Episode 81: When Soft and Fluffy Met Coronavirus with Steve Andrews

Many professionals were struggling with their well-being, even before COVID-19 pandemic, and through the pandemic it became apparent that the traditional ‘command and control’ leadership model was failing people in the healthcare industry. This episode is all about how you can take the initiative and develop compassionate leadership among your teams of healthcare professionals.

In this episode, Steve Andrews, Associate Director of Leadership for East and North Herts NHS Trust shares how, through using just five crucial questions, you can check in on people, rather than check up on them. The 5 questions will help you to find out how people really are, help them look out for their colleagues, empower them to solve their own problems AND communicate empathy and support.

We discuss the importance of asking the questions – and being genuinely interested in the answers. By developing and maintaining these human connections throughout an organisation, you’ll start to create change and help others relate more to the struggles and victories their colleagues are going through. And through this all, you’ll realise that you’re not alone. You’re part of an organisation that serves a higher purpose.

Want to know how you can apply compassionate leadership in your organisation? Then, this episode is for you.

Here are three reasons why you should listen to the full episode:

1. Discover how Steve successfully developed a program that promotes compassionate leadership.

2. Learn the five important questions you should ask your colleagues to increase compassion and connection
3. Find out how compassionate leadership can make a difference in an organisation.

Episode Highlights

[05:00] Rebuilding the NHS after the COVID Crisis

• Steve likens the recent COVID crisis to circumstances after the Second World War.

• He believes that one of the keys to building the NHS lies in compassionate leadership. Listening to the workforce and taking care of their psychological well-being is essential.
• When people are told to do something and don’t understand why they should do it, they will lack motivation.

[8:28] Soft and Fluffy: Why Compassionate Leadership Is Important

• Fear generates particular knee-jerk reactions and anxieties where people are quick to make decisions.

• By using compassionate leadership, people can follow easier.
• When Steve was undergoing training as a nurse, technical skills were the most vital. Importance wasn’t placed on lectures on leadership.
• When you start to explore the art of medicine, you will be concerned with how you can collaborate with colleagues and other teams.

[12:08] Stopping the Command/Control Leadership Model from Coming Back

• The first thing to do is change habits in leadership.

• Evidence shows that compassionate leadership worked well during the COVID pandemic.
• Steve hopes that this becomes the driver to make compassionate leadership the norm.

[13:24] Checking Up vs Checking In

• Checking up means that you’re asking someone if they’ve done a task.

• Meanwhile, checking in means that you’re asking about the well-being of the person. This is a form of compassionate leadership.
• Steve shares that the five questions of compassionate leadership came from two papers and one phone call.
• Through this, Steve and his team formed a rhythm to check in on people.
• Steve explains that the questions aim to maintain the human connection and provide psychological safety.

[17:42] The First Three Questions of Compassionate Leadership

• Question number 1: How are you doing? This emphasises how you show genuine and authentic concern for your colleague.

• Question number 2: How is your team doing? This shows collective leadership and is a technique to create psychological safety.
• Question number 3: How are your colleagues doing? It promotes the connection with your colleagues for a shared, higher purpose.

[24:15] The Last Two Questions

• Question number 4: How can you help them? It is about creating an opportunity to give people back control over the situation.

• By helping others, you also get a sense of well-being.
• At this point, you start to coach your people and see how you can help them to feel good about themselves.
• Question number 5: How do I serve you? This pertains to servant leadership.
• Steve explains that the five questions’ overall theme is compassionate leadership.

[29:52] Results from Asking the Five Questions

• Steve and his team started putting the word out through T-shirts, notes, and Youtube videos.

• Eventually, people started sharing the results of these conversations with Steve. These questions gave people the opportunity to form connections.
• Steve also shares that other hospitals in the UK picked up the five questions.
• Eventually, they became a training program.
• These questions emphasise connection, coaching, listening, and serving.

[33:09] Who Can Use the Five Questions?

• Steve uses these questions to start conversations with people.

• Steve’s team became known as the ‘how-are-you-doing’ team.
• The questions became a movement instead of just a tool.

[36:12] Making a Difference with PTSD

• Steve shares how he has a portfolio of personal messages, gratitude, and moments from people who used the five questions.
• People find value in using the five questions to form connections.
• Show compassionate leadership by taking action and being visible.

[39:08] Tips on Using the Five Questions

• Know that you’ve asked a fundamental question. You recognise that you want to make an impact.
• Don’t give yourself tasks that are too big. Leadership means experimentation. These questions are your hypotheses for that experiment.
• Give yourself time. People will eventually realise that they need these questions.

7 Powerful Quotes

[06:38, Steve] ‘That’s what used to get called soft and fluffy. We would put mental health, psychological well-being well down the list. I think [the] coronavirus showed us that these things are now essential for us to rebuild our NHS.’

[18:33, Steve] ‘So “How are you doing?” is compassionate leadership. This is now saying, “I have a genuine and authentic concern and care about you.”’

[19:49, Steve] ‘Question number two, ‘How is the team doing?’… This is collective leadership, and collective leadership is about the team.’

[23:26, Steve] ‘By connecting people to colleagues, the idea here is that we keep connecting to that higher purpose… It’s like connecting to you’re not alone, you’re connected to a team. Team, you’re not alone, you’re connected to other teams. And this network of teams, this team of teams is called an organisation. And this organisation is going to do something awesome and fantastic.’

[26:52, Steve] ‘When we then say, “What can you do to help them?” When they go away to help, to do something to take an action to help somebody else, A) anxiety is reduced… And when we’re kind to other people, we feel good about ourselves.’

[27:56, Steve] ‘With leadership comes this notion of service. “How do I serve? How do I serve my colleagues, my team, the purpose?” So the question here is, “What can I do to help? What could we do to help? What one thing could I do that would make things better?”

[31:42, Steve] ‘I think the most important bit of the whole program was to reinforce those initial principles: connect with genuine concern, listen deeply, coach people to their potential, but be ready to serve others.’

About Steve

Steve Andrews is the Associate Director of Leadership and Change at the East and North Hertfordshire NHS Trust. Since 2016, he leads the Organisational Development service towards excellent leadership. Steve focuses on developing internal talent and creating new opportunities for people.

In 2008, Steve became the Director of Programmes (Education) at UCLH. He developed and delivered training programs on team development, human factors, patient safety, and leadership. In 2010, he became the Chief Instructor for the NHS Staff College. In his time there, Steve initiated leadership programs with the NHS, the military, and other independent specialists.

Steve is also a qualified nurse specialising in care for children and young patients with cancer. In his clinical career, Steve became a CNS, Ward Manager, and a Senior Nurse.

Steve has a master’s degree in Organisational Behavior and Health. He also has a Diploma for Higher Education in Nursing and Health Management.

If you want to subscribe to Steve’s mailing list, send him an email at steve.andrewsfive@nhs.net. You can also connect with Steve on LinkedIn and Twitter.

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Episode Transcript

Dr Rachel Morris: Did you notice a change in how your organisation treated its staff at the beginning of the COVID pandemic, and have you noticed a distinct return to normal since then? Do you sometimes wish to be paid more attention to people and less to tasks? In this episode of You are Not a Frog, I’m joined by Steve Andrews. He is Associate Director of Leadership at East and North Hertfordshire NHS Trust, he spotted a problem and did something about it.

We talk about how he and his team were proactive in trying to prevent the things they were worried about in their staff, such as burnout and PTSD following the pandemic. And they came up with a novel way of checking in with people, rather than checking up on them, which combines an ingenious blend of different leadership styles in just five simple questions. We talked about the power of just showing concern and really listening and how a simple intervention done right can help change a culture and create a movement. So listen, if you want to know how the command and control model is failing us in healthcare, what the most effective way is of supporting your staff in a crisis, and the five simple questions which could transform the interactions within your team and within the wider organisation.

Welcome to You are Not A Frog, life hacks for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP turned coach, speaker and specialist in teaching resilience. And I’m interested in how we can wake up and be excited about going to work no matter what.

I’ve had 20 years of experience working in the NHS and I know what it’s like to feel overwhelmed, worried about making a mistake, and one crisis away from not coping. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water, working harder and longer. And the heat has been turned up so slowly that we hardly noticed the extra-long days becoming the norm, and have got used to the low-grade feelings of stress and exhaustion. Let’s face it, frogs generally only have two options: stay in the pan and be boiled alive, or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. You have many more options than you think you do. It is possible to be master of your destiny and to craft your work and life so that you can thrive even in the most difficult of circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues, and experts, all who have an interesting take on this. So that together, we can take back control and thrive, not just survive in our work and our lives and love what we do again.

For those of you listening to the podcast, you need to get some continuous professional development house under your belts. Did you know that we create a CPD form for every episode so that you can use it for your documentation and in your appraisal? Now, if you’re a doctor, and you’re a fan of inspiring CPD, and you’re sick of wasting a lot of time you don’t have on boring and irrelevant stuff, then why not check out our Permission to Thrive membership. This is a new venture, a joint venture between me and Caroline Walker, who’s The Joyful Doctor. And every month we’re going to be releasing a webinar fully focused on helping you thrive in work and in life. Every webinar is accompanied by an optional workbook with a reflective activity so that you can take control of your work and your life. You can increase your well being and you can design a life that you’re going to love. You’ve got to get those hours so why not make your CPD count? Choose CPD that’s good for you. So check out the link to find out more. Thanks for listening to my shameless plug. And back to the episode.

It’s really great to have with me on the podcast today, Steve Andrews. Now Steve is the Associate Director of leadership at East and North Hert NHS trusts. That’s in Stevenage. And he’s got a background in paediatric oncology nursing. And he sends out this amazing email pretty much every single week, I think it is, about leadership. In the context of health care the NHS, and that’s been a real inspiration. For me, he’s always got some really thoughtful things to share, as well as lots of really amazing links and resources. So it’s a real pleasure for me to have you on the podcast today, Steve. Thanks. Well,

Steve Andrews: Thank you very much and a pleasure to be here. Thank you.

Rachel: So one of the things that we were talking about when we had a phone call recently was the initiatives that you’ve started around COVID and we got to talking about what had changed and how we were treating people and how staff had just been so completely amazing throughout the crisis and still continue to be.

Steve: I agree completely. Our staff across the NHS have been outstanding over the last 18 months. And one thing which I think should be forgotten when we emerge fully from coronavirus is that contributions made, almost a cry should go out like it did after the Second World War after the Second World War. It was built, build a country fit for the people who’d endured that time period. I think the cry at the moment should be building NHS fit for the people who’ve done what they’ve done over the last 18 months. And one of the things that will be key to building that NHS will be our culture, teamwork and leadership. And often the leadership that I’ve been connected to, been passionate about, really supported and tried, wherever possible to see and acted was often referred to as soft and fluffy.

When I would say coaching should be a leadership style when I talk about autonomy, etc. The door with somebody had come back with kind of, well, that’s nice. That’s, that’s nice when it’s all going well, that’s nice and soft and fluffy. But in the harsh realities of the world, Steve, people need to be told that. I just didn’t buy that, and I never did. And I think coronavirus showed that actually, the soft and fluffy was absolutely the necessary and vital component to our success. Treating people with respect and dignity, getting people involved in the decisions that we made, making sure we will listen to our workforce or who could hear their ideas, their innovation, really respecting the effort and the workload that people were putting in and taking care for their of their mental health as much as their physical health. That’s what used to get called soft and fluffy, we would put mental health, psychological well being well down the list. I think coronavirus showed us that these things are now essential for us to rebuild our NHS.

Rachel: Yeah, I totally agree with that. Did you see instances in the pandemic where the other approach was tried and and failed?

Steve: I wouldn’t go as far as they failed. But did I see it tried? Did I see it implemented? Did I see that command and control? Yes, and poor decisions and poor actions were taken, giving instructions around particular elements of our store keeping, PPE, etc. And people not understanding why these things were being done and without an understanding of why, call that soft and fluffy. But without understanding why I’m being asked to do something, people’s motivation and engagement is lacking. When you’re told to do something which seems to equate, seems to go against your gut feeling, your evidence, what you can see right in front of you, then your passion to do it is low. And yesterday I saw quite a bit of that from time to time. I often don’t think it came from a poor place. I think people were frightened to any level. Some of us senior people I suspect were frightened. But again, because of the culture we built, that vulnerability being not open to, I’m concerned as well. I’m frightened as well. I don’t know what to do next. Being that vulnerable wasn’t allowed. We didn’t give people permission. And so the consequence was snap decisions, command and then frustration when people didn’t just blindly obey.

Rachel: And did that change throughout the crisis? Did people sort of change their style? Or was it particularly bad at the beginning

Steve: Definitely could argue that there was more of it, just in that first wave just as we were starting to get really that first wave, and there was a real fear and fear generates a particular set of knee jerk reactions, anxieties, and maybe we made quick decisions too quick. We didn’t involve people, people were not connected to the overall purpose.

Rachel: Why do you think traditionally we would have labelled these things as soft and fluffy. And it’s not important that we we’ve more consoles for command or control? Is it easier?

Steve: I suspected it easier, I suspect the other piece is that we’ve not been offered anything else. We were lovers in one respect, of role models, we see a generation ahead of it, how they’re leading, and we follow what we might do things slightly different. But change comes at a slow pace when you’re learning from the generation ahead, and the role models are not all they could be. Plus we have to say isn’t part of our training. So if I think back to my case of of training as a nurse, I can’t remember a lecture on patient safety. I can’t remember a lecture on leadership in three years, it’s not been seen as being vital. What’s been seen as being vital is a technical skill, and technical skills, whether the scientific route, the medical route of a right and wrong, good and bad and in and out, incredibly linear process.

Something about medicine when you start to get a bit more senior, when you start to really see what medicine is as you start to explore the art of medicine, not the science of medicine. And when you’re at that stage, all of a sudden ideas like working with colleagues, teamwork, multidisciplinary teams start to take on a different viewpoint. I don’t think we’re trained in many other ways. I think we revert to what we know, and we know good bad out, do it, don’t do it. What we don’t get trained in: how do I coach? How do I inspire? How do I communicate? How do I collaborate? And how do I influence? If we thinking now around integrated care systems, and even working across tribal groups, nurses, doctors, Ward A, Ward B? How do I influence? How do I get people that undertake things that I need for my success? In partnership? I have no hierarchical authority over them. But how do I connect? How do I collaborate? How do I create partnerships? Now traditional routes have been going up the hierarchy, getting the higher level of the nose to then come down into the hierarchy and get someone told, maybe building partnerships is something that a skill set that we’ve missed out on in our education.

Rachel: Whenever I run sort of my resilience training, particularly with maybe younger health care professionals, people are just sort of starting out. They really feel the hierarchy. And they feel that they can’t influence and they don’t have any impact because of the hierarchy, because they’re not at the top of the pecking order where I mean, we all know that, that if you’ve got to fall back on the hierarchy to get your way, then you’ve pretty much lost the battle anyway, haven’t you?

I remember when we were chatting before the podcast, you were sort of saying that the massive concern about coronavirus and the pandemic is that things changed quite a lot during the pandemic, in terms of working out how people are in this sort of compassionate leadership. The worry is that we’re just going to go back to how it was before and the culture is going to absolutely return to that command and control thing rather than the whole compassionate leadership thing. And how do you think we can stop it going back to how it was?

Steve: Well, I think one of the key elements resolved to start thinking about now as leaders is something we will work quite hard on before coronavirus, that we are creatures of habit. And I suspect many people will fall back into their habitual nature in terms of how they manage, how they lead, their expectations, etc. So the first thing to do is say, well, what do we know about changing habits? But we change habits because we can see purpose, we can see meaning and we can see results. And I think we’ve got great evidence to suggest that soft and fluffy compassion, looking after our people has worked incredibly well during coronavirus, our staff, our colleagues became so fundamental. The amount of resources, the well being initiatives which are underway, we’ve changed that dial on the compass a little bit, well being is really important. Now that’s the purpose, and I’m hoping that the compelling purpose that allows that habitual change, that change into something new, and it will stick. It’s that easy to get out of the groove. It’s also that easy to fall back into it really, really quickly.

Rachel: The one thing he said to me before, which really stuck with me, is that we need to change from checking up on people to checking in on people.

Steve: Absolutely. And we use this as almost our philosophy principle kind of thing during our support work colleagues join coronavirus, checking up being the idea that and as a leadership style that, have you done that yet? That’s been the checking up approach. Have you finished that? Have you got the report? And have you done that yet? Checking in approach is, how are you doing? What are you experiencing at the moment? What’s going well for you? How can I be a more supportive leader, colleague for you at this moment? How are you doing? Is the checking in process.

Rachel: And is that where the five questions came from then?

Steve: Well the five questions is a story of two papers and one phone call. I’m sure we can all remember those early pictures on the news of the coach heading to Liverpool with a few people with masks on. And we started to think at that particular moment in time, hang on a sec. This is heading our way. Across the organisation that senior levels that junior levels, people starting to ask those questions. And it was a couple of years gathered together just over coffee. And we started to say if this does become as serious as we’ve seen across the globe, and everything that we’ve got planned for the year, my entire purpose in this organisation is going to change overnight. No longer is development courses a two-day study day program, that’s just not going to be anywhere on people’s radar. So what do we have that we could offer the organisation which is going to be helpful and supportive? And at that point, we started to think about well-being, the psychological support, few people started to indicate Post Traumatic Stress Disorder, and the fact that, after it, even at that early stage, people started to talk ‘after it’. We’re going to need counselors after it. We’re going to need these Post Traumatic Stress Disorder programs.

And I think we just asked the question, hang on a sec. That’s that really old model of health, wait till it’s broken before you fix it. What about prevention, and wondered if there’s something we can do to prevent. Two papers came out very, very quickly after that, the one from the king’s bond on why compassionate leadership works in a crisis, and another from the British Psychological Society about the psychological needs of healthcare staff during coronavirus. But it was a phone call to somebody I’d worked with previously, he was a psychologist in the British Army, and really I phoned him up after some ideas had come together, and I said, you have to prepare your groups and your teams for sustained periods of stress and combat. What do you do? What is it that you do to prepare them for these sustained periods of stress and combat, so that post-traumatic stress is reduced?

And he told me a few things, a few things much exactly what were on the compassionate leadership paper, what were on the British psychological paper, society’s paper. And he used a phrase called ‘battle rhythm’. And he said, ‘Our leaders get into a battle rhythm of checking in with their people. How are we today? What’s the big concern for you today, and what’s going on for you today? This was a regular rhythm. All of a sudden that flow and rhythm was the moment of generation from some thought for us. If we took those two papers and that one phone call, and came up with a rhythm, a regular rhythm, to help our people check in with each other, to do what it says in those papers about maintain human connections, give space for people to talk, accept that some days are going to be more of a struggle than others, it’s okay not to be okay, and genuinely mean that not as a nice sound bite and a T-shirt.

Generally mean, ‘I know it’s about day to day, and it’s okay’. When we put all that together, we came up with these five questions, and I tested out a couple, let’s just do three and twos and lots of order. But we needed to create a few minutes of connection. So we needed enough questions that had a connection, more than 30 seconds, less than five minutes, though, something that maintained a human connection, some questions that provided psychological safety, but also the real attributes of soft and fluffy were present in those five questions.

Rachel: I’ve got those five questions in front of me, and they just really simple and straightforward, but I can see how they’d be so helpful. Just tell us what they are.

Steve: Okay, so the five questions are all based on a really emerging idea that we were having before coronavirus. And the emerging idea that we had was that leadership models were not helping us. If you go to the Institute of Health Management, you’ll get taught a leadership model, and it’s going to be brilliant. It’s going to be absolutely fantastic. If you go to the Kingston, they’ll teach you a leadership model, and it’s awesome. If you go to their leadership academy, they’ll teach you the healthcare leadership model. It’s fantastic. The point we were trying to get to was, we’re really inconsistent with all these models. But it’s not whether they’re right or wrong. It’s whether they’re useful or not. The usefulness of leadership models was already a conversation we were having.

And then this happened, the two papers, that conversation, it just seemed to fall into place. ‘How are you doing?’ is question number one. So ‘How are you doing?’ is compassionate leadership. This is now saying, I have a genuine and authentic concern and care about you. This isn’t a passive in the corridor, ‘Hello,’ alternative. ‘How are you doing?’ ‘I’m fine. How are you doing?’ This is a genuine ‘How are you? What are you experiencing? What’s going on for you in your world? What would be helpful? Tell me more and share your experience with me. How are you doing?’ We, and I’m sure that you in your medical training, Rachel, we’re taught exactly the same lesson I was taught in nursing training, there is only one answer. When asked when anyone asks you ‘How are you doing?’ And that answer is ‘Busy’.

Yeah, there’s no other alternative. And of course, that’s because we’re not quite sure, we’ve not quite established a level of relationship. We’re not quite sure whether if I was to really tell you how I’m doing, whether it would have a negative consequence on career, relationship opportunities. Whether I would be seen as being not coping. Or if I was to say that I’m not fine today, but actually I’m struggling today, would the response be almost to look like ‘You’re not cut out for this?’. This might not be the profession for you. So you have to say ‘Fine’, you have to say ‘Oh, busy but getting on.’.

You have to move on to question number two. Question number two, ‘How is the team doing?’ And this worked in two really powerful ways. This is collective leadership, and collective leadership is about the team. So the first thing this question does is, ‘How is the team getting on? How is the team doing? How are people around you?’ It now starts to remind that individual that you’re not alone, you’re not in this on your own is the team here. Talk to me about it. Talk to me about what’s going on for the team. It also is a technique to create psychological safety. We’ve talked lots about psychological safety in many of these forums, but we’re still not quite sure, how do we get it? We want it but, how do you get it?

Well, this question gives you a little opportunity, because the answer to how is the team doing is the third-party answer. I’m fine, but the team is struggling. I’m fine, but the team are worried about PPE. I’m fine, but the team are overwhelmed. I’m fine, but the team are concerned about the ongoing changes. What you might actually be saying is, I’m concerned about the ongoing changes. I’m concerned about PPE, but I didn’t feel safe enough to tell you when you asked it for me. But I feel a little bit safer using a third party language to say to that moment, this creates, you’re not alone. You’re a team. And here’s some psychological safety to tell me genuinely what’s going on here.

Rachel: That’s really clever. Because by asking about the team, you are asking about them, aren’t you? Yeah, because the team aren’t going to be feeling something if you’re not feeling it, you will put it together and I love that concept. And there is still a stigma in saying I’m not fine, and people feel it as much as we tell them, it’s okay to not be okay. People feel it isn’t okay to be not okay. And so, I love that, that’s very clever. Well done.It’s a really smart way of getting people to admit how that how they really are, without threatening, really great psychological safety there.

Steve: So question number three, then moves us along a little bit. So question number three asks, ‘How are your colleagues doing?’ So here, there’s something going back to our previous conversation about hierarchy. My team is my team, I might have some influence using my hierarchical position here. My reputation, my role within this team might be able to influence, but colleagues refers to the wider group. And again, picking up on some of the work from those papers that we referred to, and our understanding about what drives human beings connected to a purpose. We were all connected to a purpose during those dark days of coronavirus. And that purpose, I’m absolutely convinced, gave people energy that gave people motivation and commitment. Why would he continue to get out of bed and face some of the things that people faced is because they had a compelling purpose, the care and support and the compassion to our community, the requirements to actually do the best you can in such circumstances.

So connecting with colleagues now says, I’m connecting with colleagues but for a higher purpose here, though. This is about the nurses being interested in how the doctors are getting on, this is about the ED being concerned that one of the intake boards or other type boards is doing fine. Because with our system, what we do, though, I’m based in a hospital located around Stevenage, nobody else is doing what we do. Nobody else is doing what we do. And I get out of bed in the morning, come in to that hospital, I don’t have a competing hospital across the world, nobody else is going to be there. There’s not another ED department for this community. There’s not another hospital for this community. This is us in a privileged position to root, to deliver high quality, compassionate care and serve our community. And by connecting people to colleagues with the idea here is that we keep connecting to that higher purpose. Though, how are we getting on a ward that Ward A? How is Ward B getting on? How is the entire hospital getting on and serving our community? Just to keep actually, there’s bigger things going on here. And again, it’s like connecting to you’re not alone, you’re connected to a team, team, you’re not alone, you’re connected to other teams. And this network of teams, this team of teams is called an organisation and this organisation is going to do something awesome and fantastic. The community we serve. And it’s that kind of inspiration and motivation at that particular point in the five questions.

Rachel: You read the questions, so yeah, on the surface, they look like really good questions. But actually, when you’re now telling me what’s behind these questions, I think they’re even better, fantastic.

Steve: So of course in that, ‘How are your colleagues doing?’ question three, that’s collaboration, isn’t that, so that’s collaborative leadership. That’s everything we know we are going to need in the future. Our ICS is not going to work in any way, shape or form without partners’ collaboration. How much am I prepared to give into the system for this system to work? If I have to win everything, and then nothing’s going to work, we’ve got to be able to share, understand and actually offer for the bigger collaborative purpose. Though ‘How are your colleagues doing?’ starts to connect it up.

The next question is, ‘How can you help them?’ So this is a question directed at empowerment, autonomy, and I noticed there’s problems with it. You can’t really empower anybody else, that has to come from within. But this is about creating a climate and an opportunity. It’s saying, ‘Do you have any control over the situation you find yourself in?’ Especially during coronavirus, so much control was taken away from us, we lost control of schools, lost control of our holiday shopping, where we could go, how we could socialise, people had a lot of control. So the idea of question four is not to take more control off people by saying, ‘That sounds terrible. Let me fix it for you. Let me rescue you.’ Not ‘Let me fix all this for you and make it go away’, or to say something like, ‘Well, you know, you just have to step up, and there’s nothing to do,’ the question says, ‘What could you think? What do you think you could do to help?’

So this is my colleagues are anxious about PPE. What do you think you could do to help? Oh, I saw a really good video about PPE on YouTube, I’ll share that. Brilliant, thank you very much, what you could do. And the idea here is, is if question number one is compassionate leadership, question number two is collective leadership, question number three is collaborative leadership. The idea here in these first is connect and listen, the idea of number four is what can you do to help them is coach. At this moment, you start to coach your people, you start to ask questions. What do you think you could do to help? If you did something different, what would it be? What would be the one thing you could offer to your, from ED to Ward Four that would help? What have you learned, that if you shared it with your colleagues, would help your colleagues?

So now you’re starting to coach people into taking some actions, taking some ownership, giving some control back. Control is a really, really important element of our well being, the more control we lose, the harder it is to maintain our well being. Of course, there’s something really interesting going on here, which is fundamental to all our dimensions of care. When we then say, what can you do to help them? When they go away to help to do something to take an action to help somebody else, A) anxiety is reduced, because they’re being helpful, they’re doing something, they’re busy and doing something that reduces anxiety. But you’re also doing a good thing, a helpful thing, a kind thing. And when we’re kind to other people, we feel good about ourselves.

So in this moment, offering some control back, we’re also getting a sense of personal well being, that really controversial idea that there’s no such thing as a selfless act. Even when we give money to the homeless guy, the homeless guy gets his cup of coffee, but boy, we feel warm inside. So we’ve read the question for you, giving people opportunity to help each other, to feel good about that help. And again, that improves our well being.

Question number five is servant leadership. The servant leadership isn’t about the idea of, that’s all well and good, but there might be one thing I can do to help. How do I serve you? It’s understanding that if you’re in a leadership position, even leadership as a colleague, not leadership as a hierarchical position, but with leadership comes this notion of service. How do I serve? How do I serve my colleagues, my team, the purpose? So the question here is, what can I do to help? What could we do to help? What one thing could I do that would make things better?

So in those five questions, that can be done quite quickly, they could be used as coaching questions for a longer conversation. But the idea here is passionate leadership, checking in, how are you doing. Collective leadership. Tell me something about the theme and how the team are getting on. Collaborative leadership, what do you know? And what would you understand about what’s going on in the bigger picture, the hospital, your colleagues in other professional groups? And then coaching, or what do you think you could take ownership of, what you could change? And then servant leadership, what one thing could I do to help you in this moment? And that’s the rhythm.

And it all stemmed from a cup of coffee, some permissions given from our senior leaders near in the hospital to experiment and play, a phone call and two very short papers. And from that we just put in play the soft and fluffy that we’d cared about before coronavirus, and it now had to meet coronavirus head on. And so the five questions is soft and fluffy meeting coronavirus.

Rachel: That’s just totally brilliant. And I love those questions. I love the fact that number four comes before number five, they’re giving them an opportunity to come up with their answers, just to stop the person asking them getting into that rescuer role and being a bit heroic and stuff like that. But then you’re also acknowledging that there is something that you can do. So really carefully constructed, and I think brilliant. What results did you get from this, from using this?

Steve: So very, very quickly, we started to put out little credit card sized handy notes, started, put a few things on YouTube to try and get the news around the organisation. And we’ve got some T-shirts printed with the five questions on the back. So first of all, it was putting some of the message out there, and then I just used it with people. I was on corridors, in units on wards, just being there with people and showing that that human connection was important. Then people will take it away. And before you know it, I was getting notes and emails saying, ‘Tried out the full question, Steve, this was the result. Will try to have a full question, the five questions.’ And ‘This is where we got to, tried the five questions, Steve, and didn’t quite go to plan for we had a great three minute conversation.’

And of course, for me, that meant it went exactly to plan. I wasn’t expecting everybody to be meticulously following all five to connect. That gave people a confidence that actually, almost like a crutch. I’ve got these five questions as a crutch to help me connect with somebody. The five questions is taking me into this connection with another human being. I’m not lost and alone in that connection. And of course, the most important bit is the connection, put the five questions down when the connection is strong and healthy. But it’s that crutch to get in very quickly.

Because we’re all social media aficionados these days, I put it out on some social media, it got picked up by a couple of hospitals around the UK. And then I was hearing things back from hospitals within ICS. So a few hospitals over at Harlow in Watford, and I was hearing the same kind of stories from them that we were getting, and sort of shared five questions with them. Before again, we had now all of a sudden we were doing ‘train the trainer’ sessions to help people use it, it was becoming a part of our leadership team taught leadership programs, it was going into online sessions.

And I think the most important bit of the whole program was to reinforce those initial principles, connect with genuine concern, listen deeply, coach people to their potential, but be ready to serve others. And that’s the bit that has made the shift. I’m kind of now with the papers I put out, and the presentations I do, I give lots of alternatives to some of the questions because I wouldn’t like people to be embarrassed that they’re asking the same five questions too often. That connection, listening, coaching and serving. It’s the most powerful motivator, that soft and fluffy leadership approach.

Rachel: I really love it. And I’m thinking it would work absolutely brilliantly in general practice as well, if you have, have you heard of any GPs using it at all?

Steve: I haven’t; it went out recently, across all our ICS, which will be included. All the CCGs and the practices as well. I’ve not heard back of its deployment or use there. But I’ll be holding my breath and see how we get on.

Rachel: So I’m looking at this and I’m wondering if everybody felt comfortable using it or just the team leaders? Or was it, what are people are searching for, what I’m teaching you, I can’t ask that of people. Or did you get the message out that actually this is for anybody?

Steve: So two things around that actually, what way? The talking about the five questions, and not doing the five questions was equally as helpful with junior staff. Though I did, it’s a bit like, we have a conversation about the five questions and both of us are feeling energised. Both of us are feeling, ‘This is good’. This is what the effect of the five questions is working on, is without asking the five questions. And I noticed that, really interesting. So I did a stint where I welcomed, I mean, there’s two things I wanted to do, I wanted to welcome people into the hospital when they were coming in for shifts and I wanted to say thank you to the night staff as they were there with me. So we did this for a little while. And it would stop people wherever I saw that there was a little opportunity for conversation.

And with very junior staff, I would talk as we’ve just talked almost, and explained what the five questions were, no pressure. No, you must now go out and do this, but almost in its colour scheme, in its structure. And in that conversation. It was a badge, an emblem, a visible moment that said there’s something else going on here. You know, how are you doing? Is this really important? So much so that the group of us who met for that coffee and began talking about how our role was we’re going to change on coronavirus. We got known as the ‘How are you doing?’ team. So we’re a bit puzzled, so we have an email address, to how, contact ‘How are you doing?’ team and so it became a movement rather than an implementation of a tool.

‘How are you doing? team’, when we were asked during the summer of last year to do a report on how things had gone in terms of psychological support for staff. That report was called the ‘How are you doing?’ report. Grateful that we’ve been shortlisted for some awards and things like that. Very nice. But I think it’s the fact that people could recognise it early in its simplicity. Not necessarily that I do it as a team leader, but actually I can see the relevance of it for me. And what if you just ask them of yourself? How am I doing? What am I feeling about being a member of this team? What am I seeing in my colleagues, which is inspiring me or concerning me? If I was to change something that I’m doing, what would I change? What do I need to do to serve myself better, to take care of myself, self care, well being, etc. And wherever we are, we’ve kind of bumped into people to talk about the five questions. It’s been the lines that the conversation has taken, which has been equally as valuable as the five questions themselves.

Rachel: Yeah. And I like the way that they combine all those different leadership principles for those that they, that the new leadership styles are so so important, and just make some so accessible, and helpful. You said you were thinking about how you prevent PTSD, rather than just sort of fixing it. Do you think it’s made a difference?

Steve: I’d love to have one of those wonderful numbers, if I, but if I did, or didn’t have the wonderful number, some would or wouldn’t believe. I have a faith in things, and my faith in this is quite strong. I have a record. I have a portfolio now of personal messages, gratitude. moments when people have just dropped me a note, just just out of the blue to said, Steve did the five questions. They just did this: Steve, thank you for the conversation you had in the corridor and five questions was the invitation to the conversation, because then that’s the conversation that was this? Has it made a difference? Absolutely. I’ve got reams of emails and messages on my text messages and Twitter feeds, etc. The British, the Royal College of Psychiatrists picked it up, and it’s on their website now as part of best practice for coronavirus, which, again, very grateful for that kind of support.

For this has been by a movement and as most is by people finding value in and if people then pick it up, the people download it. If people ask me for a company’s value in that, there’s, they’re reaching out a connection. Some people are asking themselves a question, and they want to ask the teams that they care for a question. Well, I don’t have one of those magic numbers. I have a faith that the work we did in the ‘How are you doing?’ team from five questions, is one of the interventions we had. We did lots of one to one conversations, we ran some team debriefs, we made ourselves visible strong pointing in all the leadership pieces and even the conversation with a psycho psychologist from the British Army: be visible.

By visible they weren’t talking about the senior leader walking around going you’re wonderful, but visibility in terms of leadership and action, a presence a sense that there’s something is happening because of you or because of your concern your your respect and your your compassion for us to have visibility in action as well as physical presence. And I think all that those combinations of work that we did we do quite a lot of work. The five questions was often a really nice introductory piece to get us to a conversation about the huge well being support that was on offer through the coronavirus, the downloading of apps like Headspace the use of text services like Shout the access to help lines, though the five questions were often part of that wrapped up package. The five questions which seem to have emerged as a standalone piece host coronavirus.

Rachel: Steve, we’re nearly out of time. And we could talk about this for another, a few hours I think. But if someone was thinking, ‘Actually that would work really well in my practice or in my workplace. But healthcare or not, what’s the three tips would you give people for starting to use this?

Steve: Tip number one, recognise that you’ve just asked yourself a really fundamental question. You’ve just said to yourself, I want to make an impact. I want to do something different. And actually wanting to do something different. You’ve identified a gap, a need at something’s going on. Tip number one, recognise what you’ve just done, you’ve just done, I’ve seen something, I’ve recognised need.

Tip number two, do not set yourself up to a bigger task. Don’t say, I’m going to get the five questions and fundamentally rock the foundations of your world. I’m going to get this and I’m going to experiment. I think one of the big differences between management and leadership. Leadership is an expense. Every act of leadership is an experiment you have no guarantee this is going to go well or not. So have a hypothesis and test that hypothesis. And five questions is your test for a hypothesis.

And finally, number three, give yourself time. I remember a couple of interventions I’ve tried in the past, and especially in sort of education, where all of a sudden you put something out there, which you think is revolutionary, you think people will absolutely solve this then. And then all of a sudden, nobody turns up, but nobody’s on the call. When that happens, persevere, just keep going. If you build it, they will come. And there’s something about just them realising the team realising or the need, realising that you’re not going away. The case of nobody turned up today. That’s all that happened. That didn’t mean your idea was wrong. It didn’t mean that you’re wrong. It didn’t mean that everything you do is now just that today wasn’t the day, tomorrow might be the day that this moves a step ahead.

Rachel: Brilliant, thank you so much, that is just really, really helpful. See, if people then wanted to use these, how can they get hold of them that they copyright? Or is there a sort of an open resource that they can find them?

Steve: So they’re absolutely welcome. It is an open process. I’m a jobbing NHS worker, I think I’ve sent you the three documents that are connected to this image. And I’m really happy for them to be shared. there’s a couple of words which matter hugely to me, in NHS, national and service stand out as being really important. I might work for a hospital in Stevenage, but I’m part of a national, a national commitment to improve the health of our community. And service is as much to our patients and our families and carers that we look after book service to my colleagues. So people can have this. It’s, if it’s just if it’s helpful, it’s yours.

Rachel: Steve, if people want to get a hold of you personally, or get onto your amazing mailing list with a weekly sort of emails about leadership or fully on Twitter or LinkedIn, how can they do that?

Steve: Absolutely, welcome anybody to join our network and our distribution. If you want copies of the five questions or to get on the mailing list, just email me at steve.andrews5@nhs.net, and if people want to pick up on my Twitter feed, it’s @SteveAndrews3. And if you do contact me, I’ll do all I can to share and spread the word.

Rachel: Great. And I do recommend your emails that come out each week that they’re fantastic. Thank you so much, Steve. Can I just say I think that the trust in which you’re working, absolutely so fortunate to have somebody like you with the values, and the enthusiasm, the commitment that you have to your staff working there. And I just just think this has been such a brilliant initiative. So thank you on behalf of all those staff.

Steve: Thank you, Rachel. And it’s been a pleasure to chat this afternoon. Thank you very much indeed.

Rachel: Really great to chat and I’d love to have you back. So you have so much wisdom about it. It’s so we’ll get you back at some point to talk about or find out how it’s, I’m sure this is gonna go, this is going to go national and it will be really interesting to see what happens with this. So thank you so much. Speak again soon.

Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You are Not a Frog email list and subscribe to the podcast. And if you have enjoyed it then please leave me a rating wherever you listen to your podcasts. So keep well everyone. You’re doing a great job. You got this.

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