Independent Thinking

My advice to NHS chief - be nice to your staff

28th October 2013

Simon Stevens, the new chief of the NHS, won’t be short of free advice. He should, say people on the left, halt the rush to competition. He should, say people on the right, speed it up to weed out the losers. He should clamp down. He should toughen up. He should do everything he can to hold his 1.7m employees to account. He should, perhaps, run it like an army.

It’s a shame he didn’t have time to pop along to a conference at the Southbank Centre last week. If he had, he might have learnt a few things that made him think. He might, for example, have learnt that human beings, and employees, function best when the “threat” system in the brain (which kicks in in response to fear) is balanced with the “soothing” system (which kicks in when mammals are nurtured). He might also have learnt that one of the best ways to get your employees to do a better job, and meet their targets, and get more done in less time, is to be nice to them.

The conference was on “empathy and compassion in the workplace”. For those of us who’ve worked on daily newspapers, it was almost an idea to make you laugh. No one really expects a newspaper to be a place of great compassion. The journalists who were bawled out by their bosses for failing to get the stories that would sell the paper, and who ended up hacking people’s phones to get them, probably wouldn’t say “compassion” was the thing their employers cared about most. But in the NHS, and particularly after all the scandals about terrible care, everyone talks about compassion. They just don’t talk about it in relation to the staff.

If Simon Stevens thinks it sounds a bit soft to be thinking about things like “compassion” towards his staff, perhaps he’ll listen to some people who know a few things about business, and the brain. Perhaps, for example, he’ll listen to the research that the neuroscientist Antoine Lutz talked about, which shows that organisations that are more “compassionate” to their staff have better productivity, lower employee turnover and lower sickness levels than those that aren’t. The organisations he talked about weren’t ones that are meant to be about things like health and healing. They were organisations that were meant to be about money. And the people who had done the research weren’t all neuroscientists who were interested in things like “compassion”. They were people like management consultants.

A man called Richard Barrett talked about his work with banks. He talked about something he called “cultural entropy”, which is, he said, “the amount of energy an organisation spends doing unnecessary or unproductive work” or caught up in “conflict, friction and frustration”.   He talked, in particular, about a bank called Nedbank, which spent seven years looking at their “limiting values”. In those seven years, “cultural entropy” went down from 25 per cent to 10 per cent. The number of people taking part in the project went up from 8 per cent to 75 per cent, because everyone could see it was having an effect.  And it affected the bottom line. Banks, as we all know, and even more now that we’ve bailed so many of them out, are very keen on the bottom line.

A young American professor called Adam Grant, who looked very like the man who was asking him questions, spoke to us all via Skype. He’s written a book called Give and Take, and is quoted in Malcolm Gladwell’s new book, David and Goliath. There are, he told us, three basic styles of interaction. There are “givers”. There are “takers”. There are “matchers”. “Matchers”, he said, are the people in the middle who do both. The worse performers in an organisation, he said, were the “givers”, who are so busy helping everyone else that they run out of energy to get their own work done. But if the “givers” were the worse performers, they were also, strangely, the best. These, he said, are the people at the top who do “a lot of five-minute favours”. They aren’t, he said, Gandhi or Mother Theresa. They set clear boundaries and block out time.

When you’re trying to change a culture, he said, you don’t have to choose between bottom up or top down. What you need, apparently, is both. You need to “get the right people on the bus” and “keep the wrong people off it”. You’ve got, in other words, to weed the nasty people out.

Daniel Goleman, who also took part in the conference via Skype, and who will always be known as the man who came up with the phrase “emotional intelligence”, talked about the “mirror neurons” in the human brain. These neurons, he said, prompt us to see, and maybe even feel, the same things as the person we’re with. If you see someone in pain, he said, the circuitry in your brain that would activate if you were in pain lights up.

You don’t have to be Einstein to see what this means at work. It means, of course, that if your boss is in a positive mood, you’re likely to catch his or her mood, and what businesses like to call “performance” will go up. If your boss is in a bad mood, which isn’t entirely unknown on, for example, a daily paper, your “performance” is likely to go down.  Plus, you’ll have a really horrible time.

The Israeli film director Yoav Shamir talked about his new film, 10 per cent – What Makes a Hero. He wanted, he said, to “identify the secret ingredient all heroes share”. He talked, in the film, about the Milgram experiments, conducted in the Sixties, in an attempt to understand more about Adolph Eichmann’s defence that he was “just following orders”. Sixty five percent of the people who took part in the experiments agreed to give other people what would, if they had been real, have been lethal electric shocks. He talked about the Stanford Prison experiment, where students were put in a simulated prison and asked to take on the role of prisoners and guards. The experiment was supposed to run for two weeks, but had to be stopped after six days, because the "guards" were out of control.

He watched chimpanzees “somewhere in southern Africa”, and could see why heroes were so rare. They are, he pointed out, “notorious for cannibalism and infanticide”, but he was, he admitted, quite “flattered” that the alpha male in the group seemed to see him as a threat. “Somewhere in the Congo”, he watched animals that looked like chimps but were actually called bonobos. Bonobos, he said, “prefer to make love, not war”. They also, by the way, have a female in charge. Give a Bonobo a choice between hogging a pile of food and sharing it, the bonobo, apparently, will choose to share. We are, he said, genetically more like bonobos than chimpanzees.

Shamir met a bloke who leapt on the tracks on a New York subway to save a man who had fallen off the platform, and ended up having the top of his head scraped off by a train. He met a woman who had hidden Jews in Belgium during the Second World War. He met a man who’s given away 99 per cent of his income and, in the process, lost his wife. This man, who’s a surgeon, has done scientific research that shows that when you do good things for other people, it lights up the pleasure centres in your brain.

Shamir hoped, he said, to find the secret formula for a hero, but by the end of the film he hadn’t. What he did notice, he said, was that the “heroes” he met seemed to be having a lot of fun.

For too many people, work isn’t fun. For people in the NHS in particular, it doesn’t seem much fun at all. So many people working in the NHS seem to wish they had a different job. People hardly ever do their best work when they wish they had a different job.

If Simon Stevens wants a better NHS (and he should want a better NHS) he should employ nicer bosses, who are nicer to their staff. He should remind them that work isn’t actually meant to be a punishment. He should remind them that there was a time when people actually went to work and had a laugh. Doctors were famous for their black humour. Nurses didn’t spend their days looking grim. Having a laugh was one of the things that helped doctors, and nurses, and all the other people involved in caring for patients, deal with the things that might make them cry.

There’s plenty in the NHS to make us cry. There’s plenty in life to make us cry. We can’t all be heroes, but if we’re happier, and our bosses our happier, and we even sometimes actually smile at each other, we can probably do a fair bit better at everything than we seem to be doing now.

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