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Jeremy Hunt would appear to be in a difficult situation.  His threat to impose changes to doctor’s contracts in the drive to create a seven day NHS has directly resulted in a defiant and militant response.

First there was the avalanche of #ImInWorkJeremy posts on twitter.  Now a group of NHS doctors have responded with a stinging post in response to the government’s reply to a petition that has almost 200,000 signatories calling for a vote of no confidence in the Secretary of State for Health.  This post goes beyond the issue of weekend working and accuses Mr Hunt of ‘misinformation’, ‘failure to engage with professionals’ and ‘alienating the entire workforce of the NHS’.

The eleven writers are supported by GP Survival which claims to have over 2500 followers and growing.  The difficulties appear to be going beyond his relationship with NHS Consultants.  It’s difficult to see a way forward from Mr Hunt without either loss of face or implementation of his threat which can only lead to greater friction.

Stepping back from the political arena for a moment, what can doctors learn from this situation that can be applied to the everyday work environment?

One point to consider is that every day, doctors are required to influence one another, their teams and their management in order to get things done and done properly.  There are a number of models which outline the range of tactics which are available to exert influence.  The following set of tactics is derived from the eponymous titled 2005 book by The Mind Gym.

1:  Reason – explaining the facts and putting the logical argument

2:  Inspire – painting a vision of the future, appealing to the emotions

3:  Coach – using questioning techniques which encourage others to make their own conclusions

4:  Feel Good – flattery or celebrating what you appreciate

5:  Deal – offering something in return

6:  Favour – simply asking for help

7:  Silent allies – peer pressure and referring to the success of others

8:  Authority – Utilising hierarchy and the rule book

9:  Force – including threats and warnings.

To the aggrieved doctors, The Secretary of State for Health seems to have failed to win the argument with the tactics near the top of the list – ‘deliberately using poorly evidenced, inflated figures to win headlines and generate fear’.  He has then jumped to the bottom of the list, resulting directly in destructive open conflict.

Which of these tactics do you rely on in your everyday practice and which could you use more often?

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing interview, leadership, management, teaching and communication skills in the medical environment.  Influencing skills are discussed during a number of our courses including our 3 Day Leadership & Management Course for Doctors and our 2 Day Advanced Communication Skills Course for Doctors.

The General Practice Extraction Service was planned as an IT system which would make data from GP systems in England available across the health service.  It was intended to dramatically improve quality and planning for the NHS.

Unfortunately, the National Audit Office has reported that the service has so far cost £40m, rather than the intended £14m.  In addition the scheduled 2010 launch date failed to materialise with the first transmission taking place in April 2014.  Usage so far has been minimal and the report states that in its current form, it was unlikely that the system could deliver what it was set up for.

Way over budget.  Way behind schedule.  Not fit for purpose.

Surely this situation could have been averted?  The Health and Social Care Information Service who are responsible for the running of the system themselves state: “It is clear the procurement and design stage was not good enough.”

Such large scale failure with the apparent squandering of time and resources inevitable receives a high degree of focus.  How does the impact of this single, high-profile, failed project compare to the collected waste of time, resources and effort on the countless ineffective, badly set-up, small projects which are initiated on a daily basis in every corner of the NHS?  If they are added up are they likely to exceed the waste from the GPES?

Projects which deliver quality, on time and fit for purpose must be set up well from the start with a document or charter which is agreed by all concerned.  This document should be comprehensive in all aspects and include the following points as a minimum:

• What is the headline aim?
• What do we want to end up with?  What will it look like/ feel like/ be like?
• Why is this being done?  What and who is it for?
• What are the expected benefits and impacts for patients?
• What are the expected benefits and impacts for the people in our team as individuals?
• What are the expected benefits and impacts for our practice/ department/ ward/ organisation?
• What other benefits and impacts are expected?
• How will we know we have been successful?  How will we know that the results are fit for purpose?
• Who has overall accountability for key Yes/No decisions?
• Who is responsible for the day to day management of each aspect of the initiative?
• Who are the key people whose direct contribution and input is essential for success?
• Who must be kept unformed of progress and/or output and why?
• What is in scope?  What will be addressed or incorporated as part of this work?
• What is out of scope?  Explicitly list will not be addressed or incorporated that some people could expect to be part of this work, but will be excluded.
• What assumptions are being made?
• What other events or pieces of work are you relying upon delivering for the success of this initiative?
• What are the risks to the success of this initiative?
• What are the risks from progressing this initiative?
• Which key decisions have still to be made?

Once created, this document must be appropriately agreed and then referred to on a regular basis to ensure the project is on track.  Inevitably, events and experience will mean that some aspects will have to change.  It is imperative here that the impacts of any changes are properly reviewed, with all relevant stakeholders consulted or informed as appropriate.  The toughest decision can be when to call a halt to something when you have already invested time, effort and resources.  Cost versus expected benefit must be closely monitored and balanced.

Well executed projects and initiatives are essential for progress to be achieved.  A properly set up plan, with regular monitoring and control is essential.

How well are you setting up and controlling your projects and initiatives?

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing interview, leadership, management, teaching and communication skills in the medical environment.

The Parliamentary and Health Service Ombudsman’s Dying Without Dignity report is an uncomfortable but essential read for anyone concerned with healthcare: doctors; nurses; patients; carers; even politicians.  The key themes are graphically illustrated by real case reports ahead of the conclusions, with poor communication clearly identified as a major issue.

“Almost all the cases we looked at highlighted failings in communication: between clinician and patient, clinician and families, clinicians and their teams, clinicians and other teams and between hospitals and care providers in the community.”

In the conclusions section there is the statement: “the cases in this report show health care professionals need to be supported to be better at having open discussions about care towards the end of life.”

End of life conversations are clearly at the extreme end of breaking bad news and agreeing care plans – a more common requirement for some clinicians than others.  “Bad news” is a very broad spectrum, meaning different things to different people and must always be handled carefully.  Any of us are likely to be upset by “life changing” news.

So how can health care professionals be most effectively supported in this area?

On one hand there is the essential, direct support of colleagues and peers.  Within the workplace this requires the conscious development of Team communication skills and knowing where to escalate issues, e.g.  counselling by appropriately trained professionals where the clinician has themselves been traumatised by events.

On the other, there are models to support the development of direct communication with patients and those concerned in their welfare.  On our Advanced Patient Communication Skills course we regularly explore utilising the SPIKES model.  Originally developed in the field of oncology it has been effectively applied across healthcare disciplines and beyond.  If you are unfamiliar with the model, or not reviewed it recently, the steps are as follows:

• Set up – Prepare yourself, the receiver of the bad news and the environment
• Perception – Check what does the patient knows, understands and believes?
• Invitation – How much information does the patient want to know and how do they want to receive this?
• Knowledge – Deliver the facts, ensuring what needs to be heard is heard
• Emotions – Manage the emotions with empathic concern
• Strategy and Summary – Agree on how to proceed and recap

Of course each step mentioned requires in-depth comprehension and significant skill with an appropriate attitude demonstrated by the clinician.  This can only be achieved through deliberate review and proactive development activity, an expectation of which is made clear within Good Medical Practice and the various codes of ethics for every healthcare discipline.

What proactive steps are you taking to enhance your communication skills?

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing interview, leadership, management, teaching and communication skills in the medical environment.

Good Medical Practice is a comprehensive description of the professional and ethical conduct required of a doctor in the UK.  It therefore provides an excellent framework to structure a review of performance.  In this piece I am going to start off by focusing on two key statements from the standards:

7: You must be competent in all aspects of your work, including management, research and teaching

39. You should be prepared to contribute to teaching and training doctors and students.

In a world where the collective knowledge of disease and treatment is greater than ever, active teaching ensures that the baton is continually passed on.  With classifications and sub-classifications totalling over 16,000 conditions with thousands of treatment options, it is no surprise that each doctor has increasingly become a unique specialist to a greater or lesser extent.  Engaging in the development of peers is a key to spreading what has been learned, again to avoid this being lost, but also to support increasing breadth as well as depth of knowledge.  The obligation upon every doctor to be active in the development of others is clear and explicit.

I’d like you to pause and consider exactly what you are involved in teaching.

Take the time to re-read the top level of Good Medical Practice listed below and consider the extent that you are actively supporting the development others for each listed attribute:

Domain 1: Knowledge, skills and performance

• Develop and maintain your professional performance
• Apply knowledge and experience to practice
• Record your work clearly, accurately and legibly

Domain 2:  Safety and quality

• Contribute to and comply with systems to protect patients
• Respond to risks to safety
• Protect patients and colleagues from any risk posed by your health

Domain 3:  Communication, partnership and teamwork

• Communicate effectively
• Work collaboratively with colleagues to maintain or improve patient care
• Teaching, training, supporting and assessing
• Continuity of coordination of care
• Establish and maintain partnerships with patients

Domain 4:  Maintaining trust

• Show respect for patients
• Treat patients and colleagues fairly and without discrimination
• Act with honesty and integrity

Are you engaged in teaching causation, diagnosis and treatment or are you engaged in teaching Good Medical Practice with all of the breadth that this implies?

If being ‘a good doctor’ demands more than just great ‘technical expertise’ it would follow that good medical teaching practice must also go beyond this focus.

The next question to consider is how you have developed yourself to be able to teach the essential ‘soft’ skills.  For example, is your personal comprehension of effective methods to break bad news developed, structured and up to date – or is it based purely upon your own opinion?  Are you capable of genuinely supporting another doctor’s ability to recognise why they may have upset a patient and help them identify how they can change their behaviour?

Committing to the development of others often means that we have to pay close attention to our own development and can drive us to structured learning of our own.

What steps are you taking to develop yourself toward good medical teaching practice?

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication and teaching skills in the medical environment.

With Hippocrates considered as the Father of Modern Medicine, the influence of the ancients on the 21^st century doctor is very clear.  So what about the teachings of Confucius?  Though revered by many, the power of the great philosopher’s teaching is often diluted by the world of throw away fortune cookie wisdom.  A great deal can be gained however from taking time to consider his numerous quotations.  Let’s take for example, “I hear and I forget, I see and I remember, I do and I understand.”  Does this have any relevance to today’s medical practise?

Benjamin Franklin paraphrased Confucius’ words as “Tell me and I forget. Teach me and I remember. Involve me and I will learn.”  The approach of involvement to support learning is a concept which we explore during our Teach the Teacher courses at Oxford Medical Training.  It is also a principle which can have great benefits for improving patient communication.

There are three key reasons for a patient to be ‘non-compliant’ with their doctor’s advice:

• They do not understand what they are supposed to do
• They know what to do but choose not to
• They know what to do but are unable to act on the advice

Although the communication approach has to be suitably adjusted for each case, patient education is at the centre of both avoiding and correcting compliance issues.  “Involve me and I will learn,” is clearly relevant.  The big challenge is how?

Howard Gardner’s model of Multiple Intelligences can prove useful here.  His defined seven distinct cognitive processes and explained that we all have our own preferences.  We function and learning in different ways.  His principles can be applied to improving patient communication as successfully as they are to numerous training situations.  Here is a list of Learning Preferences based on his model with a few examples of their application to patient communication:

• Linguistic:  Verbal explanations, spoken or written; what words mean
• Logical-Mathematical:  Cause and effect; sequences; patterns; logic and numbers
• Visual-Spatial:  Seeing; pictures; diagrams; models; visual descriptions
• Musical-Rhythmic:  Repetition; rhyming mnemonics; rhythmic phrases
• Bodily-Kinaesthetic:  Doing; feeling; touching; holding; practicing
• Interpersonal:  Discussion with others; asking questions; different people
• Intrapersonal:  Time to reflect; diaries and logs; setting personal goals

You may be able to recognise your own set of preferences from the list.  It’s very easy to fall into the habit of communicating with over-reliance upon our personal preferences, whereas the most effective approach is to use as many methods from all styles with everyone.

Consider how you currently connect with these learning preferences in your daily practise.  What do you do well and what approaches could you use more?

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication and teaching skills in the medical environment.  Our new Advanced Patient Communication Skills Course for Doctors is now available for bookings.

On the 1^st of April the HSJ published an exclusive report.  “Performance Bonuses for NHS board directors which could be worth up to £1m, are the flagship recommendation of the report prepared for the government by former Marks & Spencer boss Sir Stuart Rose.”  The proposal is to adopt an approach modelled on those used by the FTSE100 companies, attracting and retaining the very best and motivating them to achieve success.

The idea is bound to divide opinion.  “An April Fool prank?” you may think, shuddering as you recall the scandalous impact of bonuses on the global financial crisis.  Alternatively you may take the view that the NHS is in effect a huge service provider business – one which we all pay for indirectly – and so it should learn from big business.

Doctors are expected to practise Evidence Based Medicine.  The question is does the NHS practise Evidence Based Business?

 

 

Before reaching your conclusion it is worth watching this thought provoking talk on motivation by Daniel Pink.  It’s one of the top 10 most watched videos on the TED website.  Over the 18 minute presentation  he eloquently and entertainingly explores the impact of incentivising performance.  He argues that there is “A mismatch between what science knows and what business does.”  He refers to information from studies by the Federal Reserve Bank in America and London School which conclude that bonuses work as long as the task involved has a simple set of rules and a clear destination.  However they are detrimental to performance when there is a need for creative conceptualisation, when the rules are not defined or when the solutions may be surprising, the destination unobvious.

Though you may not be in the position to decide whether or not NHS board directors will receive £1m bonuses, it is worth thinking about how you personally try to influence your colleagues and teams for performance at work.  Bonuses and incentives take on many forms: the ‘thankyou’ box of chocolates; letting someone finish their shift early; “I’ll do this for you if you do that for me” and so on.

There is an analogy of bonus and incentives as an addictive drug:  the first hit is fantastic; the next few times are good; you then start to expect or even rely upon it; then when you don’t get it ………….

Daniel Pink presents Autonomy, Mastery and Purpose as the three building blocks of performance, focusing on autonomy, with self-direction as the key to engagement.  There’s a key link here with the current Challenge Top Down Change Campaign for the NHS which reflects the spirit of the 5YFV.

So where is your personal emphasis on influencing others at work: incentives and bonus to get your will, or engagement through autonomy?

 

Oxford Medical Training is the UK’s leading provider of high quality career development for doctors of all levels.  We specialise in advancing leadership, management, communication interview and teaching skills in the medical environment.  Influence and achieving performance is a topic regularly explored in a variety of our courses.

At Oxford Medical Training we support thousands of doctors each year through our training events, programmes and materials.  Here is some information about the recent changes which we have made in our drive to continually improve our service to you.

• New locations – Belfast, Leeds/Wakefield and Nottingham

• Advanced Patient Communication Skills for Doctors

• Presenting, Lecturing and Public Speaking for Doctors

• New 10% discount for returning course delegates

NEW LOCATIONS

To make it easier for you to access our interactive training events, we now offer a selection of courses in the following cities:

• Belfast – NEW
• Glasgow
• Leeds/Wakefield – NEW
• London
• Nottingham – NEW
• Manchester
• Oxford

Why not double up attending a course with meeting up with friends or family?

ADVANCED PATIENT COMMUNICATION SKILLS FOR DOCTORS:

Introducing:

• Advanced Patient Communication Skills Course for Doctors, and
• Advanced Patient Communication Skills for Doctors – our new book

As a doctor, your ability to interact effectively with others – to ensure that all concerned hear what needs to be heard whilst you demonstrate respect, compassion and commitment to care – has a powerful impact upon your patients, carers and colleagues.  This is explicitly recognised within the third and fourth domains of Good Medical Practice.  A proactive approach to reviewing and enhancing your patient communication skills must therefore be treated as equally important as any other clinical skill.

Our brand new Advanced Patient Communication Skills Course for Doctors ran for the first time in January this year to excellent feedback.  We explore how we create dialogue, factors affecting communication and behaviour as well as communication approaches in healthcare.  Along the way we support you to consider your current practice and the challenges which you face.  We work with you to increase your self-awareness, building on your current abilities to improve patient interaction, particularly applying this to gathering information, making effective recommendations, breaking bad news and saying ‘no’.

This course is designed to be both distinct from and to complement our Advanced Team Communication Skills Course for Doctors.  We therefore schedule the two courses to run on consecutive days where possible to make it easier for you to access both.

The next dates for these courses:

• Advanced Team Communication Skills Course for Doctors – Friday 8^th May 2015
• Advanced Patient Communication Skills Course for Doctors – Saturday 9^thMay 2015

Alternatively try our new Advanced Patient Communication Skills for Doctors book, a comprehensive resource which is packed with information and useful exercises to challenge your thinking and support improvements.

What are you doing to improve your communication skills?

INTRODUCING ‘PRESENTING, LECTURING AND PUBLIC SPEAKING FOR DOCTORS’

Around a thousand doctors each year enjoy participating in our renowned two day Teach the Teacher Course for Doctors.  You may well have been one of these delegates.  Many doctors tell us that they would love to attend a one day course to concentrate specifically on presenting and lecturing, so that is what we’ve created.

Our highly interactive one day course, Presenting, Lecturing and Public Speaking for Doctors focuses on improving the skills you require for presenting to medium and large sized groups. Our expert facilitator will coach you in applying the theoretical concepts which are shared in an effective and practical manner. Discover and improve your ability to structure content for maximum impact, create messages which appeal and are memorable, and develop strategies to cope with presentation nerves.  The course provides you with the time and opportunity to practice and refine your techniques with feedback from both the course tutor and other delegates, to ensure that your future presentations will have the desired impact.

If you have an important presentation coming up why not come along to this course, practice it live and get immediate feedback from a professional presenter?

The next date for this course is:

• Presenting, Lecturing and Public Speaking for Doctors – Saturday 9^th May 2015

10% DISCOUNT FOR RETURNING DELEGATES:

We trust you have enjoyed the Oxford Medical Training products which you have used to date.  We now offer a 10% discount on any course to our returning delegates.  This makes it easier for example to attend both versions of our communication skills courses.  Alternatively you may want to attend Teach the Teacher and then Presenting, Lecturing and Public Speaking for Doctors, or you may want to mix and match courses from our medical interview skills or medical leadership and management categories.

You will have been given a code whenever you have attended a course by your tutor.  Simply use this when you are using our online booking system.  If your code has been misplaced, or if you are booking more than one course at the same time, then either call us on 0131 526 3700, or email [email protected].  We will check our system for your details then help you to book and receive your discount.

We look forward to working with you again in the near future.

Stephen McGuire – Training Manager

Demanding, intolerant, short-tempered.  The towering, cartoon-like figure of Sir Lancelot Spratt as chief surgeon in the old Doctor in the House series of comedy films is clearly a figure from a bygone age.  In this era it was accepted and even expected that senior figures should strike terror into less experienced and ‘less important’ people.  How things change we’d like to think.

Yet the GMC’s recent report, Building a Supportive Environment, explores the topics of bullying and undermining within modern medical education and training.  Within the content is comes a reminder of the 2013 NHS Staff survey where 23% of staff in England reported they had been bullied, harassed or abused by other staff members in the previous year.  This was starkly illustrated by the Francis Report into Mid Staffordshire released the same year and the GMC remind us of the consequences.

Doctors in training who have been bullied are more likely to make mistakes at work, are less likely to work well in a team and less likely to raise concerns they have over patient safety.

‘Bullying’ has many levels and at the lowest end we may be less likely to use that label for demanding, intolerant or short-tempered attitudes.  This is especially true when the perpetrator is tired, alarmed or stressed themselves.  The danger, however, is that the “well that’s what I experienced” approach continues to stifle the cultural change required.

Thankfully many doctors in training have good experiences.  On our Teach the Teacher Course for Doctors we regularly ask delegates to picture and describe their best teacher: “Challenging”; “High expectations”; “Put me on the spot”; “Kept me on my toes”, are common answers.  Standing alone, these behaviours may not seem to be distinct from the problem attitudes mentioned earlier, however they are always countered by a second dimension: “Understood me”; “Recognised when I was struggling”; “Re-assuring”; “Celebrated my progress” are also common responses.

When we have low challenge and low support the learner is less likely to push themselves.  “If no-one else is bothered, then why should I?”

High challenge with low support is stressful and is often accompanied by the fear of mistakes, stifling initiative and growth.

Low challenge with high support feels very pleasant short term, but if learners are not made aware when they have gone wrong, or of the standards required then they are again unlikely to make progress and learn from mistakes.

Striking a balance with both high challenge and high support on the other hand creates an exciting, rewarding environment, where learning is a stimulating experience.

“The more I practice, the luckier I get”, quipped Gary Player in response to a wisecracking spectator who had watched him hole a difficult shot from a deep bunker.  To demonstrate his point, the master golfer took his detractor’s bet and successfully repeated the shot – then did it once again just for good measure and double money!  Player may, or may not have coined the familiar phrase, which has been echoed by numerous high performers, from all walks of life.

“Practice makes perfect, but nobody’s perfect, so why practice?” is an alternative view from Kurt Cobain – singer, songwriter and guitarist from 90’s alternative rock legends Nirvana.  This quote reflects what frustrated many about Cobain, who is remembered as both genius and squandered talent in equal measure.  Type the phrase into your internet search engine and you will find numerous variations of the quote being used as a focus for juvenile rebellion and avoidance.

On one hand we have an example of professional dedication, constantly striving for improvement and not settling for anything less than being the best he can be.  On the other, an undoubted talent uses his skill with words to casually excuse himself from putting in any effort.  Just turning up was enough.

Are you expecting to have an interview for a new role in the near future?  Where do you sit on the “Gary Player vs. Kurt Cobain Scale”?  Have you begun to prepare and to practice?  Have you taken the time to consider which experiences most effectively illustrate your abilities?  How well do you actually understand your key strengths and development needs?  What are your opinions on the current hot topics in healthcare?  How much do you actually know about these topics?  Will you be able to communicate your thoughts clearly and concisely, ensuring that the interview panel will get to know the real you – and be suitably impressed?

Dedicated, intentional practice is fundamental to being able to deliver a coherent, reliable and impressive performance, especially when you are under pressure.  Raw talent and knowledge is never enough.  The worlds of sport, music and academia are littered with unpredictable prima-donnas who failed to hone their skills and ultimately fell short of their potential.

A true pro would never dream of performing without coaching, feedback and practice in a safe environment.  Time needs to be planned and set aside to seek appropriate critique and support.

Doctors expecting to present themselves for interview can significantly boost their chances of success in this way.  Just like the golfer who regularly practices how to get the ball in the hole from difficult situations, it pays to practice responding to difficult or unexpected questions, to describe events, express your opinions and then receive feedback from an experienced coach in a safe environment.  Investing time and effort leads directly to new ideas, improved skills and confidence.  This will in turn increase the chances of the top performance required and therefore success.

So how effectively are you preparing and practicing for your medical interview?  Is your approach closer to a dedicated, consistently high performing sportsman, or to an inconsistent, if sometimes brilliant rock star?  Gary Player or Kurt Cobain?

And a final thought.  Do you really think that Nirvana delivered their outstanding, career defining MTV Unplugged show without rehearsal?

Oxford Medical Training is the UK’s leading provider of high quality career development and interview preparation for doctors.

“How effective are you as a catalyst for change?”

Whenever you are preparing for your medical interview it pays to consider as many potential questions as possible as this will help you to clarify your experience and opinions in advance of the event.  You will always impress most if you can illustrate your responses with real life examples, explaining yourself clearly and succinctly which can be a challenge when faced with a broad, open question like the one above.  It therefore helps if you can use some form of relevant framework or model to help structure your answer.

Having a clear model in mind can enable you to think of specific events when you have demonstrated positive behaviours and to identify your development needs.  There are numerous frameworks to consider, ranging from complex personality type profiles, through processes like the GROW model for coaching, to simple lists.

One such list format has come this week in the shape of the output of the first phase of the Challenge Top Down Change initiative.  This is a joint initiative by HSJ, Nursing Times and NHS Improving Quality which is trying to pave the way for bottom-up change by an empowered frontline, rather than continuing with the current top-down culture of imposed change.  They have produced two lists which collate the anonymous opinions of a large numbers of workers in the NHS.

The first is a list of the top 10 barriers to bottom-up change:

• Confusing strategies
• Over-controlling leadership
• One-way communication
• Poor workforce planning
• Stifling innovation
• Playing it safe
• Poor project management
• Undervaluing staff
• An inhibiting physical environment
• Perverse incentives

The second is a list of 11 fundamental building blocks that can support bottom up change:

• Inspiring and supportive leadership
• Collaborative working
• Flexibility and adaptability
• Smart use of resources
• Autonomy and trust
• Challenging the status quo
• A call to action – clearly articulating purpose and meaning
• Fostering an open culture
• Nurturing our people
• Seeing the bigger picture
• Thought diversity – valuing dissenting opinions as much as coherence and conformity

When, how and how often have you demonstrated the elements in the list of fundamental building blocks for change?

When, how and how often have you demonstrated the elements in the list of top 10 barriers to change?

What are you doing about this?

 So, how effective are you as a catalyst for change?