On being a ‘hard done to’ bottom

Learning is a funny thing isn’t it? – The things you remember and then those things you don’t. I’ve had my learning muscles tested recently as part of my Organisational Development Practitioner Programme which I chose to do as part of my Florence Nightingale Foundation Burdett Leadership Scholarship. My instinct was right, by the way, there is much useful learning in OD for people interested in leadership. I know that some of the theories passed me by and weren’t retained in my pooh bear sized brain but some things have stuck and some of the systems thinking from this week has definitely stuck; it’s all about tops, bottoms and middles.

organisationsThe theory is quite simple; people in organisations adopt very predictable patterns of behaviour and that breaking out of these is what we need to do before we can really achieve but of course changing behaviours is a real challenge for all of us. Systems thinking is from work by Barry Oshry that explains that organisations are broken down into ‘Tops’, ‘Middles’ and ‘Bottoms’ and that each of these, naturally as part of a system, moves back to unhelpful behaviours that create many of the organisational issues we face. This week we did the organisational workshop to experience the system workings of organisational life in a way designed to magnify these natural and unhelpful behaviours that manifest in the worlds of Tops, Middles and Bottoms; before you say you are never a ‘Top’ etc we all occupy these roles at one time or another, they do not necessarily reflect organisational status (but they might). I had great fun 🙂

The process of allocation to a role in the workshops was random and I was delighted to find myself as a ‘bottom’. That’s where the fun started! I have to say that although in my role I wasn’t unhelpful nor was I as focussed at first as I should have been and I did revert to the behaviours that Oshry would have predicted, for me this was to withdraw to almost a playful space. I was experiencing true ‘bottomness’.

Those of you who have done the organisational workshop will understand significance of this picture :)

Those of you who have done the organisational workshop will understand significance of this picture 🙂

Oshry predicts that people will revert to an unhelpful behaviour and unless we can break from this we will perpetuate the same issues over and over again. Tops at times of pressure suck up responsibility and become ‘burdened’. Middles slide into the middle between tops and bottoms and become weak and ‘torn’. Bottoms hold higher ‘ups’ responsible and become ‘oppressed’. Oshry also explains that Customers also fall into a pattern of unhelpful behaviour where they become ‘righteously done-to’.

Sure enough, as the great workshop panned out, all of these behaviours were exhibited. My bottomness centred on a feeling of no one telling me anything and therefore I didn’t know what I was supposed to be doing so along with my mates we had a grand old time – playfulness as withdrawal.

Oshry goes on to explain that we chose how we behave and that these patterns do not need to persist – we can chose to be different.

Partnership is the key and changing and transforming our relationships can stop these behaviours and stop recreating the organisational patterns.


A relationship in which we are jointly committed to the success of whatever project, process or endeavour we are in.’

Partnership 2We can chose to be part of what he describes as the ‘side show’ where we make up stories about it and evaluate others as malicious, insensitive and incompetent or we can take the centre ring and have understanding and empathy for others, staying focussed on the best outcome and take a wider view where you take into account the perspective of others. Tops should take a position where they focus on developing responsibility throughout whole organisation. Middles should maintain independence of thought and act in service of the whole system. Bottoms should take responsibility not only for their thing but also for the whole thing.

I think I recognise Oshry’s organisation in many places I have been in my career, where ‘stuff’ happens and I also recognise my own unhelpful behaviours in those he describes. I can also adopt some of the more helpful behaviours that move to a better position of partnership. If you ever get chance to do the organisational workshop I would recommend you jump at it; it certainly fits with my experiential model of learning.

There is no way I will forget being a hard done to bottom and also the need to stop those old behaviours developing, even without thought, and I will try to take a more helpful partnership position.

You can find out more about the organisational workshop and Barry Oshry here and here.

Go on, reach out and build your networks!

I’ve always liked to get to know people and stay connected. My Myers Briggs type is ENTJ and my most extreme preference is extroversion – I know I’m a sociable animal. When you have those preferences it’s easy to under play the value of networks, after all connecting, learning and sharing are second nature to me and it’s how I stretch myself too; making sure I have interesting conversations that make me think. It’s also good fun.Myers Briggs

But as leaders in a system where it feels more complex and harder to achieve what we need to do than ever before, networking to share ideas and co-create solutions must be part of the future. Relationships that bridge organisational boundaries and stretch us to acquire new perspectives and look at things in new ways must surely be part of our future?

Networking sometimes has a bad reputation. That funny look people give you when you say you are meeting someone for coffee, a sort of ‘nudge, nudge wink, wink’ and a ‘tapping on the side of the nose’ as if to say – ah you are off for a quick skive or you must be job hunting. That’s not how I see it and how it works for me. I see meeting people and getting to know them part of my knowledge network; it enables me to stop worrying about not knowing so much but knowing others who do, or who think differently, or have different experience to me. My brain sometimes feels full-up and not able to absorb more – I need to share brains through my networks. You know the old AA advert ‘But I know a man who can’. 

Networks are also brilliant for finding people to test my madcap ideas on – it sometimes takes someone to say to me – whoa! Hold that thought right there!



You need to nurture and grow your networks, they don’t just arrive, and once you have them they need loving care and attention.



Here are my top 10 tips for developing and growing your networks:

  • Always be genuinely interested in people and what they have to say
  • Find common ground and share what you know too – it’s not a one way street
  • Try to stay connected as much as you can – close connections need more of your energy than loose ones but both need your attention
  • Always try to give as much as you take – generous spirits tend to be good networkers
  • Only promise what you can deliver
  • Build trust and mutual respect and keep at it
  • Never, ever, ask for anything that you know is wrong, however good the relationship
  • Use social media to connect and share
  • Share your connections – you will extend your networks this way
  • Enjoy yourself and relax!

Leeds connected coffeeI recently had the very great pleasure of meeting Phil Jewitt @philjewitt from Leeds City Council as my NHS Change Day pledge for Leeds Connected Coffee. A great example of networking; we both come from very different professional backgrounds but we found much common ground and I feel sure I will be meeting Phil again  and I wouldn’t hesitate to ask his advice on local authority stuff! If we are to connect across systems it is the people who can do this, not sterile organisational structures – so go on, reach out and build your networks!

Finally have a look at this short RSA film about where good ideas come from and spot how networking might play a role here too 🙂 Its a good watch too!


Perceived Weirdness Index and Leadership

Sometimes I think I can be seen as being a bit eccentric and to be honest I quite like it; although it doesn’t mean I am fond of being the centre of attention. I often feel on the edge of things, not quite mainstream, sometimes it’s fun, other times it’s lonely. But is my eccentricity something that can be a help?who are you

I have been studying the practice of Organisational Development (OD) recently as part of my leadership scholarship and am learning lots of things that I think have equal applicability in a leadership space. OD practitioners use the concept of ‘self as instrument’, understanding that any intervention has an impact and think carefully about how they act, think and do – their presence. I think leaders could usefully think like this too. I started to wonder if my perception of ‘self’ and my presence might be something to do with how I affected things around me. Presence can be thought about as impact created by personal appearance, manner, values, knowledge, reputation, and so on. So, if ‘self’ is important in leadership interventions, is my possible eccentricity an advantage or a disadvantage?

There is a fascinating idea first described by Halafin (1976) called the ‘Perceived Weirdness Index’ (PWI) that I came across exploring the OD literature. Your PWI may make you more or less effective as a change agent. The PWI is a spectrum of behaviours with a ‘sweet spot’ where you are not in the mainstream of the organisational culture but just weird enough to be at the edge, the theory being that if your PWI is just like everyone else’s you are less likely to be successful at effecting change as you are absorbed into the organisational culture but if you are in the ‘sweet spot’ then you can be more effective as a change agent.pwi

Are the people who you think are change agents just a bit weird? Where do you think your PWI score is in your workplace? How different are you? All very interesting thoughts!

odd one out

Never, ever back off a challenge! Update on Florence Nightingale Foundation Scholarship

It’s a few months now since I was given my Florence Nightingale Burdett Trust Leadership Scholarship – I’m starting to feel the pressure, yes, I actually have to do something (!) but this week I started to work on how I might add some value through my project.

social media networkI knew I wanted to think more about social media and how professionals behave alongside the public in these digital spaces; I am keen that we recognise the potential for social media, as well as the usual rules that we seem to need to establish, in terms of ‘you must do this’ but more usually ‘you must never do this!’.

I want to interview new people who may not usually get heard in the health space, this includes people who use health services but also those outside the sector. It was this in mind that I travelled to Plymouth Plymouth 2to see Steve Wheeler (@timbuckteeth). I have known about Steve for a while and follow his blog, which almost always makes me think. It was a real privilege to meet him – to put it into context his blogs get massive numbers of reads and comments and his following on Twitter is almost 20,000.

This is how Steve describes himself on Twitter:

‘Web 2.0 researcher, author of The Digital Classroom, Associate Professor of learning technology, Associate Professor of learning technology in the Faculty of Health, Education and Society, at Plymouth Universityinternational speaker, disruptive activist.’

Steve, amongst his many research interests, is interested in Web 2.0 social technology. Steve’s blog is called ‘Learning with e’s’.

I had a long chat to Steve about my scholarship and what I was interested in. Essentially I am interested in trying to help health professionals make the most of the opportunities that social media presents, not just for professional development but also to work with patients and citizens.

Steve has some interesting views about social media and how we interact with it. He is generous and knowledgeable. I made the mistake of asking him how he would tackle the questions I was asking and he came back as quick as a flash – ‘make a video documentary’ – he says. I paused for about 20 seconds and said ‘I’m going to do that’.

Steve Wheeler 1

So here we are. I have no video equipment and no experience of audio-visual ‘stuff’ but there is nothing I like more, than a challenge. It made me reflect on myself as a person and why I always end up with the strangest jobs and doing the things everyone says won’t work, or are too hard – I like it that way 

So I will be going back to Plymouth at some point to video Steve and to put down on record my exploration of social media for my scholarship – putting the output on YouTube seems fitting somehow.

My very great thanks to Steve, Pam (@pam007Nelmes) who arranged the meetings for me and the delightful Ray, Professor of Informatics also at Plymouth (@rjonesplymouth) for his insights and looking after me

If you want to try a taster of Steve’s blogs try this one on digital tribes – I promise it will make you think too.

PS – There is still time to apply for a Scholarship – look here and why not have a go – its a fantastic opportunity!

Reflections on the Florence Nightingale Foundation Conference 2013

It was a real pleasure to attend the Florence Nightingale Foundation Conference 2013 a couple of weeks ago. It was a real nursing leadership conference – the hall was rammed with some of the most inspirational nurses you could wish to meet; nurses committed to making a real difference for patients. It was a real change for me – a nursing focussed conference rather than an IT one!
We also had the opportunity to hear some really good speakers and this blog is my reflections about some of the messages that resonated with me – a personal reflection rather than a full account of the event.

First of all I attended a really interesting session about Schwartz rounds, presented by Jocelyn Cornwell from the Kings Fund and Vanessa Snowdon-Carr and Martine Price from Musgrove Park Hospital, Taunton where Schwartz rounds have been implemented. Schwartz rounds provide monthly one hour sessions where staff can discuss the emotional issues that arise from delivering care. The originated in the US where healthcare attorney Ken Schwartz, who died at 40 years of age of lung cancer, left a lasting legacy of a center that nurtures compassion in care-giving.

You can find out more about the Center here:

The Kings Fund is running pilots of Schwarz rounds in the UK and is looking for more sites. You can find out more here: http://www.kingsfund.org.uk/projects/point-care/schwartz-center-rounds

I found the idea of staff being able to talk about topics such as ‘the patient I remember’ very moving and I found that I could remember a number of patients who had stayed ‘with’ me for many years.

We also had a fascinating presentation from Professor Davina Allen, a Health Foundation Improvement Science Fellow. Davina’s research is looking at what nurses actually do, how their work is organised and structured and hopes to describe the complexity of nursing – it’s a fascinating analysis that she described as ‘An Articulation of Healthcare’. Davina observed 40+ hours of nursing activity and has analysed this to describe in new ways some of the complex things that nurses actually do; issues like negotiating transition and information. Davina was describing her early findings and I’m looking forward to hearing more. There has never been a more important time for us to be able to describe and evidence what nurses actually do in more than a task orientated way.
[It was interesting to see and meet Davina – she is one of my fellow Johnson & Johnson/Kings Fund leadership group (please see previous blog)! As is Martine Price from Musgrove Park Hospital. – It’s a very small world!]
There were 2 speakers who said things in their sessions that really resonated with me. Ros Moore CNO for Scotland said two important things:


Ros indicated that she even used this language and approach when talking to ministers – interesting! I thought this was particularly important in terms of achieving a change in culture and emphasis. If we share a common language and it is orientated towards improvement surely this will help us to improve safety and care? Ros’s point was also reinforced later by a presentation by Jason Leitch (@jasonleitch) – equally impressive and consistent. It may be that consistency is important?
More about Scotland’s improvement policy can be found here:


Ros’s second point was a line on her strategy slide:

tweet 2

I thought placing trust in people in the system demonstrates value and encourages people to perform at their best. I liked it.
Finally, the one point that has really stuck with me was a point from Dame Ruth Carnell. Ruth was a great speaker, she was honest warm and engaging but she also said some very important things. The most important for me was about the leaders of the future.

tweet 3

Ruth said that we needed to think about inversion of leadership. What I think she meant was that the elder leaders in the system needed to focus on bringing the new generation of leaders to the fore, to supporting them to mature as the brilliant leaders we will need in the system for future generations.

This made me reflect again on my blog on eldership:
I definitely will be focussing how I can help/support/coach and mentor young leaders and I have made this one of my #NHSChangeDay pledges!
Watch out for next year’s Florence Nightingale Foundation Conference. If it’s a good as this one I hope to be there 