The Q health framework

Developed to support leaders in planning and delivering large-scale improvements across health systems, this framework (image accompanying this post; Q, 2024) was a collaboration with a broad range of British medical sector leaders.

The framework falls into two halves: the first half is focused on sustainable development and creating the conditions for a sound health/wellness system; the second half is on how that service should be delivered, via service and outcome transformation. Within each half are thee sets of activities: collective vision and leadership; an aligned operating model; capability, connections and culture in the sustainable development half. In the service and outcome transformation half there is: system and pathway redesign; continuous quality improvement; and targeted innovation. Around these six activities are 18 key considerations which all stakeholders must address for this type of system change to work and to stick (Q, 2024). They are:

• Co-creating a vision and narrative for change
• Building leadership support
• Understanding together the nature of the system
• Engaging with all partners and communities
• Redesigning management systems to enable improvement 
• Aligning resources and incentives
• Agreeing priorities and mediating expectations
• Developing goals and the ability to measure progress
• Enabling productive cross-silo connections and reflections
• Creating collaborative learning habits and structures
• Building skills and space for everyone involved in the change

And in the second half:

• Understanding the context, needs and assets of those served
• Diagnosing and redesigning end to end pathways and service models
• Delivering multi-strand 'transformation' programmes
• Incrementally improving hundreds of processes with service users
• Adapting roles, ways of working, metrics and linked systems
• Ongoing monitoring, adaptation and control of service performance
• Testing, experimenting, scaling and embedding innovations
• identifying priority gaps and/or innovations
• Understanding the current situation and desired futures

In order to create the right conditions, the framework emphasises building a collective vision, prioritising transformation efforts, and developing sustainable change through culture and capabilities. These elements rely heavily on engagement with partners and communities, shared understanding, and strong leadership support across organisations (Q, 2024). The delivery aspects focus on three key areas: system redesign, continuous improvement, and targeted innovation. These require deep understanding of local context and population needs, iterative testing with real-time data, and identifying promising innovations that can be scaled effectively across systems. This will need programmes combining pathway redesign with changes to funding, IT, and infrastructure. Tools for reviewing and planning large-scale change is built into the system. This is not easy work, but will require investment over multiple years, and a government committed to making change. I am not sure than any government on the planet is realistically in that space right now... and as for making cross-party long term funding commitments... well. I think that too is a wait and see thing.

The framework is a partnership between the Health Foundation, the Q community, and NHS Confederation. It will be nice if it works, and if the UK government actually fund it and back it. 

Sam

References:

Q. (2024, August 29). Improving across health and care systems: a framework. Q, The Health Foundation. https://q.health.org.uk/resources/improving-across-health-and-care-systems-a-framework

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Tools to help in recreating self-identity

Last year I was in touch with a friend whom I hadn't caught up with since Covid-19 rocked our collective worlds... to find that things were not going well on many fronts for my friend. Work was great, but everything else felt like it was coming unglued: they felt they had lost their sense of self; no longer knowing who they were. I was so very grateful that they were honest and open, and felt able to talk to me: but I was out of my depth in providing any actual help (and said so). I suggested that my friend ask around their network to find a counsellor who could guide them through what they were experiencing (as being a career development practitioner doesn't equip me for helping someone who needs emotional guidance!).

However, in the same week, two magazine articles crossed my desk which sparked the inspiration for this post. I passed these onto my friend, who may feel ready to take these actions at some point, to help them address the sense of loss they are experiencing.

• Write 1. Get a notebook. At the beginning of each day - perhaps on our commute - we note down what we expect to stress us today. At the end of each day before we go to bed, we note down what actually did stress us. We do this for a month, then review (West, 2024), potentially with a counsellor. We look for patterns, then try to do something about (a) the gap between our expectation and reality, and (b) what behaviour patterns we can begin to change. And it is easy to see why we might need to find someone who can help us effect change with behaviours which are eroding our sense of self.
• Write 2. We divide a piece of paper - or a page in our new notebook - into two halves. We "Head one column self-pity and" then head "the other one self-compassion". Under "self-compassion" we write the definition, "Is constructive and promotes emotional resilience, self-awareness and growth". Under "self-pity" we write "Is destructive and leads to a cycle of negativity, helplessness and emotional stagnation". Then we consider how we "talk to [...]ourse[lves] about [...]our life and what actions or inactions [we] are taking", and put each of those into the appropriate column, e.g. "doing something proactive [...], like reaching out for help, would go in the self-compassion column"; or where we "feel uniquely wronged or afflicted and where [we] resent others, which leads to inward-looking rumination and a downward spiral, would go in the self-pity column" (Perry, 2024). Two further illustrators show us a difference in thinking reminiscent of internal or external locii of control (here, Lefcourt, 1966) or mindset (here, Dweck, 2006): "Everyone makes mistakes. I’ll learn from this and do better next time" on the self-compassion side, versus self-pity as "It’s not fair I wasn’t trained right" (Perry, 2024).
• Experience new things. Being more active and trying new things - think activity tasting platter - may help. Find someone - so we can travel in company - and 'taste' loads of new-to-us experiences. Not too many things, but perhaps two each month, over a year or so. We can go through community newspapers and read local notice boards to find those little community groups, then inquire about visits. We might try things like cold water swimming. The local Horticulture Society. Tai Chi. Orienteering. Tapestry. Lawn Bowls. Beginner's Spanish. Anything that we stumble across, that sounds like it would be fun to try. Our partner in crime may change on the journey, or we may eventually fly solo. We can stick at things we enjoy until we don't need it anymore. In the process, we will (a) rediscover ourselves, (b) develop as a person, and (c) meet new people. Slowly we will make new friends. And by doing that we will create a renewed sense of our own identity.

It should be noted that these three ideas are small fixes, not substitutes for the professional guide I think my friend may need (and is currently getting). But sharing these may enable us to help ourselves, or others, a little.

Sam

References:

Dweck, C. (2006). Mindset: The New Psychology of Success. Baltimore Books.

Lefcourt, H. M. (1966). Internal versus external control of reinforcement: A review. Psychological Bulletin, 65(4), 206-220. http://dx.doi.org/10.1037/h0023116

Perry, P. (2024, September 8). Bad events knocked the joy out of my life. How do I get it back?. The Guardian. https://www.theguardian.com/lifeandstyle/article/2024/sep/08/bad-events-knocked-the-joy-out-of-my-life-how-do-i-get-it-back

West, T. (2024, August 27). The reasons why we fall out of love with our job. Radio New Zealand. https://www.rnz.co.nz/national/programmes/afternoons/audio/2018952948/the-reasons-why-we-fall-out-of-love-with-our-job

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Knowing where we stand

I was reminded recently of Simon Sinkek's work in beginning with why (TED, 2010). While this idea appears quite simple, the way Simon phrases it makes it seem like a no-brainer: "why". Where do we begin? With 'why' (read more here). 

However, identifying a core purpose, philosophy, goal, or outcome is hard work. But doing that work really pays off, because all other decisions can flow from the place where we stand. That place where we stand might be our turangawaewae (if really long term), our philosophy (if more broad), our vision (if we have a goal that is aspirational) or our mission (if we want a day to day guide). 

I tend to use that place where we begin, our central idea, as a "rule of thumb": if we have done that skull sweat initially to know clearly what we want to get to, then all later decisions fall naturally into place. For example: 

• if we are aiming to build a low maintenance structure [goal], when given cladding choices, we are likely to go for the option needing the least maintenance
• If our goal to build as cheaply as possible, then the lowest cost option will be selected each time
• If we are doing a research project and are taking a subjective approach, then we are unlikely to adopt hypothesis testing and use a Chi squared analysis tool (i.e. objective tools)
• Microsoft's mission is "to empower every person and every organization on the planet to achieve more" (2024). However, if we want to empower our customer, then we probably shouldn't roll out unavoidable computer updates and patches on a Tuesday, which are then seem to be tested in the wild as people are trying to do their work (as Microsoft seems to do). Rigorous testing behind the scenes would be more sensible... but that adds cost. 

Knowing where we stand smooths decision-making. If we look at the technology company, Apple, the aim looks to be delivering seamless technology results to the customer. They do everything they can to smooth the user path so that the user can use the apps. Apple keeps all the hard-, soft- and firmware programming, updates, and other IT stuff off the user's desk... but at a higher cost. Yes, their vision appears to be "To make the best products on earth and to leave the world better than we found it" but their mission - the day to day work - is quite clear: "To bring[...] the best user experience to customers through innovative hardware, software, and services" (Abbott, 2024). But we will pay more for that.

Our first job is to understand where we stand.

Sam

References:

Abbott, A. (2024, March 22). Apple Mission Statement | Vision | Core Values | Strategy (2024 Analysis). https://bstrategyhub.com/apple-mission-statement-vision-core-values/

Microsoft. (2024). Empowering others. https://www.microsoft.com/en-us/about4

TED. (2010, May 4). How great leaders inspire action | Simon Sinek | TED [video]. YouTube. https://youtu.be/qp0HIF3SfI4

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So, what is organisational development?

Swanson suggests that organisational development, or OD, can be defined as "a system-wide application of behavioral and social science knowledge (primarily psychological, systems, and economic theories) to the planned development, improvement, and reinforcement of the strategies, structures, and processes that lead to organization performance" (2022, p. 286). 

While this is pretty long-winded, a shorter version is also supplied: "Organization development is a process of systematically unleashing expertise to improve performance at all levels" (p. 286). So OD can be thought of as (a) a continuous, holistic organisational improvement process, and (b) the department for change, and - somewhat tongue in cheek - (c) the hit squad. 

 Two sentences that Swanson outlines clearly shows the 'rock and a hard place' which OD practitioners may find themselves in: "Using OD to get employees to accept unfair and exploitative policies and practices is rarely discussed. Most organization bankruptcy and restructuring efforts rely on sophisticated OD tools to get employee acceptance of downward compensation and benefits while at the same time, upper management often retains and even gains added rewards" (2022, p. 287). The executive bonuses paid during the global banking crisis illustrated the latter point very well. 

 OD focuses on improving organisational effectiveness and efficiency by having: improved strategic alignment; a productive organisational structure; the 'right' people in the 'right' roles; appropriate remuneration; sound measurement and data; and reliable and rigorous management processes (Association for Talent Management, 2023a). Then the OD decisions made need to be grounded in research, tapping into the disciplines of organisational psychology; management (HR, Leadership, OB); social sciences; education (pedagogy); and research methods (Association for Talent Management, 2023a).

In thinking about the job of OD, it is to increase organizational effectiveness and competitive advantage. Organisational outcomes from improvement need to be clear, and - while differing between organisations - usually include "financial performance, customer satisfaction, organizational member engagement, and an increased capacity to adapt and renew the organization" (AIHR, 2023). 

I hope that helps!

Sam

References:

AHIR. (2023). What is Organizational Development? A Complete Guide. Academy to Innovate HR. https://www.aihr.com/blog/organizational-development/

Association for Talent Development. (2023a). What Is Organizational Development?. https://www.td.org/talent-development-glossary-terms/what-is-organization-development

Association for Talent Development. (2023b). OD Strategy [image]. https://d22bbllmj4tvv8.cloudfront.net/23/c8/3a130d734b41a011ae822f4b890c/563492443-organization-development-graphics-r2.jpg

Swanson, R. A. (2022). Chapter 14: Overview of Organization Development. In Foundations of Human Resource Development (pp. 286-305). Berrett-Koehler Publishers.

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A Few Useful Career Theories

Careers theory has been developing since the end of the 19th Century, formally commencing with the work of Frank Parsons in Boston, USA (1909). Initially focused on the individual and the static, career theory has evolved into holistic and life-long endeavour for each of us.

Theories are a tremendously useful thing. They can help us to deconstruct complexity through the lens of a simplified, organised model (Thompson, 2008). In order to create a personal sense of structure, I spent some time categorising parts of the career theory field that I was interested in, developing a timeline to provide clarification, trends and demonstrate relationships (download by right-clicking the image & selecting "Save Link As"):

Like most of us in the career field, I do not subscribe wholly to any one theory. The variation amongst clients is too great to ever assume there can be an effective ‘one size fits all’ approach. It is only by using a very broad range of career tools from a number of different theorists and theories that I can meet my client’s needs.

So I am going to take a quick look at some career theories, a mixture of structural (individual) theory, and developmental (holistic) theory. Structural theories focus on individual characteristics and occupational tasks such as Trait and Factor, Vocational Personalities and Environments, Socioeconomic Theory. Developmental theories focus on human development across life span and include lots of wonderful models including Super's Theory, Krumboltz's Social Learning Theory, Decision Making Theories and Cognitive Theories.

The theories I am going to explore are the Framework of Occupational Choice, constructivism and sociological perspectives. We will travel from the micro, focused in on the individual; through their view of their world; to conclude in the macro, where we consider how each person fits in their society. Each of these theories provide me a slightly different career perspective, enabling me to continue to develop fresh tools and ideas to offer my clients.

Ginzberg, Ginzberg, Axelrad and Herma’s 1951 Framework of Occupational Choice is a developmental theory (Howell et al, 1977), and is now considered to be one of the Life Span theories, a field dominated by Donald Super. The Ginzberg & Associates team recognised that our career choices are influenced by four factors; ‘reality’, the effect our education has on us, our emotions, and those individual values we hold. Ginzburg et al propose that from primary to secondary school, we grow from a primary ‘fantasy’ stage, work through ‘tentative’ until our career choices firm – our educational process is almost complete, we are more emotionally mature, our values are more formed and reality steps in – to ‘realistic’. Young people’s skilled, interested or preferred activities are consolidated into likely career roles. If done well, the young person feels a strong connection to what has become, for them, a logical career choice (VirtualHabitats, 2003; Penn State, 2003).

The fantasy stage, where as a child we are free to pursue any role, is a wonderfully freeing tool for us to use with adults. I really enjoy using this with clients to retrieve childish things and, through role play, mind-map, drawing or dialogue, feel our career through the freedom of a child’s imagination. I find it good as an exercise to break free from old thinking patterns, although I find that often older men find this an uncomfortable or a difficult activity. I think, from my observations, that this may be because they find it harder to suspend disbelief (must investigate this one day!).

Super too has some extremely useful and durable career tools, but for me, the star in the crown of developmental theory is this simple model from Ginzberg & Associates.

While the Framework of Occupational Choice can be a tool for liberating the mind, and letting go of what has gone before, my next theory is a tool for seeking patterns.

Constructivism – the idea that we create knowledge and meaning from the interaction of our experiences and our thoughts – is about seeking patterns. We human beings naturally look for connections and structure in everything, and over time, we will see similar themes emerge. In the process of understanding increasingly complex and changing patterns, we derive meaning from what we see and feel, and form our own constructions of reality (Bright & Pryor, 2005; Careers in Theory, n.d.).

Working with a client to reflect on a behavioural pattern that has held them back is an extremely rewarding process; as is helping a client to identify positive life-patterns to repeat. I have a Buddhist friend who asks “How is that working for you?”; a wonderful constructivist phrase for someone who has the strength of character, reflective maturity and self-esteem to accept the challenge of personal responsibility. Holding up a mirror so that the client can see themselves reflected clearly, but without judgement, can at times be difficult. I usually find it easy to respect and understand my clients and their contexts, but I find it hard at times to help them see themselves. Clearly. Honestly. Without self-judging themselves.

Peavy (1997) feels there is no one “God’s eye” real world; he feels there are multiple realities. He also feels that as we are "self-organizing" animals; we are pattern seekers. We make our own reality, we tell our own stories, we create our own meaning and use multiple voices. We are relational beings, and it is through reflecting on those relationships that we feel connection with others. Without critical reflection, we are not fully empowered.

I like Peavy’s views on reflection; the process of career guidance is all about personal, critical reflection supported by a trusted guide. Like the timeline of career theories I put together to give myself structure to understand the career field, I attempt to simplify my client’s career critical path so they can identify their cusps and critically reflect.

From the seeking of patterns and self-reflection, I lastly turn to sociological perspectives; or, more simply, “where do I fit?”.

Sociology focuses on socio-economic variables, and looks at how we construct and live in our societies. The career aspect of sociology looks at the mobility of our careers, how we enter work, our gender and our societal standing, but is not an exact or accurate science (Palmer & McMahon, 1997) because of our human observational bias.

Roberts’ “Opportunity Structure Thesis” (1981, cited in Palmer & McMahon, 1997, p. 343) is a very interesting concept; Roberts feels that in many cases people have no choice about their job. They simply take what is available.

I think this lack of choice is 'true' for many people, and as a result is a key area in which I can make a real difference for my clients. When clients come to me, we work through their self-concept, their behaviour patterns and then look at how they fit in their world. Then, once I understand who they are as a person, I aim to work with them so that they can see choice.

Sometimes clients need to give themselves permission to move on, sometimes they need the support and permission of their partner, their parents, their families, or their wider
whānau. Sometimes a barrier is necessary for the person’s or their social group’s happiness, sometimes it isn’t; but for me, it is about giving clients the tools to make their own choices in their life context.

Understanding the society in which people live is essential to understanding the person themselves. While much of our career theory has come from the United States, now in New Zealand we now have two Māori career perspectives, which I feel fit with sociological theories; the model of Whakapapa Tikanga (the spirituality of representing all those who have gone before us; and ownership of cultural protocol) and Durie’s model of Te Whare Tapa Wha (Careers NZ, n.d.).

These models have been purposefully and carefully designed to reflect the spiritual and traditional aspects of Māori culture, to explain the difference in cultural approach to careers. It is fantastic to have Māori contextualised models for me to help clients understand who they are from a Māori perspective, and where they see that they fit within those. I have found that these models often have value for non-Māori New Zealanders, particularly people born in Aotearoa.

While New Zealand does not have the very broad gap between the ‘haves” and “have nots” that many other countries have, we do have a certain amount of stratification of society; along lines of wealth, profession, birth, gender, ability, sexuality, belief and culture. As career counsellors, we need to remain alert for making stereotypical assumptions about our clients’ barriers, beliefs, attitudes and abilities. As professionals, we must leave the determination of the barriers to the client. As my mother always said, “Assume makes an ‘ass’ out of ‘u’ and ‘Me’”.

To help avoid me falling into the "assume" hole, I use sociological perspectives as a tool by asking clients to create me profiles of successful people whom they admire (I have developed this model myself in my practice). There is a list of questions in a table – such as what kind of car does their person drive? Where do they live? What training did they do? It is usually surprisingly easy for a client to quickly construct a profile. They can then use this to determine if that successful person’s career is something that the client could aspire to, and why or why not. We usually manage to quickly identify a number of barriers that we can examine and test.

Testing barriers is what I feel career counselling does best. The leap of excitement for the client when they realise that the barrier they held onto is no longer there is very rewarding; just as is the quiet content that comes with the reaffirmation of the status quo.

Career theory provides a structure for career practitioners to help clients with their work issues. So we can conceptualise concerns and bring about change for our clients, having a sound theoretical grounding is really important. It is what PD is all about!

The theories I have touched lightly on assist me to provide sound feedback to my clients. They assist in creating positive and beneficial outcome to both partners in the process.


Sam

References

• Bright, J. E. H. & Pryor, R. G. L. (2005). The Chaos Theory of Careers: A User's Guide. The Career Development Quarterly, 53(4),  291-305.
• Brown, M. T., Lum, J. L., Voyle, K. (1997). Roe Revisited: A Call for the Reappraisal of the Theory of Personality Development and Career Choice. Journal of Vocational Behavior, 51(2), 283-294.
• Careers in Theory. (n.d.). Using the Chaos Theory of Careers in Counselling.  http://careersintheory.wordpress.com/tag/coaching/
• Daft, R.L. (2009). The Leadership Experience (Australia Pacific ed.). Cengage Australia Pty.
• Department of Employment Services. (n.d.a). Structural Theories.  http://www.does.dc.gov/does/cwp/view.asp?a=1233&q=538107 
• Department of Employment Services. (n.d.b). Structural Theories. http://www.does.dc.gov/does/cwp/view.asp?a=1233&q=538100
• Durie, M. (1982). Te Whare Tapa Wha. Careers New Zealand. http://www.careers.govt.nz/educators-practitioners/career-practice/career-theory-models/te-whare-tapa-wha/
• Howell, F. M., Frese, W., & Sollie, C. R. (1977). Ginzberg's theory of occupational choice: A reanalysis of increasing realism. Journal of Vocational Behaviour, 11(3), 332-346. 
• Palmer, S., & McMahon, G. (1997). Career Theory, sociological perspectives (2nd ed.). British Association for Counselling. 
• Parsons, F. (1909). Choosing a Vocation. Gay & Hancock Ltd. 
• Peavy, R. V. (1997). Constructivist Career Counseling. http://www.ericdigests.org/1997-3/counseling.html

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