1. Values in the NHS Mrs Clare Inkster Consultant Ophthalmologist, Bolton NHS FT Associate Dean, HEE (NW Team) Jan 2016

2. “Important and lasting principles which guide thoughts and actions”
What are Values?
“Important and lasting principles which guide thoughts and actions”
Different from beliefs as they are independent of context.

3. Do we even need to talk about them?
Story of obs and gynae trainees

4. Do we even need to talk about them?
HEE tells us we need to develop people with the right skills and the right values. Presumably they want this to translate into the right behaviours. So what are the right values?

5. Do we even need to talk about them?
New GMC standards – domain one is about the right culture and environment for training

6. So how do values form?

7. So how do values form? Upbringing – parents
Culture/environment – media, peers, teachers
Personality
Current context – degree of fear - physical and psychological safety (eg poverty, war, authoritarian regime)

8. So how do values form? Conscious reflection – considered
response to experience
Reflective exercise

9. Do we even need to talk about them?
“It is not possible for a single person living a single life to live consistently with all values.”
Isaiah Berlin
Compromise (between two people) and prioritisation (within an individual) are required.
Eg expensive cancer treatments – fairness vs compassion

10. Fairness Do we even need to talk about them?
“It is not possible for a single person living a single life to live consistently with all values.”
Isaiah Berlin
Fairness
Compromise (between two people) and prioritisation (within an individual) are required.

11. Fairness Compassion Do we even need to talk about them?
“It is not possible for a single person living a single life to live consistently with all values.”
Isaiah Berlin
Fairness
Compassion
Compromise (between two people) and prioritisation (within an individual) are required.
Now do personal values assessment – need list of values

13. Personal values assessment
Pick your top ten values from a list – as you live them
If you tick more than ten, you will have to start prioritising…

14. Barrett 7 Levels of Consciousness Model
Selfless service
Making a difference
Internal cohesion
Transformation
Self esteem
Relationship
Survival

15. Provides a way to start a conversation with trainees about the values they hold and those of the organisation they work within. Can map their personal values to those of the Trust/ HENW and the NHS.

16. Values into Behaviours…

17. Values Gap
Implicit bias (Harvard Implicit Association Test )
Values clash – eg honesty vs caring
Reduced resilience
Personality traits/wiring eg impulsivity, narcissism, neuroticism
Cultural norms
Poor leadership results in adverse role modelling and a deterioration in team behaviour – eg Mid-Staffs

18. Values Gap
Implicit bias (Harvard Implicit Association Test )
This is a test which is free to take, and can uncover our unconscious biases. Two types of bias – I used to work for a cardiologist many years ago who had an intense and explicit bias against obese people. His favourite phrase as that no fat people ever came out of Belsen. However, explicit biases of this type are less common now, whereas implicit biases are present in everyone. Form in much the same way as early values, from life experiences, role modelling and perhaps more pervasively, through the media, which can have a huge impact. Individuals are not responsible for their own implicit biases, but we should be aware of them so that we can act to minimise their effects.

19. Different types of values…
Personal
Organisational
National
Up until now, we’ve just been talking about personal values and their impact on our behaviour. But people may talk about national values, we are all familiar with organisational values, and have a sense of our own personal values.

20. Shared Different types of values… Personal Organisational National
First two are examples of shared values and the third is individual.

21. What are Values
Organisational – NHS Values

22. Organisational – NHS Values
What are Values
Organisational – NHS Values
Working together for patients
Respect and dignity
Commitment to quality of care
Compassion
Improving lives
Everyone counts

24. Personal to Cultural Values
Asks three questions – what are your top ten:
Personal values?
Values of your organisation currently?
Values of your organisation if it were to achieve its full potential?
So is there a way of finding out whether organisations are living up to their values? Barrett have a range of assessment tools which are able to do just this, and the main tool is the cultural values assessment. This is sent out in the form of a survey link much the same as the PVA.

25. Personal to Cultural Values
Level of congruity between personal and current cultural values – generates understanding of employees’ experience of organisation
Difference between current and desired culture of organisation shows whether organisation is living its values
And whether it is displaying the values which will allow it to reach its maximum potential.

26. Current Culture Values (CC) Desired Culture Values (DC)
Level
Personal Values (PV)
Current Culture Values (CC)
Desired Culture Values (DC) 7 6 5 4 3 2 1
IRS (P)= IRS (L)=0-1-0
IROS (P)= IROS (L)=
IROS (P)= IROS (L)=
caring 8
2(R)
commitment
5(I)
dependability
3(R)
humour/ fun
efficiency 7
3(I)
trust
5(R)
honesty 6
balance (home/work) 5
4(I)
being liked (L)
cooperation
family
positive attitude
teamwork 7
4(R)
information sharing 6
4(O)
competence 5
3(I)
continuous improvement
cooperation
5(R)
efficiency
3(O)
enthusiasm
5(I)
excellence
patient satisfaction
2(O)
continuous improvement 8
4(O)
efficiency
3(O)
teamwork
4(R)
continuous learning 7
cooperation 5
5(R)
information sharing
patient satisfaction
2(O)
professional development
commitment 4
5(I)
competence
3(I)
employee engagement
5(O)
employee fulfilment
6(O)
trust
PV - DC 4 0%
GP practice in the north west. Zero percent cultural entropy. All positive values
Orange = PV, CC & DC
Blue = PV & DC
L = Potentially Limiting (white circle)
R = Relationship
S = Societal
Copyright 2015 Barrett Values Centre
Values Plot
May 1, 2015 26

27. Marus Bridge Practice: Group (14)
Values Jumps
A value jump occurs when there are more votes for a value in the Desired Culture than in the Current Culture. Listed below are the values with the largest increase in votes. The values in bold are represented in the Desired Culture.
Current Culture Votes
Desired Culture Votes
Jump
continuous learning 3 7 4
continuous improvement 5 8
efficiency
employee fulfilment 1
shared vision
professional development 2
trust
leading by example
financial stability
listening
open communication
sustainability
Copyright 2015 Barrett Values Centre
Values Jumps Table
May 1, 2015 27

28. Current Culture Values (CC) Desired Culture Values (DC)
Level
Personal Values (PV)
Current Culture Values (CC)
Desired Culture Values (DC) 7 6 5 4 3 2 1
IRS (P)= IRS (L)=0-0-0
IROS (P)= IROS (L)=
IROS (P)= IROS (L)=
fairness 8
5(R)
caring 7
2(R)
honesty
5(I)
positive attitude
coaching/ mentoring 6
6(R)
continuous learning
4(I)
leadership
6(I)
dependability 5
3(R)
integrity
listening
professional development 10
3(O)
information sharing 9
4(O)
excellence 8
3(I)
trainee engagement 7
5(O)
bureaucracy (L) 6
continuous learning
embracing diversity
4(R)
hierarchy (L)
safety
1(O)
teaching
trainer engagement
excellence 8
3(I)
professional development 7
3(O)
adaptability 6
4(I)
innovation
4(O)
leadership development
6(O)
leading by example
5(R)
trainee engagement
5(O)
trainer engagement
continuous improvement 5
continuous learning
PV - DC 1
15%
Orange = PV, CC & DC
Blue = PV & DC
L = Potentially Limiting (white circle)
R = Relationship
S = Societal
Copyright 2015 Barrett Values Centre
Values Plot
November 4, 2015 28

29. Royal College of Obstetricians and Gynaecologists: Group (16)
Values Jumps
A value jump occurs when there are more votes for a value in the Desired Culture than in the Current Culture. Listed below are the values with the largest increase in votes. The values in bold are represented in the Desired Culture.
Current Culture Votes
Desired Culture Votes
Jump
adaptability 6
innovation
leadership development 1 5
leading by example 2 4
shared values
financial stability 3
courage
empowerment
fairness
open communication
openness
Copyright 2015 Barrett Values Centre
Values Jumps Table
November 4, 2015 29

30. Current Culture Values (CC) Desired Culture Values (DC)
Consolidated Cultural Data – Health Care
Level
Personal Values (PV)
Current Culture Values (CC)
Desired Culture Values (DC) 7 6 5 4 3 2 1
IRS (P)=6-4-0 IRS (L)=0-0-0
IROS (P)= IROS (L)=
IROS (P)= IROS (L)=
honesty
86%
5(I)
respect
64%
2(R)
accountability
63%
4(R)
commitment
62%
responsibility
4(I)
caring
57%
humour/ fun
56%
family
48%
positive attitude
integrity
40%
customer satisfaction
62%
2(O)
teamwork
56%
4(R)
continuous improvement
44%
4(O)
bureaucracy (L)
41%
3(O)
cost reduction (L)*
1(O)
accountability
38%
commitment
36%
5(I)
organisational growth
33%
confusion (L)
25%
hierarchy (L)
teamwork
72%
4(R)
continuous improvement
68%
4(O)
accountability
63%
customer satisfaction
56%
2(O)
open communication
49%
2(R)
commitment
41%
5(I)
employee recognition
40%
employee fulfilment
28%
6(O)
compassion
23%
7(R)
integrity
respect
Matches
PV - CC 2
CC - DC 5
PV - DC 4
*Cost reduction was changed to a potentially limiting value in our standard template in 2011.
Black Underline = PV & CC
Orange = PV, CC & DC
Orange = CC & DC
Blue = PV & DC
P = Positive
L = Potentially Limiting (white circle)
I = Individual
R = Relationship
O = Organisational
S = Societal
Copyright 2014 Barrett Values Centre
Values Plot 30

31. UK National Values Caring (49%) Fairness (27%) Family (46%)
Honesty (40%)
Humour/fun (39%)
Friendship (30%)
Fairness (27%)
Compassion (26%)
Independence (25%)
Respect (24%)
Trust (24%)
Look at number of values matches between yourself and rest of the country.

32. Areas of matching Caring / compassion Fairness (everyone counts)
Respect (and dignity)
Friendship (working together)
Honesty (respect and dignity)

33. Areas of non-matching Humour / fun Independence
Humour/fun – 39% national values (4th most common), 57% of a large, highly successful GP practice, 56% from consolidated healthcare data, only 21% senior medical educators

34. Areas of non-matching Humour / fun Independence (autonomy)
Both feature high up for UK national values, GP practice and senior medical educators

35. Areas of non-matching Humour / fun Independence (autonomy)
Leadership, personal and professional development, innovation, creativity, adaptability
First two from UK national values assessment, remainder are a strong theme running through consolidated healthcare data, GP practice and senior educators. These are the values which will lead to an increase in staff engagement and discretionary effort, with ultimate benefits for workforce including trainees and ultimately patients.

36. What can we do with this information?
Encourage trainees to think about what their own values are – personal values assessment
Compare with your own
Can be done in a group
Compare with hospital’s values
Use in reflective practice
In the context of clinical and educational supervision. Group values can be a very helpful thing to do at induction – create a sense of shared identity. Map personal values on to them and NHS values (bottom up rather than top down)
Can be useful in reflective practice particularly in the area of conflict with team members or patients.. Consider the possibility of unconscious bias, and the role of potentially limiting values such as being liked.

37. To sum up…
HEE mandate / GMC standards

38. To sum up… HEE mandate / GMC standards
Individual values influence behaviour
Personal values assessment can be a useful tool to explore behavioural concerns in trainees.

39. To sum up… HEE mandate / GMC standards
Individual values influence behaviour
Shared values influence culture

40. To sum up… HEE mandate / GMC standards
Individual values influence behaviour
Shared values influence culture
Role of reflection, conscious decision-making

41. To sum up… HEE mandate / GMC standards
Individual values influence behaviour
Shared values influence culture
Role of reflection, conscious decision-making
Barriers to living consistently with values
Remember barriers (personal and organisational) – lack of support, reduced resilience, unconscious bias, inadequate time for reflection, poor role modelling/sick culture

42. To sum up… HEE mandate / GMC standards
Individual values influence behaviour
Shared values influence culture
Role of reflection, conscious decision-making
Barriers to living consistently with values
Additional tool for educational supervisors
Can be used as a way of looking very positively at difference, and can help you get to know your trainees with a depth that can enhance the learning relationship.

43. Thank you!