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19 Oct 2022

Articles

Are your Team’s Performance Measurements and Reviews Up to Scratch?

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Coaching & Development, Leadership & Culture, Premium
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https://leadersinsport.com/performance-institute/articles/are-your-teams-performance-measurements-and-reviews-up-to-scratch/

The San Jose Earthquakes’ Max Lankheit explains the approach he has developed as Director of High Performance at the MLS side.

By John Portch
“High performance doesn’t end with the players,” says Max Lankheit.

The San Jose Earthquakes’ Director of High Performance, who took the role in January this year having previously served as the team’s Head of Athletic Performance, is discussing his thoughts on where ‘high performance’ starts and ends with the Leaders Performance Institute.

“That was one of the things I wanted to change the moment I took charge of a department,” he continues. “High performance affects the entire organisation and it’s something we need to instil – not only in the high-performance department – because I think it’s a misconception that high performance only affects what’s happening on the field and the front office absorbs this just by association.”

The idea of holistic high performance is what drives our conversation around the usefulness of objectives and key results as a goal-setting framework for a sports organisation. “OKRs originated from Intel and Andy Grove (in its original form ‘output-based management’) and the concept was further developed into OKRs by John Doer with Google,” says Lankheit, who has piqued our interest through his work at San Jose.

For over an hour he describes the processes he has introduced to enable effective performance reviews across his high-performance team. His account is detailed, personal and laced with conviction but comes with a caveat.

“It’s important to understand that you cannot just do OKRs,” he says. “I’ve tried it twice in the past and both times I’ve failed miserably. It’s not to say that someone else couldn’t do it the first time but nobody I know has done an OKR implementation right the first time they do it; and I think you need to make those mistakes to understand what you could have done differently.”

Here, we delve further into Lankheit’s approach to performance reviews and the rationale behind his approach.

Results

Lankheit states that measuring staff performance and impact is difficult, but his efforts at San Jose are guided by five “imperatives”. “They are: clear vision, targets and commitments – individually as well as group-based – transparency, meaningful marketing, which translated into our environment means a player-centric approach and, finally, performance-oriented management.”

With those imperatives as the starting point, Lankheit explains that the objectives of an organisation are necessarily influenced by its vision but are not necessarily cascading down into the objectives of each department. He says: “Your department objective may change every 4-6 months, and for us right now, it’s ‘establish a seamlessly integrated player-care system’. This means that for this objective, every individual has certain key results that they need to hit. ‘Individuals’ in this case meaning the staff members of my department.”

Lankheit begins to illustrate his point with the hypothetical target of treatments administered per day by his staff (“a silly example but easy to comprehend”).

“At the beginning we sit together and say, ‘OK, we mutually agree that the result for you is to deliver ten treatments each day’. That’s the key result the staff member is committed to achieve and that’s going to be put into our management system so it can be tracked. It’s tangible and it’s quantitative – not qualitative – the qualitative aspect is the department objective, but the quantitative aspect is what each individual can provide because that is measurable. That’s important to me because either you achieve it or you don’t. You have a direct influence on that that nobody else has.”

The last point about the individual’s agency in delivering upon a key result is important. “Before I took over this department, bonuses were only connected to player availability,” adds Lankheit. “Now, you and I both know that player availability depends on so many factors that it’s out of our hands as a department.” A common enough example is a player selected to play a match against the recommendation of the high-performance department. “That’s why it’s important to me that we find performance measurements that are directly under the sole influence of that individual or department.”

Those measurements also provide the basis for review conversations that should take place in pre-determined timeframes, informally and formally. “And it’s not a perfect world because I currently underdeliver on this,” he admits. “I just had some performance reviews with my staff, and then you talk about, ‘OK. These were the deliverables and did you or did you not get there? If yes, awesome. Maybe the performance goal wasn’t hard enough, so maybe you should have delivered 15 treatments each day’. OK. Does it make sense to raise that or are you like, ‘actually, it didn’t have the impact that we expected, and I think we should focus on something else’?”

Lankheit then further breaks down key results into ‘commit’, ‘target’, and ‘stretch’. Ten treatments per day could be the commit and 12 could be the target. “I could say ‘this commit is the least I expect from you and if you don’t deliver on this then we’re going to have a very hard conversation about it because you committed because you had the resources, you thought hard enough, it can’t be on our end.’

“If you’re able to do the commit goal, the target is what you actually want to achieve but knowing that if you didn’t hit this you can say to me ‘this was the goal but I was unable to do it. I hit the commit but I didn’t do the target because I didn’t have enough resources from you. Or if we had another table, no problem, but the tables were always full’. Now they can come back to me and say there was a problem, which helps me to raise the bar as well.”

He continues: “The stretch goal is kind of a grey area where everything needs to fall into place for you to be able to do 15 treatments, for example”. Stretch goals are beyond an individual’s control. So then if you hit 15, we say ‘this is fantastic, you had a fantastic quarter, but I don’t expect it and the person also doesn’t expect it to happen.’ A coach might say ‘I wasn’t able to deliver more than those 12 treatments because we trained twice a day and there was a gym session in between, so there was no time for me in those two hours to do that’. So you need to change the whole structure to achieve that. Or ‘we had so many injured players that we had to focus on those guys. I couldn’t do treatments for injury prevention’. “Consequently, while ‘commit goals’ are under the sole influence of each individual, ‘target goals’, and ‘stretch goals’ might need contributions from co-workers, disciplines, or even departments.” Hence, by doing so Lankheit embeds cross-functional, interdisciplinary collaboration into his people and performance management.

“That offers me the opportunity to go outside of the department and go, ‘OK, this is what we need to do as an organisation. We have a structure problem here. If we really want to do better then we have to do this’. That helps me to manage upwards and outside of the department.”

Values and traits

Under Lankheit’s Leadership San Jose’s Performance Department also lives by certain values and he assesses how his staff deliver on those values. “Was it ‘sometimes’, was it ‘consistently’, was it ‘most of the time’ or was it ‘always’? I don’t have to give an example for ‘always’ or ‘most of the time’ because then a person knows if they’re doing the right thing,” he says. “But the moment it is just ‘sometimes’ or ‘consistently’ then I will have to give examples where I’ll say ‘look, this is where you didn’t deliver when you had the chance to, but you didn’t’. Or ‘we have six core values in our department and you didn’t deliver on this one’. One aspect is the pure performance side and another is how culturally the person delivered on the promise of ‘this is what we stand for’ from a personal or overall cultural perspective.

Lankheit will also assess his staff based on four traits: problem-solving, execution, thought leadership, and emerging leadership. He says: “It’s the same with the values – ‘never demonstrate it’, ‘sometimes demonstrate it’, ‘consistently demonstrate it’ and so on – that way you do that development right there as people will say ‘this is a companion area I need to improve on’.

“We can say, for example, ‘in this performance review we identified that you are a thought leader but you are not showing emerging leadership skills, meaning you’re a fantastic individual contributor but it’s now on you to lead others’. Two different things. ‘People come to you because they know you’re the best at what you do, but you have to proactively go out there because you are a subject matter expert. Then you need to reach out to others to ask how what I do can make you do your job better?’ That comes from those reviews and then we work on that.

“We essentially take one main goal out of what we identified of those four traits that is the most important to work on in the next four months. It may also be the following four months as well, but that’s how we balance it out to personal development. Now, if emerging leadership is the one thing we want to work on in the next four months, that means I need you to take part ownership of someone else’s results. Now you need to demonstrate that you can support that person.”

At that stage, the conversation may return to commit goals and target goals. “Values and traits work hand in hand with goal setting. That’s also why the constant communication of meeting once a day, even for two minutes, to say something like ‘there was a chance where you could have done that – does it make sense to you? ‘Yes’. ‘Perfect. Next time I want you to jump in on that.’ I am always encouraging my staff to take responsibility. I would like them to do everything they do without me being there. They should be thinking ‘what is Max’s job here anyways?’

“We also have 360 reviews. I get the feedback from my employees. The employees each get one from me and also get to nominate one or two people, depending on how big the department is, that they want to be evaluated by, peer to peer. I don’t like the fact that I, as manager choose a person to evaluate you – I think it’s more helpful if that person nominates somebody that they want to evaluate them. Obviously, if they nominate their brother and I say ‘I don’t want your brother to evaluate you’, they understand, but generally, at least in our department, they would choose somebody who’s not necessarily their closest peer because they want that feedback.”

Removing subjectivity

In concluding his thoughts on how he is working to make staff assessments more effective, Lankheit once again emphasises the value in setting tangible goals. “It takes the subjectivity out of it,” he says. “If there’s tangible goals, I have nothing to argue. If you’ve delivered on a certain result, behaviour, or trait, you did it, so you deserve your bonus. We in pro sport live in a result-driven world. If someone doesn’t reach it the person has to tell me why. There might be a explanation that’s reasonable, but otherwise it’s just me saying ‘I think you should have done more or I think you didn’t deliver on that.’ It leaves room for this discontentment and resentment in your staff because they could always say ‘it’s because you don’t like me’ or ‘it’s just your perception. You never spend time with me, you’re always in the gym or at training. You only see me once a week so how does that make you the judge of the other 200 times I’m in contact with the player?’ With that embedded objectivity you take it out.

“The other thing, the cultural component, is subjective, which is why I need to bring examples. If I don’t bring examples, then there’s no point in me bringing it up in the first place. It also helps to create that feedback loop mindset in your employees as well because they’re doing the exact same thing. They’re not setting me targets but they’re evaluating me as well, so they understand it.”

Lankheit also ensures that staff members are given a copy of their review a day or two ahead of their appointment. “I give them my review 24 to 48 hours beforehand so that they have time to digest and think about my feedback instead of getting it on the fly and potentially reacting out of emotion. They have time to blow off steam if they don’t agree, they have time to reflect and come up with objective objections, if they disagree.”

It is not, however, intended as an exercise in micromanagement. “Everyone’s had micromanagers in the past,” he says with disdain. “It is important to get out of people’s ways and let them do their best work. When something is on my table, there has to be a good reason it ends up there otherwise I trust the fact that you’ll do the best job you can, you’re committed to your key results, so now you execute on them. Then we can have a conversation if you didn’t meet them and then I can jump in if you feel you need help from me. Otherwise, go and do the best job. I hated the micromanagement aspect of it when I was in certain roles and I think that’s why I am trying to be hands off.”

If anyone would like to discuss Max’s approach to OKRs and performance reviews, please contact a member of the Leaders Performance Institute team.

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28 Sep 2022

Articles

Are you Doing Enough to Help your Coaches and Practitioners to Develop?

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Processes should be baked into your systems, according to the NBA’s Jon Bartlett.

By John Portch
  • Leaders should promote a mindset of curiosity and safe learning.
  • Learning and development are the responsibility of both management and the individual themselves.
  • Adults learn through reflection and making meaning of experiences whether individual or shared – do not place too much emphasis on formal courses.

It starts with the leaders

The leaders are an obvious but essential place to start. The topic of coach and people development is one that the Leaders Performance Institute discussed with Jon Bartlett, the Elite Basketball Performance & Program Operations Advisor at the NBA, in April 2022. He said: “It’s no good if it just comes from one person and you’ve got 250 people in your organisation because it’s difficult for them to align all the different verticals. Leaders have got to promote this mindset of curiosity and asking questions without feeling threatened because what we want to do is learn together.”

What is learning and development?

“Is there a shared understanding within your organisation of what learning and development is? It sounds like a simple question but it’s actually quite complex when you break it down,” said Bartlett. “The initial thing to recognise is that it’s a shared responsibility between the organisation and the individual staff member. It’s not just the responsibility of the staff member or the responsibility of the organisation. We are responsible for engaging in our own development, but  organisations have to take responsibility for investing time and resource into their staff.”

Too much focus on the 10%

Bartlett highlighted the lack of emphasis on people learning within their current roles and cites the popular ’70:20:10’ model to make his point. The model suggests that 70% of learning is done from experience, experiment and reflection; 20% is learning from working with others; and 10% is learning from formal interventions and planned learning solutions. “Most focus on the 10% and organisations support the 10s and the 20s, but how many processes are set up effectively to support the 70 percent?” he said. “If you shape this in the right way, with the right processes, you can learn and develop in specific areas every day, not just thinking ‘I need to do a course, conference, seminar or webinar to learn – I can learn every single day if I have the right process set up for reflection, review and evaluation.’”

Bake the process into your systems

There are some simple steps that all teams can take. “Organisations can consistently provide opportunities, tailored towards each staff member, and you can visit progress on a frequent cadence. It could be monthly, quarterly or biannually,” said Bartlett. “Often, performance reviews in sport are done on an annual basis. Now, if you’re just going annually, and you’re on a three-year contract, you basically only have two touchpoints on your development. Some contracts only operate on a 12-month cycle. So how can an organisation focused on the development of their people make it more tangible? Bake the whole process into your system on a daily basis. For example, something as simple as after-action reviews. They have a massive part to play in learning and development. They can be as simple as: ‘what were the intended outcomes? What actually happened? What’s the gap between those two? And how can we bridge that?’ You might have one or two outcomes. We’ve learnt what worked well, we learnt what didn’t, and so we can apply those outcomes next time. We know from adult learning pedagogy that learning takes place through reflection and making meaning of experiences, whether that’s individual or shared.”

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24 Aug 2022

Articles

Creating Staff Development Opportunities At Brighton & Hove Albion WFC

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Coaching & Development, Premium
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https://leadersinsport.com/performance-institute/articles/creating-staff-development-opportunities-at-brighton-hove-albion-wfc/

Manager Hope Powell relies on her diverse workforce to prepare the team for the rigours of the Women’s Super League.

By John Portch
There is a common perception in football that if you finish lower in the table than you did the previous season then you have failed.

The truth is not always so simple. Women’s Super League [WSL] side Brighton & Hove Albion finished sixth in 2020-21 and followed that with a seventh-place finish in 2021-22. Last season was their fourth as a WSL team, having received a top-tier licence in 2017, and the first where they were unable to match or better their previous position.

It is a source of frustration for Manager Hope Powell, who shares the view that outcomes are not everything. She says: “We were really disappointed because we should have finished sixth, but it was still a really successful season because of some of the performances we had. The way the team performed, the way the staff performed – we put things in place and we delivered in lots of areas. It’s been a successful season for us and, for me, success is defined in so many different ways on and off the pitch.”

Powell, who also admits that she “cannot ignore the league table”, describes the challenge of taking on the WSL’s wealthier clubs as Brighton’s “greatest opportunity”. “From a football perspective, challenging those bigger, more established clubs that have been in the high end of the game for so many more years than we have is a daily challenge for Brighton, in a good way,” she continues.

The Seagulls are looking to meet that challenge both on and off the field, with Powell discussing player development in the second part of her interview with the Leaders Performance Institute. In the third and final instalment, she reflects on the culture at Brighton and the steps she and her team are taking to develop a high performance environment conducive to challenging for the top four in the WSL. “That’s where we want to be and we have to strive to be better than they are [the clubs who make up the current top four], to shift our club from where we are now to where we want to be.”

A nimble approach

Powell explains that at the end of the WSL season, the team generally holds a review, which is a process led by her psychologist [Beth Yeoman was appointed as Senior Psychologist for Women and Girls in May 2022]. “It’s standard stuff,” says Powell. “What went well, what we want to keep doing, what we want to let go and what new things we want to introduce.”

The most important thing, she continues, is the weekly conversations between Powell and her staff about the environment and the culture. “Is it working? What do we need to do now? What’s important? What isn’t important? I find that to be a weekly conversation so that we don’t just say ‘all the way through the season we’re going to do this’ and then at the end of the season decide if it’s been good or bad. I think it’s just about conversations and setting the tone of where you’d like the environment of the people you’re working with to be. I don’t think it’s too onerous.”

The Leaders Performance Institute suggests to Powell that it sounds like cultural mapping. “You can call it that,” she replies, “I think it’s just about having open and honest conversations. Certainly for me and my team. How does the environment feel? How are the players? What do we need to change? How do we need to engage them more? What about their voices? Is it too much? Too little? If that’s called ‘cultural mapping’ I don’t know, but that’s what we do on a regular basis.”

Powell has learned, during the course of her coaching career, to trust her gut. It served her well in the 15 years she spent as Manager of the England women’s senior team between 1998 and 2013 and so far during her five years at Brighton.

“I really believe that coaches have a gut feeling,” she says. “‘How does this feel today?’ Or during the week I’ll ask myself ‘how is training?’ Maybe it didn’t feel or look right. ‘What’s going on?’ Or, ‘this feels good – what happened? The players seem happy’. It’s those conversations and I get those feelings and so I like to challenge those feelings. ‘Am I missing something? It doesn’t feel right’. Generally my gut tells me ‘stick to it, Hope’ and every time I don’t, it doesn’t quite work out.”

Adding value

Powell speaks fondly of her coaching staff. “I believe I have the right people,” she says. “The most important thing is providing the opportunity for the team to say ‘this is what I think we should do next’. I am not precious about what we do as long as it adds value. If we think that it will work and we try it, that’s where the constant conversation is important. ‘It doesn’t [work]? Well we’ve tried it. I want the staff and, more importantly, the players to own it, be engaged, to have some pride in what they do and add value.

“It’s a chance for the multidisciplinary team to go, ‘this was really good, I didn’t think this worked, I think we need to change it, I don’t think it’s right, Hope.’ ‘What do you think then?’ I’m very much ‘what do you think?’ because even though I’m the leader, I’m not – we’re all leading it, they’re all experts. I manage it and I make the overall decision because if it doesn’t work, I lose my job. I get the input of everybody. My favourite words are ‘what do you think? What are your thoughts?’ That’s how I work. If you can’t trust your team or the people you’re working with then they’re not the right people.”

There is occasional turnover of staff and Powell will pay more attention to the work of new staff. “And then those conversations become less and less,” she says. “‘Just tell me what you are doing so I know’. ‘Is this OK?’ ‘ Yeah, go for it. Let me know when it’s done.’

She also senses when new staff members are keen to make a good impression. “They come in, and try to make an impression, as people do, and I have to say to them ‘don’t just say something because you feel that you have to. You’re not going to be judged because you don’t say something – say something only when you can add value. If there’s nothing to say then you don’t need to say anything’, but people want to make an impression. You make impressions in other ways, don’t you, it’s not all about having the last word. It’s not always copying in everyone in an email, which absolutely drives me crazy. Why do people do that? Because they’re trying to look good. That’s really sad, actually. That’s the world in which we live. I’m just not like that.”

CPD and mentorship

Powell is a big believer in keeping herself fresh and current through presentations, seminars, podcasts and conversations with other coaches. “When you have been on a journey as I have been, everyone thinks that you stop learning,” says Powell, who also serves as a coaching mentor with Fifa, Uefa, the Premier League and the Football Association. “The younger coaches come through and they want to absorb all of the information and quite often forget that you are still on a journey and you are still learning yourself. I think it’s really important as older coaches that we have that capacity and we have the will to do that.”

Of her own mentors, Powell recalls a former coach who, in his day job, was a senior manager at BT. “A lot of people reported into him and that really helped me when I went into management,” she continues. “It wasn’t about football, it was about managing groups of people, having a strategy, having a plan, how you communicate to groups of people, how you share your vision with your team and all of those sorts of things. I think if you can get a mentor outside of your sport, that is really powerful.” What about mentors within football? “I also value the people I talk to and the mentors I had in the sport because they understand it from the sporting context. If you can get a balance of both it’s really helpful.”

Brighton will provide and finance regular CPD opportunities both internally and externally for staff members. “The staff, or ‘coaches’ as we call everybody, have a responsibility to deliver CPD so that it enhances their knowledge, their learning and their development. I think it’s really important,” says Powell. “So all my staff have to deliver whether they’re a junior therapist or a senior practitioner. It’s very important that everyone gets the opportunity to deliver and to lead. It’s not just about the most experienced person in the room giving all the information.”

Diversity as a competitive edge

Powell is a pioneer in English football. She was the youngest-ever Manager of England when she was appointed, aged 31, in 1998. She was also the first woman and first black person to take the position.

Her role at Brighton affords her the opportunity to directly impact the diversity of her staff. “I guess I’m in a good position as I have the responsibility of recruiting and hiring staff,” she says. “You try to get the best players and the best staff possible. I quite like an equal split of male and female.” She points to the fact that she has a female assistant manager [Amy Merricks] and a male goalkeeping coach [Alex Penny].

“I think it’s important to have a diverse group. We have people who are from abroad as well, not just English. We’re down by the south coast and the demographic is very white and middle-class. I’m very happy to recruit from closer to London – I live in London – and I’m quite aware and mindful of that, to make sure the group is diverse, because then you get diverse thought. Otherwise you get everything that’s exactly the same and that just doesn’t work.”

Powell actively tries to provide employment opportunities for women because they are all too often lacking in English football. “I want the best person but I’m also mindful of the diversity in the group and, if I’m honest, I’m a bit biased because of opportunities for women in the game. If there’s a good female, I look at the female first if I think they’re good enough. They’re more likely to get the job simply because the opportunities for women aren’t afforded as much as they are for men, especially in football.”

She prides herself in her honesty but also in her support for her staff. “I think if you were to ask any member of staff if they feel supported they’d all say ‘yes’,” she says, reflecting on  Brighton’s progress on her watch. “Everyone believes in what you’re trying to achieve and everyone is prepared to work together.”

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22 Aug 2022

Articles

Making the Most of a Training Session When There Is Limited Time to Coach and Assess Athletes

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https://leadersinsport.com/performance-institute/articles/making-the-most-of-a-training-session-when-there-is-limited-time-to-coach-and-assess-athletes/

By John Portch
  • Combine physical, mental and tactical aims
  • What can you ask athletes to do in the ‘other 22 hours’?
  • Load manipulation is the last resort

Representative training design

The international footballing environment, as Bryce Cavanagh explained, inevitably limits the amount of time coaches and staff can spend with athletes. With this in mind, Cavanagh, who serves as the Head of Performance at the Football Association, told an audience at 2020’s Virtual Leaders Meet: Total High Performance that efficiency can be found in representative training design. “Firstly, we look at areas that stretch us on the field,” said Cavanagh, who works primarily with the England men’s senior team. “We tend to look at those denser periods, those peak periods, and we feel they tend to be represented by three things commonly. One is the intensity; generally the intensity goes up during those periods, so you’ve got a physical construct or a physical risk around fatigue; or an opportunity. Clarity, so players needing better decision making, performing under pressure and whatnot. And the other one is execution; execution of skills. That’s where they either break down or you execute them correctly. So there’s a physical, psychological and a tactical, technical construct there.”

Psychological stress under fatigue

Cavanagh recommends recreating the stressful conditions of match play to the greatest possible extent in training drills at both youth and senior levels. “We’re really careful to look at those peak periods and look at those three constructs [intensity, clarity and execution] and try to create opportunities in training where we’re hitting two or three of those in what we call ‘mutualism’ or mutual benefit between them,” he said. “An example might be something that’s got a technical or tactical outcome but we’re doing it under physical stress that you would find in those peak periods in the game. We can obviously feed back live and feed back GPS metrics around what some of those look like from the rolling average research that many practitioners do these days.”

In some ways, such sessions can serve as talent ID opportunities. “All the way down the pathway it’s important for us because we get such limited time with players; and coaches get limited time to assess the players,” Cavanagh continued. “Having more and more representative training is almost like having a talent ID tour in a way because you’re seeing how the players stand up in a game-like situation. If you haven’t seen a lot of a guy who’s come into an England camp, you can get a better indication of how he’s going to perform when he gets to the business end.”

The ‘other 22 hours’

Players arrive at international camps in different physical states. This necessitates an assessment that eschews traditional methods of gap analysis – “we have not got the luxury of 52 weeks of unlimited datasets”. There is, however, good communication with the English Premier League clubs that supply the bulk of England players, which enables the sharing of some metrics, such as GPS data. There is also a lot of relationship-building with the players that come into the squads.

Cavanagh and his colleagues also understand that every activity in training or during a match comes at a cost and, if the gap is too large, it may see a player miss training or even a match, the first thought goes to what can be achieved away from training. “We try to look at other areas to offset that set of scales,” he added, referring to the “other 22 hours”. “So if the cost is X, what can we do to offset that cost? Chronically, you increase the capability of the player and more capable players recover better, handle the cost better, but the more acute stuff we’ve gone after really hard. We’ve got a camp, we’ve got a captive audience, we’ve got them 24-7, so we’ve gone after the sleep, nutrition and recovery stuff.

“What can we do there to offset that cost acutely before the last resort being the load manipulation or training manipulation?”

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15 Aug 2022

Articles

Why the Best Person Is Not Always the Best Hire

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https://leadersinsport.com/performance-institute/articles/why-the-best-person-is-not-always-the-best-hire/

David Tenney of Austin FC on how to build a successful, cohesive staff.

By Sarah Evans
  • Building an effective team takes time
  • Adaptability is a key trait in new recruits
  • Staff development is an evolutionary process

Evaluate where you are and what you need to implement

“Building a successful team takes time,” David Tenney, High Performance Director at Austin FC, told the Leaders Performance Institute while still serving in the same role at the Orlando Magic. He spoke about how he sees his role as a leader is in developing his team over time to problem-solve better, to become more resilient, and to grow. Tenney then explained how, ultimately, he wants to facilitate a process by which his people, as staff members, are able to say, “we are getting better, making good decisions and continue to grow as people and practitioners.” He also went on to highlight that “there will be a certain point when they can grow and move on and you start the process all over again.” Then, he made clear that it is of critical importance to take time to evaluate where you are and what needs to be implemented or changed. He said: “When new hires come in, everyone doesn’t know each other’s strengths and it takes time to build those relationships. The first three or four months will be messy, but that’s OK.”

Don’t just hire the best people

Tenney spoke about some of they key characteristics he looks for in the practitioners he brings onto his staff, and explained how adaptability was one of the most crucial attributes. He highlighted that he often looks to hire people from outside of the sport as they can bring in fresh new perspectives. “Putting departments together is really hard, as it is a dynamic structure,” he said. One hire can impact on who the other hires might be, therefore, “it’s not always about hiring the best person for each role – it’s really trying to figure out how they’re going to fit together”. Elite sport is exceptionally chaotic, and Tenney highlighted the need to be able to evaluate whether someone coming into the team has the emotional resilience to deal with the pressures of elite sport. He said that many of the practitioners are the first people the athlete will see in the morning, and so they “can set the emotional tone for the building the moment the athletes walk in. So if you’re tired and frustrated, and the athlete walks in and we’ve just lost five games in a row, you’re sending that message to the athletes. Not everyone can do that – it’s a key trait.”

Making staff feel invested is key to their development

Tenney stated that “staff development is an incredibly evolutionary process.” As staff teams get bigger and practitioners that used to be part-time consultants are now becoming full-time hires, there are more interactions. With this in mind, Tenney shared with the Leaders Performance Institute that “the hardest part of my role is to bring people together, make sure information isn’t lost, and make people feel invested.” Often the practitioners are so focused on connecting with the athletes, that they actually miss connecting with the other staff members. Thus, Tenney said: “it is really important to set an environment where we’re collectively acknowledging each other’s individual strengths over a period of time, and I think that makes people feel more invested and committed.”

11 Aug 2022

Podcasts

Leaders Performance Podcast: ‘They didn’t enjoy the assessment at the time, but when they reflect on it, it’s powerful’

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Coaching & Development
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https://leadersinsport.com/performance-institute/podcasts/leaders-performance-podcast-they-didnt-enjoy-the-assessment-at-the-time-but-when-they-reflect-on-it-its-powerful/

Phil Church of the Football Association discusses manager, coach and technical director education in elite English football.

“Our mission statement is probably a good place to start,” says Phil Church, “and it’s to increase the number of English-qualified leaders, which is managers, coaches and technical directors, working at the highest levels of the game.”

Church is the Senior Professional Game Coach Development Lead at England Football Learning, which oversees the Football Association’s [FA] education pathways for youth and senior coach development and technical director development.

He joined the Leaders Performance Podcast to discuss the FA’s suite of programmes and courses as it works towards fulfilling England Football Learning’s mission statement.

Within that discussion we also touch upon:

  • The selection process for the courses [8:00];
  • Talent mapping with a view to adding support and value for learners [12:00];
  • Programmes for graduates to continue their CPD and to meet the needs of the game [17:40];
  • Why diversity and inclusion still needs attention at the FA [28:00].

John Portch: Twitter | LinkedIn

Listen above and subscribe today on iTunes, Spotify, Stitcher and Overcast, or your chosen podcast platform.

7 Jul 2022

Articles

Leaders Performance Podcast: ‘Ultimately, Leadership Is About Influence – it’s Not About who Takes the Most Action’

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Leadership & Culture
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https://leadersinsport.com/performance-institute/articles/leaders-performance-podcast-ultimately-leadership-is-about-influence-its-not-about-who-takes-the-most-action/

John Wagle debriefs his last days serving as the Kansas City Royals’ Director-Performance Science/Player Development.

A Leaders Performance Podcast brought to you by our Main Partners

“We want to be able to sustain excellence and in order to do that you have to move very precisely,” says John Wagle.

“It’s more so about connecting with people at the right time, having the right information, listening first, serving their needs, and then nudging towards whatever the process needs to look like.”

Wagle, who has just left his role as the Kansas City Royals’ Director-Performance Science/Player Development, reflected on his four years working in the clubhouse in the latest edition of the Leaders Performance Podcast.

Also on the conversational agenda were:

  • Knowing when to listen and when to implement change [4:30];
  • Learning how to learn – then learning how to lead [10:30];
  • The challenge of integrating technology in player development [16:45];
  • Why John says that players challenge him on a regular basis [21:00].

 

John Portch: Twitter | LinkedIn

Listen above and subscribe today on iTunes, Spotify, Stitcher and Overcast, or your chosen podcast platform.

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11 May 2022

Articles

Innovation Under Pressure: How the NHS in Wales Has Enabled its People to Thrive During the Pandemic – Part III

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Leadership & Culture, Premium
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https://leadersinsport.com/performance-institute/articles/innovation-under-pressure-how-the-nhs-in-wales-has-enabled-its-people-to-thrive-during-the-pandemic-part-iii/

By Dr Peter Brown and Dr Adrian Neal
This is the third and final instalment of our three-part series exploring the parallels between high performance sport and healthcare, drawing upon our experiences within the Aneurin Bevan University Health Board (ABUHB), which serves southeast Wales in the UK.

In our first piece, we described the context of operational delivery throughout the pandemic and the effect this has had and continues to have upon the workforce. We then provided comparisons between healthcare and performance sport, specifically in relation to performance plans and outcomes.

Then, for our second piece, we then moved on to present the opportunity for innovation within a crisis and the role of leadership within this to create the time, space and options for to enable novelty to emerge drawing upon the theoretical frameworks of complexity science and drive theory.

This final instalment wraps up our series by describing the potential route out of the pandemic in healthcare, or as is frequently coined, the ‘recovery’ from the pandemic. We will describe the new norm and the timescale and context of what recovery looks like for us and, importantly, the potential learning for and from performance sport.

Recovery: the impossible utopia for healthcare

There are many parallels between healthcare and performance sport, although one major point of difference is the ability for the performer and their support team to recover after training and performance.

In the recent Tokyo Olympic Games, teams were encouraged to decompress, which provides a time and space to adjust to a more relaxed state after the biopsychosocial stress of the event allowing the processing and acceptance of both positive / negative feelings and experiences to minimise maladaptive adjustments.

In healthcare, either on an individual level or an organisational level, recovery is not operationalised as an essential component of the performance cycle which might support biopsychosocial adaptation for sustainability. Instead, National Health Service [NHS] systems and the individuals within them are faced with a renewal of demands e.g.: political pressure to resume services and meet targets, public pressure to meet needs and address an increased acuity of patients linked to services not being accessible during the pandemic, budgets restrictions and, in some cases, cuts, the need to continue to provide Covid-related services, and increased staff absence and turnover.

The demands are relentless, leaving little space for recovery as a concept or as an essential component of sustainability and performance. Recent survey data from our Health Board demonstrate that significant numbers (>50%) of staff are physically and psychologically exhausted from the pandemic and are worried about how they can continue. In the eyes of many this situation represents a dichotomy, both an existential threat to the NHS but also an opportunity to motivate a system to change. Change the system to enable recovery of the people and the organisation, which may slow down services, or carry on as we are and risk staff leaving the profession, which creates even more disruption both fiscal and patient facing.

What we also know is that offering NHS workers a greater opportunity to have a positive experience of work is now an organisational priority. If we can help them do the work they have trained to do with purpose, reduce avoidable harm created through our processes, and at the same time help them feel like they are valued, we will have made radical progress – and desired ‘performance’ outcomes will increase.

From healthcare worker to healthcare performer

When considering the consistent demands placed upon healthcare workers, whether this be the porters and domestic staff preforming up to 30,000 steps per day, or the intense cognitive capacity required by surgeons to perform prolonged procedures, or the emotional demands faced by staff regularly exposed to distressed patients and demanding concerned relatives, maybe it’s time to reframe how we conceptualized this work.

Perhaps we should reframe healthcare staff as ‘performers’ not workers. When considering the athlete approach to performance in any given discipline, it considers the performance plan (see Part I) and the outcome ambitions that create focus, we consider the multidisciplinary performance science teams which surround the athlete planning. Then, we can adjust the environment for optimal training, including coaching, nutrition, sleep, mental preparedness and much more. Critically, this process revolves around optimising the athlete’s ability to be available to perform, to exert the appropriate effort in context and to recover, be ready to go again when it matters and, ultimately, to achieve the agreed and often very clear goals (i.e.: medals or improvements on previous performance).

There is little of this process present in healthcare. We have staff who regularly work 12+ hour shifts (in spite of evidence stating this is detrimental to their health), surrounded by poor quality nutrition, sometimes limited managerial and leadership support, often with insufficient staffing levels. Paradoxically this combination of factors almost guarantees high or sustained performance is not possible. If we consider the healthcare performer, we will need to re-engineer huge parts of the healthcare system, but perhaps now is the moment to do so.

A possible way forward might be to, rather than focusing on arbitrary goals or key performance indicators which are externally generated and often inherently political and perversely promote gamification and minimise intrinsic motivation/discretional effort, we focus on clear mutually agreed objectives in the present, and use this to shape how we optimise performance today, this week, this month.

We support this by co-creating meaningful performance measures which reflect the work being done by the people doing the work, and have a strong link to their sense of purpose and moral justice. If we focus on these factors within healthcare, as in the educational sector, for example, to be intrinsically motivated, their work has to give them meaning to be validating thus rewarding and internally motivating.

An irony within healthcare is that we know through research that many of the stressors faced by the workforce are not necessarily due to the work itself (primary stressors) but rather factors classed as secondary stressors (e.g.: bureaucracy without overt meaning, formal processes, management / leadership capability, psychological safety, inadequate job descriptions or role clarity). Left unchecked, many of these secondary stressors will have a negative impact on wellbeing and performance and have the added potential of creating unintentional harm to both individuals, teams and the organisation itself.

Changing both the narrative (workers as performers) as well as re-engineering the structures that are in place that maintains the identified performance inhibiting dysfunction is easier said than done clearly in the public funded healthcare sector, especially our Health Board which has nearly 15,000 employees. Notwithstanding this, there remains a pandemic-generated window of opportunity where we might be able use ‘recovery’ as a platform to initiate some of the changes we have highlighted and examine the way we support and develop our people, because we very much need to do it differently to enable the people of the NHS to thrive.

This message also serves as a call to arms for performance leaders in sport: are you providing an environment which enables your athletes to thrive, providing co-created measures of performance markers, with a strong focus on their internal sense of purpose, their sense of meaning gained from being an athlete and moral justice and not just the quantifiable performance per se (being mindful that the opposite of these psychological components being burnout)?

To bring together, our thoughts over this series of papers bringing together Organisational Development and Clinical and Organisational Psychology in a novel way, we are determined at the Aneurin Bevan University Health Bored to be different, to disrupt for a better future. What’s more, together between sport and healthcare, there is much we can learn together in order to create something which is compelling and will move the future of sport and healthcare to the next level.

Dr Brown is Director of Organisational Development (OD) at the Aneurin Bevan University Health Board (ABUHB) in South Wales and spent 10 years as the Head of Performance Knowledge at the English Institute of Sport.

Dr Neal is a Consultant Clinical Psychologist and Head of Wellbeing at the ABUHB and has researched and published widely across organisational health and wellbeing.

27 Apr 2022

Articles

Innovation Under Pressure: How the NHS in Wales Has Enabled its People to Thrive During the Pandemic – Part II

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Leadership & Culture
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By Dr Peter Brown and Dr Adrian Neal

 

This is the second instalment of our three-part series exploring the parallels between high performance sport and healthcare, drawing upon our experiences past and present within the Aneurin Bevan University Health Board (ABUHB) which serves southeast Wales, UK.

In our first article, we described the context of operational delivery over the past two years of the pandemic, the effect this has had, and continues to have, upon the workforce in healthcare and the comparisons between healthcare and performance sport: specifically in relation to performance plans and outcomes.

The pandemic continues to have a significant impact upon the delivery of all NHS services in Wales and across the UK. Most services (clinical and corporate) are feeling the exhaustive pressure of increased demand for clinical services, disrupted service models, record levels of staff absence (linked to sickness or self-isolation) and the weariness associated with responding to the recent Covid surges.

However, like many disruptive forces it has also given opportunities for innovation and creativity and this instalment of our three-part series explores the key opportunities for innovation within the ABUHB in response to the pandemic.

The leader’s choice within a crisis

Without using the phrase lightly, the NHS is operating within a crisis. As an organisation, many of our clinical and administrative teams have been redeployed from their normal roles to mass vaccination clinics and/or to help on wards with various tasks. We’ve been pulled from pillar to post both metaphorically and often literally. But despite this context, there is a choice to be made by leaders. Do you a) roll over and admit defeat or b) use it to your advantage and harness the opportunity a crisis brings. In the ABUHB Organisational Development and Wellbeing Teams, we’ve stood up to this disruptive force, looked it square in the eyes and chosen to use it to our advantage and innovate.

When working in a crisis, it’s no good doing the same old things in the same old ways. You need to be able to flex, adapt, and evolve to the situation.

Two key theoretical frameworks have supported and enabled our thinking during this: i) complex adaptive systems and ii) Three Motivation System model[1]. What is fascinating is that the optimal way to function in a crisis and complexity according to complexity science is somewhat opposite to people’s and organisation’s natural autonomic response. Complex adaptive systems present us a novel lens of making sense of our environment in order to act within it. Specifically using the Cynefin framework which is part of the naturalising school of sensemaking tools, we know that we operate within one, multiple, or the liminal spaces of multiple systems. These systems may be ordered where cause and effect are linear, known and repeatable with robust or governing constraints; complex where cause and effect are only known in retrospect and enabling constraints are present and, lastly, chaos, where there are no effective constraints.

By knowing the system you are in at a given time and the relative distance from the other systems by understanding the constraints of your environment, you create coherence enabling your leaders, people and the organisation to act with maximal understanding and minimal energy cost.

Innovation within a crisis

Our present situation in this pandemic throws the NHS well and truly into chaos where there are (at times) no effective constraints. The absence of constraints has enabled us to act and try new ideas shifting us from a system of chaos to one of complexity. For leaders, this can be worrying and energy-sapping, on the other hand, it’s also liberating. The absence of constraints makes innovation possible, it allows ideas to emerge rapidly, for us to learn through self-organisation, rapidly adjust to our environment and to navigate our world by maximising our contextual understanding. It allows us to create some form of coherence within our system and nudge it back to a space where we have elements of control. Within ABUHB we have taken advantage of this creating several game changing interventions such as:

  • #PeopleFirst #CynnalCynefin project – reconnecting with the workforce using naturalising sensemaking and narrative capture to shift positive change to the adjacent possible and maximising peoples effectiveness and purpose at work.
  • Test, trace and jab – rapid reorganisation and repurposing to support new and essential services, vaccination of over 600,000 people in a matter of weeks pre-Christmas 2021 due to Omicron.
  • Stepping away from bureaucracy – streamlined decision making during the early high peaks of the crisis.
  • Better understanding the factors that help create and sustain working environments for thriving not just survival (in principle).
  • Using the opportunity to innovate to shape our thinking about multi-systems pandemic recovery.
  • Develop a model of how we can minimise unintentional harm to our workforce and systems.
  • Develop a model of moving away from death rates, waiting lists to survival rates, surgical successes.

Linking motivation with complex systems

The second key theoretical paradigm shaping our work is Three Motivation System model (Gilbert, 2009). This evolutionary psychology model identifies that humans self-regulate their emotions (their autonomic nervous system) in three distinct ways;

i) by initiating a threat response and rallying social and intrapersonal defences;

ii) harnessing action or drive such as by focusing on detail, being productive and trying to exert control over the environment;

and iii) by soothing via meaningful contact with others or relying on one’s own internal recourses.

For people, this model supports evidenced-based psychological treatments for a range of mental health difficulties (e.g.: types of eating disorder, depression, shame, perfectionism, and psychological trauma). However this theory also has powerful relevance when applied to an organisational or system context. For example we can see how the two most common (and least adaptive) motivations manifest as omnipresent behaviours within an organisation such as the NHS i.e. the compulsion for increased control (grip) through detail and increased bureauocracy and social aggression (bullying, passive aggression and territoriality) which are in opposition to the naturalising sensemaking approach where the constraints of the system govern behaviour, not the other way around. This may also present in performance sport such as in the high performance training environment, the construction of performance plans or in the lead up to a major event.

Motivation, psychology and innovation

Emerging from a crisis, in the context of our people, the Three Motivation System model suggests that innovations that can be used to increase the frequency and quality of prosocial (soothing) interactions will help both individuals and systems to regulate their emotional states – leading to more prosocial behaviour, increased productivity and psychologically safer working environments.  What’s more, this model encourages us to better understand the core conditions that allow humans to thrive, which has in our context led to the development of our Employee Experience Framework with its six core conditions focusing on peoples sense of: control, feeling cared for, purpose, fairness, belonging, and having value (most of which are determined by social context and culture).

We are now starting to see how the Three Motivation System model and naturalising sensemaking can help us shape our organisational recovery plans, by identifying the working conditions that will promote the most positive and adaptive means for our workforce to start to recover from the unprecedented biopsychosocial demand of the past two years and navigate the challenges to come.

For leaders in performance sport, knowing the system(s) which you are operating within at a given time and the psychological frameworks underpinning and governing the organisation and the people that operate within it, you can begin to apply the right nudges to people, processes and behaviours to accelerate performance through innovation at an individual, team, organisational and system-wide level to create the right conditions for the emergence of the outcomes we believe are favourable.

Table 1 describes some of the innovations we within the Aneurin Bevan University Health Board have begun since the pandemic hit using these frameworks.

Table 1. Innovations, target problems and progress so far for the Aneurin Bevan University Health Board.
Area of Innovation Challenge to address Progress
Promote optimal working conditions to ‘Thrive’ using the Employee Experience Framework. Working cultures that are threat based – focused on performance and control, with limited understanding of human motivation in a professional caring setting. Promoting a work environment that supports ‘thriving’ will become our number one objective, our north star.
Evidence-based recovery planning The need to help the organisation understand the impact of the pandemic on the workforce and which human factors are necessary for it to recover its capacity to meet the health needs of the public. In development, this strategy will form the backbone of our short, medium and long term planning.
#PeopleFirst #CynnalCynefin

(Welsh phrase meaning: to reconnect with self and others in your multiple places of belonging)

Workforce disengagement, over-reliance on centralised decision making and loss of trust in local leadership. Lack of personal agency and control. Organisation wide project using naturalising sensemaking methods to understand the current state of all staff and shift to a better future defined by them not us.
Post-pandemic Clinical Leadership There is a real need to develop new ways of selecting, developing, and sustaining our clinical leaders and triumvirates. Existing formal leadership development opportunities are being reviewed and redesigned in light of the pandemic learning.
Increased opportunity for meaningful social interaction.

 

 

The pandemic has increased the sense of separateness at work via the physical restrictions of infection control but also due to dislocated staff groups and home working. A rolling programme of social interventions (e.g.: Schwartz Rounds, anecdote circles) have been initiated.

Summary

In summary, both complex adaptive systems and the Three Motivation System model provide an evidence-based theoretical frameworks that might allow an NHS organisation and performance sport, it’s people and networks to thrive. At Aneurin Bevan University Health Board, we are pushing the boundaries in these areas unlike any other NHS organisation. In the context of the NHS, and perhaps some elite sports functions, we also must hold in mind the magnitude of the ambition; to help an organisation recover in the least maladaptive way following a period of unprecedented chronic crises, especially since the situation was already fragile before March 2020.

In many ways, what we are endeavouring to do is radical but is borne out of a realisation that change is vital for sustainability, possibly even survival. It is perhaps apt that we are drawing upon a psychological model from evolutionary psychology literature and models of sensemaking from the natural sciences. We need to evolve to survive and to do so will require a degree of transformational thinking, while also being fully aware that the delivery of essential services cannot at any time stop.

We ask this question to leaders across sport: how much of what you do is the same now as 1, 5 or 10+ years ago? How may you be able to use the models suggested here to at least review and think about what’s possible? This may be radical change, or subtle shifts to the adjacent possible; what is the current state and the most plausible next step to take for change. To what extent is doing what you always have done self-perpetuating and missing significant emergence of factors which could be game changing for you and your athletes?

Our intension is clear, there is no fixed pre-determined or prescribed destination or goal, rather a well thought out direction of travel to allow us to discover new and emergent things along the way. This approach makes most NHS veteran managers, high performance coaches and directors deeply uncomfortable and may well trigger their drive and / or threat responses. We are however certain that the transformation we seek cannot be achieved by a linear task and finish approach alone with rigid constraints, to do so would risk missing vital context and emergent opportunities to learn and simply be a re-enacting of past maladaptive patterns which only service to meet short term and emotionally driven motivations, i.e.: to allow us to feel less anxiety for a short time.

In our third and final edition of this three-part series, we explore what’s next for healthcare as we begin to emerge out of this crisis, what scares has been left behind as an organisation and on its people and finally the parallels between recovery in healthcare and performance sport.

Dr Brown is Director of Organisational Development (OD) at the Aneurin Bevan University Health Board (ABUHB) in South Wales and spent 10 years as the Head of Performance Knowledge at the English Institute of Sport.

Dr Neal is a Consultant Clinical Psychologist and Head of Wellbeing at the ABUHB and has researched and published widely across organisational health and wellbeing.


[1] Turner et al. Systems, 2022

13 Apr 2022

Articles

Innovation Under Pressure: How the NHS in Wales Has Enabled its People to Thrive During the Pandemic – Part I

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Leadership & Culture
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Dr Peter Brown and Dr Adrian Neal
When you strip it all back, all the politics, the labels, uniforms and statistics, healthcare has many parallels to performance sport.

Within healthcare we have multidisciplinary (MDT) teams working together, problem solving quickly and using various interventions in order to maximise the probability of positive patient outcomes. In sport, we have MDTs working together to problem solve performance and use a variety of interventions in order to maximise the probability of achieving optimal performance in the moments that matter.

However, there is one significant difference between the two: the gift of the performance plan and periodisation within elite sport. Regardless of the sport and the level of competition, following any major event such as a World Cup, a world championship or the Olympic and Paralympic Games, there is always a full stop, a closing parentheses of the performance plan, a break to rest, recover, decompress biologically, socially and psychologically.

In healthcare, however, the stark difference is that there is no end, no rest, no full stop and no decompression or recovery. There may well be a period of rest and recovery for the patient but not the clinical support staff. Another significant difference is the variability and visibility around agreed objectives within healthcare; there is rarely a shared line of sight within an objective across an organisation. Objectives can change rapidly leaving little time to recalibrate an MDTs team’s shared sense of purpose or expectation of their work. What’s more, there is rarely a performance plan which factors in milestone events to support performance beyond KPIs. Instead despite delivering world class care to patients daily, the pressure only builds, the demands increase; the treadmill gets faster and the gradient steeper.

The past two years or so, since Covid officially struck within the UK, have exacerbated these ‘normal’ pressures and context. Accordingly, this three-part series of articles aims to provide:

1. A guided tour of the experience of the pandemic for individuals, teams and organisations delivering healthcare within the NHS at the Aneurin Bevan University Health Board (ABUHB) with a provocative comparison to performance sport.

2. The interdisciplinary innovative response from this health board to overcome some of this context so that we ensure performance of our healthcare staff.

3. What the future holds for the NHS in Wales and importantly the principles at play which performance sport can learn from within our novel approach to optimising performance of our healthcare workers.

The reality of burnout in healthcare provision

The Aneurin Bevan University Health Board (ABUHB) employs ~15,000 people and is the largest employer in the south east Wales county of Gwent. Approximately two thirds of these staff are patient facing, with ~600+ consultants, over 1,000 hospital and general practice doctors, 6,000 nurses, midwives, allied health professionals, health care scientists, community workers, and estates and facilities workers. All of this functions within a range of primary care provisions, five enhanced local general hospitals and a new acute care hospital. The past two years have been unprecedented within the Health Board, with the entire service provision turned on its head in 24 hours, with mass redeployment of staff to critical administration, control, coordination roles and deployment to mass vaccination clinical hubs across the county of Gwent.

The reliability of our understanding of the impact of the pandemic on the NHS workforce is rapidly improving. Initially during the first wave (March to June 2020) there was an emphasis on predicting a major mental health crisis especially around PTSD. Data from meta analyses is now rewriting this prediction even though rates of reported anxiety and depression in the workforce have risen. What has become apparent is that the impact is more diffuse and less overtly clinical in nature. Disengagement and burnout is now more of a reality and potentially a threat to performance in the NHS than diagnostic levels of mental illness, though distress is commonplace.

Burnout is categorised by the World Health Organization as a syndrome resulting from chronic workplace stress that has not been successfully managed. It is identified as having three dimensions: feelings of energy depletion or exhaustion, increased mental distance from one’s job (or feelings of negativism or cynicism related to one’s job) and reduced professional efficacy. Burnout has been linked to workplace performance since it was coined in the 1970s, however is not a new phenomenon in the NHS with pre-pandemic rates within Critical Care estimated to be as high as 20 per cent.

Measuring psychological wellbeing

Within ABUHB one attempt to measure broad psychological wellbeing has been monitored via a survey carried out five times since April 2020 and has now had over 15,000 individual responses. The survey asks about coping, fatigue, as well as factors considered foundational to psychological workplace wellbeing including one’s sense of fairness, control, effectiveness, belonging and others. Early in the pandemic the survey observed a pattern which suggested a third of the workforce were doing well, a third OK, and the remaining were struggling across all domains. Then, surveys conducted 21 months into the pandemic (July and November 2021) suggest this pattern has progressively worsened. Put simply, we are seeing data to suggest that at least half of our workforce are experiencing psychological difficulties and are also relating to their work and peer groups differently. Many report feeling the work they loved has changed, that they feel like they no longer make a difference, are demotivated as a result and, importantly, that they do not feel connected to or a part of the wider organisation.

This data and lived experience represents a major threat to the organisation given NHS services often rely excessively on a workforce with high intrinsic motivation, willing to offer extra discretionary effort to function let alone high performance, or any performance unremittingly.

Comparing performance measures in healthcare and sport

From a human factor perspective, the pandemic inevitably has and will continue to have an impact on NHS performance on an individual, team and organisational level, however an artifact of how performance is commonly framed in the NHS may make it even more challenging and requires closer examination especially when you juxtapose to elite sport.

When it comes to the performance and performance outcomes of performance support staff and athletes, elite sport have excelled in contrast with healthcare. Within sport there is normally a clear alignment between performance outcomes and capability of the athlete(s) and / or the service provision provided by the performance support team due to the investment and robustness of the performance plan and multidisciplinary dissection of performance through a performance backwards approach. In healthcare, it’s a little less clear with a lack of agreed and shared objectives across organisations and teams.

Table 1 below provides an example of the comparison of definitions and measurements of performance between healthcare and elite sport.

Table 1. Comparison of performance measures in healthcare and sport.
  Healthcare[1] UK Sport[2] NGB (GB Boxing)[3]
Mission Reduce health inequality experienced by our communities by improving population health, this mission will vary significantly between NHS organisation, department and team. Create the greatest decade of extraordinary sporting moments; reaching, inspiring and uniting the nation To build the world’s best performance system enabling each GB boxer to very best opportunity to reach their full potential.
Paraphrased ambitions / Priorities Every Child has the best start in life Keep winning and win well Performance focused
  Getting it right for children and young adults Grow a thriving sporting system Coach-led
  Adults in Gwent live healthily and well Inspire positive change Boxer centered
  Older adults are supported to live well and independently Open and competitive
  Dying well as a part of life One team
Typical Key Performance Indicators Waiting times – National and local KPIs vary: e.g.: Emergency Department, Psychological therapies, specific operations, HR processes. Investing £385m in 57 sports for success in Paris and beyond 3 to 5 medals at the Paris Games
  Errors 10 World championships An Olympic champion at Paris 2024
  Financial KPIs 30 European and World Series events in more than 25 sports Male and Female world champion by 2024
  Complaints – response times Generate £70m of economic impact Elite boxers to lead the medal table at the commonwealth games
  Number of Vaccinations delivered for Covid-19 Medal target 45 to 70 medals[4] Medals at every major championship throughout the cycle

 

Within healthcare, there is the obsession with key performance indicators (KPIs) which, in turn, are politicised performance targets rather than outcome focused measures of success. Performance management in healthcare is failing to measure performance and succeeding in gaming the data to achieve a given (sometimes malevolent) purpose.

Within all aspects of health and social care, we currently have a perfect storm. Rising waiting lists, greater than ever patient acuity, Covid restrictions, mass redeployment of staff from all corners of the organisation to support vaccination centers, rising staff absence, hundreds of patients clinically ready to be discharged to community but without the necessary support to leave the hospital and the numbers waiting for referrals, diagnostic tests, therapies and treatments on the rise.

The Welsh government have provided several hundred million pounds of additional funding across Wales to support the recovery from the pandemic, but the pandemic continues with wave after wave of mutated variant which doesn’t align to financial years. At 8pm every Thursday throughout the lockdown of wave one of the pandemic in the UK, the general public stood on their door steps and applauded the NHS workers and the windows of family homes were smudged with the finger prints of children who proudly displayed their paintings of rainbows to support the NHS and key workers. It feels like those days are gone. We now face increasingly high expectations from the public and government alike.

But it’s not all doom and gloom and our next instalment of this series describes how through a close collaboration of Organisational Development and Organisational Wellbeing / Clinical Psychology at the ABUHB, we are truly embracing the complexity of the situation we find ourselves in to address the key performance issues affecting our workforce. At least for us on the ground, moving away from arbitrary performance outcomes, numbers and dashboards to truly defining and understanding where we are today individually as teams and as an origination, the counterfactuals of our situation, and the adjacent possible to move towards a better future.

Dr Brown is Director of Organisational Development (OD) at the Aneurin Bevan University Health Board (ABUHB) in South Wales and spent 10 years as the Head of Performance Knowledge at the English Institute of Sport.

Dr Neal is a Consultant Clinical Psychologist and Head of Wellbeing at the ABUHB and has researched and published widely across organisational health and wellbeing.


1] Aneurin Bevan University Health Board; see abuhb.nhs.wales

[2] UK Sport; see uksport.gov.uk

[3] Performance to Paris: GB Boxing Strategy 2021 to 2025; see gbboxing.org.uk

[4] Olympic medal target for the Tokyo Games

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