?

The new long term plan for the NHS in England has now been published. Yet it hardly seems like any time since the turmoil of the major restructure driven by the Health as Social Care Act began. This act passed through parliament in March 2012. Implementation began April the next year with the final changes being as recent as 2015. One of it’s cornerstones was that every NHS Trust would achieve Foundation status by 2014.  That never happened.

And haven’t we just started working with the Five Year Forward View? Well that was published in 2014. Today, we find ourselves in a situation where the intended integration between health and social care looks very different in one part of the country to another. Just another journey started but never completed?

Think closer to home and to your own hospital, department or team.  Think of all those change-projects that have taken place. What proportion of them actually achieved anything worthwhile? How many have made a lasting impression? Multiply this across the country and now think how much these failed local initiatives have all cost in total? And for what?

With all these projects, changes of structure and direction, are things today any better now than they were in 2009? If we can’t even tell what the world will be like 6-months from now, then what’s the point in a 10 year plan? You might well be hearing some colleagues say, “Just let doctors get on with their jobs!”

So what makes a good plan?

The best plans do make a difference. Before they even start there is clarity of overall purpose. They are focused to the future and keep this purpose in mind. Though informed by the past, they go beyond simply identifying what’s gone wrong. They have identified why it’s gone wrong. Simultaneously, they pay equal attention to what is going right and why. This helps set a long term direction with clear but general ambitions. From this, projects are defined which are aligned to this direction. These projects are managed by people who have taken the time and effort to develop the skills required. We are then all in a good place to be able to work with actions at a monthly, weekly and daily level which are aligned to the direction and purpose.

To quote Nelson Mandela:

Vision without action is just a dream. Action without vision just passes the time. And vision with action can change the world.

Though we can’t always tell what the change will look like in the end, paying attention to progress and events means that direction is maintained. The greater the number of people who are working with awareness, who are informed of the plans, know the system and paying attention to progress being made, the greater the chance of achieving the purpose.

What steps are you taking to improve your ability to participate in the change?

Stephen McGuire – Director of Development