ollie: Welcome folks. Well, it's a real pleasure today to have Dr. Ben Allen with me. He's a fellow GP here in Sheffield. I've known for many years. And I have to say, I've always known Ben as one of those sort of brave entrepreneurial style GPs. He's always prepared to push the boundaries, but usually on almost always in pursuit of ⁓ great care for patients and improving things. So Ben, it's wonderful to have you on. And we're particularly going to focus today on a great paper that you ⁓ As many of you know, in health coaching and beyond, we mix up conversations between the two of us, tune over hot topics, latest news and emerging ideas, but also bringing you conversations with thought leaders and people we admire in the field of health coaching and beyond. This week, I'm joined by fellow GP, Dr. Ben Allen. We're especially excited to talk to Ben, as along with academic colleague, Dr. Natalie Jones, Ben has just published a key paper in BMJ Leader, part of the British Medical Journal Group. Following five years of carefully building a high performing primary care team at his practice in Sheffield, Ben and Natalie have refined the success factors into a very readable and insightful guide as to what's worked best. It might not surprise many of you to realize it's more of the cultural and relational aspects of their work that have made the real difference. What they have termed the social determinants of team health. In this era of developing neighborhood working, connecting across professional and disciplinary boundaries, and Natalie have just written together, haven't you? called the social determinants of team health. But before we do that, do you wanna just add a little bit more about who you are?

Ben: Yeah. Yeah, sure. So, ⁓ I've been a partner at Birley Health Centre for the last nine years and for the last six months I've also been medical director for physical health and neurodiversity at Rotherham and Doncaster Community and Mental Health Trust. I'm effectively the medical director for their community, the Doncaster Community Services is the lion's share of my work. So that's a very interesting role where I've kind of attempted to kind of

ollie: involving communities and wider range of stakeholders, we think these insights are incredibly valuable. We're delighted to bring this interview with Ben and we really hope that you read the paper and associated blogs which we'll capture in the show notes.

Ben: get into a new space that is very much bigger space in general practice than my surgery and to think, okay, of all the things I've kind of learned in my approach to my GP surgery, what things can I apply and how do I need to apply it differently at a different setting, at a different level of scale? So that is my kind of current, very challenging mental puzzle that I'm also doing. And then also,

ollie: You'll never want to never one to shy away from a challenge Ben

Ben: Yeah, yeah, and something that I sometimes forget to mention is I'm also a foster carer so we often have foster babies around and we home school and I love gardening and I love having people around for food including you Ollie as you as you'll know

ollie: Well, you're certainly a people person, Ben. And yeah, no, I really appreciate how you're very systems orientated, aren't you? And you're never one of shying away from taking on difficult systems. The NHS is full of systems that need to be organized. And so it's lovely to have the opportunity to talk about this paper that you have written. As I understand it, it's a great mixture of background theory, but... grounded in your real life practice of what you did in your surgery. And hopefully we'll go on to talk about how it could be applied wider as well. But tell me how the paper came about.

Ben: So, well the paper came out of the story of my first probably five or six years at my practice. So it was a case of going into my GP surgery and it was really, really tough going. And I thought that the staff satisfaction was not where it ought to be and the patient satisfaction wasn't where it could be. But didn't really know how to get there. And it was a load of principles and skills that are not part of general practice typically, not something that's part of my training. And I had to kind of discover them and then from outside the NHS often and then try to bring them in and flesh them out in a general practice setting. And that took a number of years. And then the actual kind of fruit of that took a number of years. And then things, you know, I think things have really improved. I think some would say kind of beyond recognition. And that journey was ⁓ a very tough one, a very long term one, but also a very satisfying one. And one in which Helen Bevan actually, among other people said, you really need to write this up. I think I was at time I was a fan of Twitter. So I would like write this stuff up in a thread, but they're just like, you you got to do better than that. This is something that ought to be written up and shared. And that's when Nat Jones came in because I'm not. I've not written a paper before, it's not within my skill set, but Nat Jones is absolutely brilliant at that kind of thing. So she and I worked together and she was able to kind of pull the stories out of me and pull the kind of the principles I learned and where I learned them from and turn it into something that was publishable with the BMJ. So yeah, so was very happy that we came together. It was a very good collaboration.

ollie: What a combination here. And that's fantastic, isn't she? There's an OT by background, but she's been an academic and a system changer as well. So the combination uses together really powerful. So what I thought we'd do, if it's okay, is go through you, sort of ⁓ landed on seven steps. And I have to say, it's rare you read a paper where you just sort of find yourself thinking, you know, yes, yes, yes, that's exactly how I felt it. And, you know, I've been in many places where these things haven't happened. And sometimes, It's the absence of these things that really convince you they're so important. So if it's okay, can we go through the seven? And there's a little bit of a logical order to it, isn't there, around how you establish them? Is that okay with you, Ben, if we just go through these seven steps?

Ben: yeah, so we've called this a social determinants of team health because I think often we're looking for what I described earlier as the fruit. We're looking for like the number of appointments and demand going down. And if your focus is on that, then you're not going to necessarily notice what are the long-term things that if you invest in over time that kind of pay back. And I think that Yeah, I think that's probably why it's hard for me to find what those things were because nobody was really talking about them or not particularly, nobody that I knew at the time was talking about them. And it's around that if we put our attention there, then the things that we really want emerge as a result, as a of a knock-on effect and a consequence. mean, one example is in the data was that we massively improved ⁓ continuity of care. We never... had any kind of project that was trying to improve continuity of care, yet we improved, I think, five by five. I think with the second most improved practice in the country for continuity of care, patients want it, staff know that it makes sense. So if you release the potential within the systems and within the teams and with communication, then you end up with the thing that you really want that makes sense to everybody, just emerging without having ever had to do an actual project on it. So that's an example of how these things emerge.

ollie: Well, certainly as I read it, often, the way you've written it, you you might think of these as being soft things, like sort of nice added extras, things that sort of, you know, you might not find as robust as some of the other sort of process and organisational things, but actually they are the real core of what makes the fruit happen, isn't it? As you say, the fruits that people are interested in. And I think we neglect them, don't we? It's somehow until someone's described them, you don't even notice them. ⁓ But now I've read them, I really notice when they're not there. they just, for me, have really nailed the substance and the purposeful stuff you need to do if you want to achieve good, good high-performing teams.

Ben: Another question about whether or not we're patient enough to wait for the benefits and the results because sometimes the benefits are just years down the line and there's a valid question of are you even willing to wait that long?

ollie: Well, do you know what? Again, I've been involved in a project where you sort of think we haven't got time to do this. We've got to rush through. We've got some targets to hit. And then three or four years down the line, you go, oops, we didn't lay the foundations. And you've wasted all that time. So let's get into them, Ben. Let's get into them. So number one, you've put down psychological safety and trust. Do you want to speak a bit to that?

Ben: sure. So this is an example where looking at well, organisational psychology was pretty much where I ended up finding myself when it came to how do you create the conditions for team for great team work to emerge. there was a study by Google called Aristotle, where it did a deep study into all its teams to try and find what were the most important factors that led to high team performance. and it's a work that Amy Edmondson has done a lot of work on as well. psychological safety is a degree to which people are able, kind of free and able to speak up with their ideas, concerns, without fear. And so that is the biggest factor in a team that's gonna get you where you wanna go. And you don't see many people really intentionally trying to set out to do that. But that was the thing that I realized that needed to change. And so there was this kind of various ways in which we've done that. And we're still a long way off where I would like to be. But yeah, that's the kind of first principle.

ollie: Yeah, I love it. And I we're both fans of Lencioni's work, aren't we? And his five dysfunctions of a team and absence of trust is his main baseline foundation, isn't it? So how did you build trust in your team then?

Ben: Lots of small things and you never really know what's the thing that's made the difference. I think modeling humility and imperfection. So making sure that you shout up when you've made an error or even cause some kind of harm is that you let everyone know that's happened. in a meeting, for example, I might just drop it in because that just again, make it kind of normalizes people vocalizing mistakes. And if people do speak up about something that's hard. being really aware of if you do anything to shut that down or make their lives difficult or make what they said sound inconvenient in any way, that's going to send a message that, you know, don't say hard things publicly. So it's always really important to kind of notice that and thank them for speaking up. There's something about getting to know each other in a kind of a deeper level. And so there might be things like around One really interesting example was that we had one room where the doctors would meet to have coffee and would have their partners meetings and to be it was the nicest room in the building and yet like it wasn't used for any other purpose. So I was like okay and it was unintentional I think it just it was just historical some people didn't even know the room existed. at one point I said does anyone mind this room being used for the reasons and then

ollie: a private members area.

Ben: And so, and of course, no one really minded, it was unspoken. that ended up becoming the staff room. And so people are then sharing lunch together, ⁓ between different teams, and you start to get to know each other just socially. People would out socializing, ⁓ I would sometimes take advantage of that go and join people and arrange social occasions, ⁓ team games and that kind of thing. can just kind blur those boundaries a little bit between each other, beyond kind of beyond our professional roles. you start to, some people even brought their family along to some things that we were doing. I mean, this isn't for everybody, but this was just one of the things that enabled us to kind of get to know each other. One of my favorite things I think is reproducible is we've, I've done a couple of times some kind of like personality typing type thing. And so, I mean it is useful for us to get to know each other, to get to know ourselves and get to know each other, but what was really, really good about it, it was a catalyst for us talking about things beyond that kind of superficial activity. We talk about who we are and why we behave that way and this thing really annoys me or this is what, if you did this for me that would really help and they often become a catalyst for that. And so there are some of the things that are, yeah, jumping out at me.

ollie: Yeah, no, it's great.

Ben: And really being careful about if there's something that is a barrier to psychological safety, if it's a person, a particular person and the way they're behaving is actually causing people to not feel psychologically safe, then that's something that's dealt with or kind of is noticed and managed in some way. I also just want to distinguish between psychological safety and it sometimes is a term that is about like not being uncomfortable. And I think that

ollie: Mm-hmm.

Ben: I think that discomfort is, and it needs to be psychological discomfort is something that can be really useful. But it's about like, so it's not about just making life as easy as possible for everybody and not to have kind of stress. I think it's about how do we lower the barrier for people to be able to share the things that are going on in their head about the work and about the organization such that. you kind of make the gap between what people are thinking to what people are saying to be as small as possible.

ollie: Yeah, I love that. And I can see already there's some leadership styles here, aren't there? There's ways of doing this purposely that make it happen. And I hear there that ability to be vulnerable as a leader, really models stuff you want people to see, don't you? Yeah. Ben, I'm going to keep this, go on, go add to that.

Ben: Hmm. and, yep. ⁓ and, but, but yeah, that, that process lead to, actually leads difficult conversations, can lead to the ⁓ conversations that require kind of tension to get through. ⁓ that's a real positive and that's not opposed to safety. That's what psychological safety often enables to happen.

ollie: Yeah, that's a great distinction. Thank you. Loads in there already. I'm gonna keep us going through our seven things. So the next thing you talked about was distributed decision-making. Tell us a little bit about that.

Ben: as I was reading these books about organizational team health, some of them were from like, know, big corporations or big businesses. And I was looking at like their board and they would have like a head of marketing and the head of engineering and the head of finance and they'd all be there, you know, having their big meetings together. And I'm thinking the partners meeting, it's just like loads of GPs. It's like everyone. everyone's from one department. you know, the issues we're going to be dealing with and the lens we have on the organization is all going to be very skewed towards the medical team. Whereas, you know, what about the, what about, and the manager is there trying to represent the nursing and healthcare assistants and the admin and the secretaries. And it just felt like, well, that's, you know, so I thought we, ⁓ We needed to have a different kind of a meeting that was at least having the kind of someone who was representing each department in a meeting together on a regular basis. But that also required, and this is one of the keys to having what I call distributed leadership, is you can't just give ⁓ authority and autonomy to a team leader if actually that's not something they're going to be able to manage well or carry well. either because they never will or they don't have the support. So you need to make sure that you've got really brilliant people in team leader kind of positions. And I think people often inherit those roles just from having been around the longest. And if people are not particularly good in that role, they can end up in it for like 10, 20 years. So it's really a case of thinking, what do you need out of a team leader? And for me, it's someone who's got emotional intelligence. who's really trusted, who's really good at listening and can bring out the best in other people. And those kind of people don't often get called leaders. So it's a case of really noticing what is the kind of leadership that we need in general practice or in complex work and enabling them to be that team leader. And then when you have that, and that's hard to get there, but when you've got there, you've then got someone who can represent well the views of a particular team. And then you can then bring those people together and have a different kind of a meeting that's got a lens on the whole organization and that is able to then kind of, you can, when you've got someone brilliant like that, you can just, know, like my lead nurse now, I'm just like, like, this is what we want you to do each year or each week. And we trust you to just get on with it and make decisions and tell us what you need. yeah, and they just self-manage. pretty much now. But also we're happy to help them if they feel like they need help.

ollie: I love how you've built on that. I think a lot of us can see the value of, you know, more diverse viewpoints around the table, of, know, wider involvement, you know, we're going to come to patients in a minute, but actually that fact that if people are going to around the table, you have to support them well and enable them to bring the voice they bring ⁓ in and that sort of equal power dynamic there as well and implicit in that. ⁓ Ben, and you wanna add a bit around ⁓ engagement as well, around this distributed decision making.

Ben: Yes, so we've got the model of where we've got the leaders of the teams, but I think it's really important that we engage directly with people so they feel included, so their voice is included. So this again, it goes back to Patrick Lengioni to an extent, is if there is a decision to make that we bring the team together and we share the challenge and we wrestle with it together and And then ideas emerge, you can use quality improvement tools to allow them to emerge. You can then use tools to try and help the team to be able to almost prioritise what matters the most or the best idea. And then you emerge with a way forward. And I think that process happening transparently in a way that people can see this kind of future plan emerging is one that I think it's really valuable that people are a part of that. And I might even use it in a smaller way around kind of doing polls for things. So rather than just kind of making a decision about like, I know what time of week we're going to do something, you might just kind of get everyone to vote on what's the best and what's the best way. And I think that kind of level of engagement I've found really, valuable as well for people to feel included and to be able to be willing to accept the outcome. so you get better ideas and you get more buy-in to those ideas.

ollie: Yeah, I love the way again, you're talking about the work that is involved in this and the actual practical steps you can take. Thanks, Ben. keep us moving, then ⁓ around your diagram, next comes purposeful communication. Tell us a little around that.

Ben: Yeah, so what things have we done there? So I think having a short meeting in the morning where we have a representative from each team just coming for 10 minutes, coming together, sharing what are the challenges each team's having at that point, anything that's happening that day, and it's a chance just to be able to get a good view of the whole organization very rapidly. We have the meetings that I of described where we might all come together, and we might have lunch together as well. and we use the WhatsApp as well quite a lot. Yeah, I think probably again, most of these things I've probably covered off in some of the things I just talked about earlier. Oh, one thing that I think has been really helpful has been we would get bombarded with emails that were forwarded from the manager. And what our new managers now, which is really helpful is that they collect all of this information that we need to know. will kind of sift through it, categorize it, and send a weekly or maybe every other week, he will send an update with everything in it together. And it's kind of reduced down the emails that we have to see by a long, long way. Or he'll just make sure he only forwards them to the things to the people who most need to know it. So again, it's a very small thing, but it makes it really, you know, it just saves a lot of time when someone does that.

ollie: you're things that are building on, these are all interconnected, aren't they? When you've got that trust there, then actually you're happy to do that. People don't need to see everything. They trust other people ⁓ doing role and the distributed leadership.

Ben: So I think the things in this section, I've probably covered some of the actual strategies for making this happen in the psychological safety bit, because this is one of the real ingredients to help make that happen. But let me just give another story of an example of the kind of thing that we've done. Again, it's probably one of my favorite meetings this ever, was if you've come across the idea of love languages. ⁓

ollie: Now go for it.

Ben: It's this idea that we all ⁓ give and receive, we all feel loved or appreciated in slightly different ways. And we tend to show our appreciation of other people in the ways that works for us, way that lands for us. And you can have it in a marriage where you've got one person like, so the examples are gift giving, ⁓ quality time, words of affirmation, ⁓ physical touch. Yeah, and there's one more that I can't remember. And I didn't share this concept. I just read out a bunch of scenarios and asked people which one they preferred and got them to stand in a particular station. What was the scenario that would mean most of them? I think access services one where you do things for people. ⁓ And so I read out three different kind of a selection of these. five different examples and got people to and eventually got people to kind of go to the station that they went to the most often or they felt the most strongly resonant with and then and then so people kind of bunched together in the things that were like that the way that they most felt appreciated and then I and then I shared what love languages it is and I got people in their groups to talk to each other about what what is it what is it like to be somebody who who has a kind of particular need of it like this. And then I got them to share back with everybody else what would showing appreciation in this way look like in the workplace. And it was really powerful, a way of people being able to share what are the things that we can do and treat each other differently and help us to feel appreciated and valued in a way that's unique to us. And yeah, that was very, very valuable. And again, it's just like working in general practice, everyone's like, we need more appointments, we need more access. Nobody would think that a meeting like this was gonna like make it, you know, it might make work a slightly nicer place to be, but it's absolutely crucial to making it a joyful place to work. It develops psychological safety. It stretches our ability to be vulnerable.

ollie: Right.

Ben: to an extent that we feel happy to and it builds those foundations, those relationships such that when someone else annoys you another day you've kind of built that relationship between each other that it can take a challenge and it means you've got those practices that you know what this person needs so that you can start to kind of show that you value them day to day and then when there's a challenge people know that you really do actually do care about them.

ollie: Yeah, yeah. I love this. love the way you're describing practical ways of doing this. know, everyone says, well, let's build relationships in teams, but how do you do that? And, you know, just your evidence, your really hard evidence that this has, this was one of the things that made all the difference to your team. What might seem stupid on the surface, frivolous even, actually was a really hard ingredient of how your team performance improved. I love that then, really love it. Let's, let's keep moving around. So, ⁓ you, the next thing you've talked about, Inclusive empowering leadership. know you've talked about that kind of diversity of decision-making and leadership, but one phrase really stuck me here was ⁓ finding the quiet leaders. Do you want to dive down onto that? I know that's something you're strong about, aren't you? That leadership comes from sometimes the most unlikely places.

Ben: Yes, this is something I touched on earlier and the sense is that get is that people become leaders often when they're confident, charismatic, maybe clinically senior ⁓ and people see someone like that and think, ⁓ they're a leader ⁓ and people who are like that think I'm a leader. And I thought that actually what I found was in my mind or certainly through some of the stuff that I've read is that the things that actually enable people to bring out the best in the people, is what I was really wanting, was people who were admired by their team and respected, who've got emotional intelligence and a desire to be kind and to empower other people and who lead by example. And those people don't necessarily think of themselves as leaders or they won't get noticed as leaders. And you almost need to find people like that and say, look, do you realize this is who you are, these are the values and the behaviors that you're expressing and this is leadership and I think you'd make a great person to lead this team in the future. So it's kind of seeking out those kind of people and helping them to see them for who they are.

ollie: you did that in your practice and how did that play out then? Did you find new types of leaders emerged? Can you think of anyone in particular who stood out?

Ben: Yeah. Yeah, so Dawn is our, Dawn Varney is our lead nurse at Burley and she's now a lead nurse within the network as well and she has always been absolutely incredible and always been exactly that kind of person but wouldn't put herself forward and was effectively leading the team when she wasn't actually in charge because people just followed her. You know, she didn't have the structural, what's the term for it? She didn't have the positional authority, but she had leadership and aligning the leadership with positional authority was really quite important. And that was the argument I made to actually make her the team leader. as a result, mean, well, within a year or two, I think they won the nursing team of the year award for general across the whole of general practice nationally. So that's an example. also in reception, we've got Someone absolutely fantastic called Rachel Robinson, again is exactly as that kind of a person I've described and just her being in charge was probably the single intervention that has enabled that team to flourish from being a very high turnover and ⁓ quite a difficult team to be a part of to one that is absolutely essential and at the heart of the practice. and been a huge part of improving things like continuity of care, making sure that we know what's wrong with patients so that can help us to triage and make good clinical decisions.

ollie: love the way you're shining light and spend it's almost like you're, this is a real root cause analysis of how you do create high performing outcomes, isn't it? And I know that was, we'll come to that in the end that, you know, you were really keen on results and I'm keen to kind of highlight, but there was, there was a couple of other things first that sort of, so there's something around value-based recruitment and role design. And then of course, patient partnership as well. Do you want to speak to, where do you want to go first with that? Do you want to talk about value-based recruitment and role design?

Ben: Yeah, so recruitment has been a big one for me. Who you bring into the organization makes an absolutely enormous difference to the quality of the work that's going to end up happening. again, it's another one of those examples where the time that you spend, the time that generally gets spent on recruitment is disproportionate to the benefit or the pain that you'll get from making a good decision. or finding the right person. So I got someone who was involved in recruitment to actually help me to learn how to be better at recruiting. And one of the parts of that is really drilling down on what it is that you want and not just on the skills, but the kind of person that you want. that would be, yeah, so part of that is finding out what kind of a practice are we, what matters to us as a practice so that you... find someone who's going to have enough of a cultural fit and finding out what you really need in terms of potential rather than the skills and what we need in terms of people's characters because often the skills are things that people can learn when they arrive yet who they are as a person is something that's much less likely to ⁓ change than their skills but what I kind of keep finding is that when people go out to recruitment They're like, okay, we need a practice manager or receptionist and they're basically looking for someone who can do the job. Well, actually what you want is someone who has the character that's going to enable your organization thrive. They can learn to do the job after they arrive. ⁓ So you massively limit. Yeah. Yeah.

ollie: You learn about that when it goes wrong, don't you? I can just think back to so many recruitment that actually you, in the end, you wish you hadn't rushed into or that you wish you'd taken the time to find someone that matches. Yeah, that's so important. Goodness.

Ben: So all of our receptionists were recruited from outside of the NHS and they brought in all sorts of diverse perspectives from the different places they used to work and our manager was from retail. But they've all blossomed into being absolutely brilliant colleagues.

ollie: So recruit for values rather than skills and build those skills as you go. Yeah, love that. and then the, you talk about wholehearted patient engagement. That word's quite weighted, isn't it? Tell me a little bit what you, how you've done patient engagement that's made it wholehearted.

Ben: So I guess we've reversed something that I noticed in the past, which was that general practice was, we were overwhelmed and then the patient feedback felt quite brutal when you were working really hard and patients weren't happy. And so the temptation was to get as little patient voice in as possible because the patient voice was actually quite painful to listen to and made it quite hard to get to do the job. But there are also massive advantages to giving them a voice and listening to them. And both in terms of being able to hear what they've got to say because some of the stuff that might get said is just people who are really angry. and it's not particularly helpful feedback. That is always going to be there, but that isn't a reason not to listen, because sometimes there's going to be really, really good important messages that they've got, and also angry, and that's quite hard, and there's really precious things in there that take a bit more effort, and sometimes it's just going to be brilliant ideas that we just want to listen to. so, opening up the views of people, and Facebook was probably the main way that we did it, and we just got a huge amount on there. But I think the thing that really shifted as well as getting the ideas was the relationship. We went from this organization where the patients may have felt we're not getting the care that we need and we can't get through to kind of tell people how we feel to one in which we had this big public transparent conversation. And if people were frustrated, we would both empathize publicly. We would share, okay, why is it? why are we working this way so they can actually understand it, they could see that we would listen to some of the time and change our mind about things. And I think that just changed the whole dynamic of our relationship with the community. And I think that gained a lot of credibility. ⁓

ollie: see that. There's so much here about how you challenge traditional power dynamics and I loved in your paper, I picked up that bit about this sort of virtuous cycle you created because you had a culture of internal listening and internal trust that built your resilience to some degree. Like you say, something can be really hard to hear feedback that is negative or challenging. It built your resilience to have that genuine external feedback from patients and from other sources that again enabled you to get better. ⁓ So that, you know, the two fed off each other. I think that's really insightful.

Ben: Yeah.

ollie: That's a yes there. And let's go, so what you've noticed then is you've achieved results. Everyone talks about outcome-based care. You what are we achieving? Like you say, are we trying to get people into GP appointments? Are we trying to sort of like reduce waiting lists? And we're often thinking about process outcomes, but you started to notice, sounds like first of all, changes in patient experience, which led on to changing staff experience and other things. Tell me about what you've noticed as a result of this, adopting these social determinants of team health.

Ben: Yeah, so again, it's always really hard to kind of look at the kind of cause and effect. And I don't think I was expecting to see anything measurable. I wasn't like doing a load. I mean, if I was to do it all again, I would have measured an awful lot of things at the beginning and to try and see if it would change. I know that the list size has kind of grew 15 % in in those kind of first five or six years. I could see that

ollie: Yes.

Ben: Yeah, I know that the satisfaction from the patients on the patient satisfaction survey really started to improve. As I said earlier, the continuity of care stats improves very significantly. And when we asked our staff about their engagement and their morale, this was a couple of years ago now, we got an average score of 9.4 out of 10 about whether they would recommend Burley as a place to work and 9.7 out of 10 about whether they would. recommend the practices to friends and family and a couple of things that people said that I think is really you know says it better than the stats can do is to say one person said I actually feel so lucky to work with amazing people that without seeing it in themselves have reached somewhere that they never thought they would it's so good and I hope you can share this with other practices I feel we've absolutely nailed it and I can't wait to see where we go so yeah ⁓

ollie: and I know you're a fan of Michael West's work and that really consistently how the team feels, how the staff feel, how enabled and engaged and listened to and involved is the strongest marker of patient outcomes in the NHS. So we will, know, this is just core stuff. I just love the way you've translated it into a sort of how to model, Ben, and you've dialed down onto the stuff that you purposefully have to do. Fantastic. And the paper is brilliant, really worth the reading. It goes on to talk about I guess the steps you can take, the progress you can make through this. What other advice would you have to people that might be following this and reading this? Has it been a complete labour of love? Has it been fun to do? What's been your perspective on it?

Ben: is really hard when you're working in an organization that is not coping with demand in some way and it's really, really busy. It takes a real grit to do the things that are gonna pay back long term. And that starts with really getting to the place where you believe it's gonna matter. We all see patients who are sick because we believe it's gonna matter and we will prioritize them. But for this to be prioritized, you really have to believe that, know, even, you know, find the data on psychological safety such that you think having a meeting that develops psychological safety is more important than lots of other things. And the same about recruitment. And then it's about having the stubbornness to do the, being intentional enough to actually then do the things that are going to make the long-term difference and know that it's going to take a bit of time to pay off. And I've... I've written an awful lot on a blog, which we can link in with this as well, that I've kind gone through. I've talked a lot about how we do engagement or how we do recruitment, examples of meetings that I've led. Because sometimes it just, I often try and write them up so that helps people to imagine what walking through a particular meeting might look like. And so if that's helpful, I can share that and that's something that people could read.

ollie: Yeah, absolutely. Brilliant, Ben, it's lovely. And I think I hear there's a real bravery in this because you do have to stick your neck out, don't you? And say, let's do the stuff that's really gonna matter. But there's so much pressure on performing and doing quick firefighting, isn't there? You there's that classic phrase, isn't there? know, the best time to plant a tree was 20 years ago. Everybody kind of like, you know, is too busy to get round to the really core stuff. But actually the next best time to plant a tree is today. So unless you start this work, unless you get... have the confidence to get stuck into these sort of ways of working, you're never gonna change anything. And it's just wonderful, Ben, to see that you've done the work yourself, you've walked the walk, and now you've written it down so that people can follow in your footsteps. And I really appreciate you and Nat Jones doing this together.

Ben: Yeah, thanks Oli for being such a champion of it and having me on.

ollie: Well, that's great. And there's so many parallels here with the power shifts that we're aiming for with health coaching and a coaching style approach. So I hope people listen to this. We'll see those similarities, but thanks Ben. We'll link to your blog. We'll link to all the, to the actual paper itself. And we again, as always, really welcome discussion and feedback. I'm sure you'll be involved. We'll try and continue this on LinkedIn, Ben.

Ben: Thanks, Ollie. All the best. Okay.

ollie: Thanks so much, Ben.