Core 10: The Change Makers' Manual

CORE Magazine is our Change Makers manual, providing you with the insights you need to succeed in a rapidly changing world. Learn more about the research conducted by our world-class faculty and how you can apply that to your own business and career. The latest edition navigates the many challenges we face in a post-pandemic world. What does the future hold for sustainable energy in the wake of Russia's invasion of Ukraine? How has employee mental health been affected by COVID and the return to the workplace? And have governments and big corporations used 'nudge theory' to promote individual responsibility and avoid making systemic changes we really need?

THE CHANGE MAKERS’ MANUAL

EDITION TEN 2022/23

Revolution or retreat? The future of green energy after the invasion of Ukraine

Workplace wellbeing: The new epidemic 8 Can entrepreneurs trust instinct? 29 How to spot a fake review 38 Avoiding the ‘great resignation’ 58 Did Trump’s tweets help the dollar? 74

FIRST WORD

T he last time I wrote my annual column, the world was emerging from lockdown and preparing for COP26. It was widely billed as a final chance to agree a plan for a green recovery and avert cataclysmic climate change. Any progress in that direction was short-lived. Russia’s invasion of Ukraine redrew the geopolitical map and the narrative around energy production. With Europe determined to end its reliance on Russian gas and oil, the priority switched from sustainability to energy security. Suddenly, fracking and even new oil and gas licences for North Sea operators were back on the government’s agenda. Yet the green transformation cannot wait if we are to meet our collective target of limiting global warming to 1.5 degrees above the pre-industrial era. Our own Professor of Global Energy, Michael Bradshaw, shares his insights on the challenges ahead in our cover story on page 42. Elsewhere Nick Chater, this year’s winner of the prestigious David E. Rumelhart Prize for his

contribution to cognitive science, argues that governments and corporations must stop passing responsibility to individuals and focus on systemic change to lead us out of this crisis on page 65. Climate change is not the only problem facing political and business leaders. Stephen Roper reveals how the post-pandemic return to the office has exposed a rise in mental health issues on page 8, Nigel Driffield analyses the challenges of levelling up regional economies post-Brexit on page 78, and Graeme Currie outlines a vision for achieving better outcomes for care leavers on page 16. At Warwick, we believe that businesses have the power to change the world for the better and that business schools have the ability – and a responsibility – to help address grand societal challenges. By working together,

Walk in, be proud of your difference, own it Justin Farrance Warwick Business School Alum, Corporate Lawyer and Founder of the charity GROW Mentoring.

we can find solutions to the wicked problems we face.

Professor Andy Lockett Dean of Warwick Business School

The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet. At its heart are 17 Sustainable Development Goals (SDGs), an urgent call for action by all countries. These SDGs are embedded in everything we do at Warwick Business School. Check the icons at the end of each article to see which goals it is connected to.

Discover how Justin is driving change by advancing diversity and inclusion in the legal industry, and how you could start your own journey of change at wbs.ac.uk

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IN THIS ISSUE HEALTHCARE & WELLBEING 08

DECISION-MAKING & ANALYTICS

LEADERSHIP

Core Magazine Edition Ten Executive Editor: Warren Manger Cover: Peter Mays Art Director: Donna Morris © 2022 The University of Warwick. All rights reserved. Neither this publication nor any part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without the prior permission of the department of Warwick Business School at The University of Warwick. Published by Warwick Business School, the University of Warwick, Coventry, CV4 7AL. E enquiries@wbs.ac.uk T +44 (0)24 7652 4306 W wbs.ac.uk @warwickbschool warwickbschool wbs.ac.uk/go/linkedin Where opinion is expressed, it is the opinion of the author and does not necessarily coincide with the views of the publisher or the University of Warwick. All information in this magazine is verified to the best of the authors’ and the publisher’s ability. However, Warwick Business School and the University of Warwick do not accept responsibility for any loss arising from reliance on it. warwickbschool warwickbschool

84 Why do managers make bad decisions? by Jerker Denrell

65 Fudge theory?

How has the pandemic affected staff wellbeing? by Stephen Roper

How corporate giants led behavioural science astray by Nick Chater 68

Leadership

WORKLIFE BALANCE PERFORMANCE AND SURVIVAL

managers make bad Why do

be ways for them to improve. Dynamic decision-making tasks are those whereby taking an action today would change the pay-off of the same or other actions in the future – for example, when an internet platform adopts a push for users that seems costly in the short term but ultimately adds value to the service and firm. An alternative example would be when someone who hates exercise resolves to go for a run every morning, which eventually makes them fitter thus enjoying their exercise more. For the manager, this type of decision-making features in many aspects of corporate life, from product development and process improvement to pricing strategies. These decisions present an interesting learning challenge for managers. Because results in the future are the product of a dependent series of events, it is difficult to detect which actions are key to producing a good outcome. It is a learning challenge that managers appear to be failing at, given evidence from a wide range of studies covering activities that include supply chain management, resource management, allocation and competitive strategy. Similarly, in experiments designed to create micro-worlds that mimic real-life business situations, participants tend to make high short-term returns but low long-term profits, compared with possible returns, even with the benefit of managerial experience. To better understand why managers perform badly, we ran an online experiment that reduced the dynamic decision-making problem to a more basic form. We used a well-known decision-making task, known as the Harvard game, that involved a series of choices between two options (in this case, pressing a green or blue button 500 times). Pressing a green or a blue button

produced a numerical pay-off, with the size of the pay-off determined by the percentage of blue or green button presses over the previous 10 choices. Participants, had to figure out the best way to maximise their pay-off over the duration of the task. By varying the information given to participants, we hoped to gain some insight into how managers approach dynamic decision-making tasks, what factors prevent them from arriving at the best strategy, and how their performance could be improved.

TO THE CORE

Healthcare & Wellbeing

1. When faced with a complex dynamic problem, the right choice is far from intuitive. However, the most common decision-making strategy among managers is ‘muddling through’, trying different actions for size. 2. In our research, individuals performed relatively poorly, even after receiving help to understand how their choices would affect future outcomes. They may need more than a simple explanation of the consequences to improve their dynamic decision-making. 3. Appreciating the nature of dynamic decision-making may encourage the persistence to obtain a better long-term outcome. Conversely, pressure to produce immediate results can prevent managers from exploring a range of actions and learning the best strategy.

WORKPLACE MENTAL HEALTH

How has the pandemic affected staff wellbeing?

decisions?

Taking into account the information provided to

participants, the results seem to exclude several plausible explanations for poor performance.

by Jerker Denrell

“When faced with a complex dynamic problem, the most common decision-making

D uring the pandemic, – many of which are strategically vital to the performance and survival of their organisation in a particularly unpredictable environment. These are often complex decisions requiring a calculation of how actions taken today could affect the results of actions taken in the future. With difficult trade-offs to consider, the route to the best long-term outcome can be hard to find. Indeed, the evidence suggests that managers are not good at understanding and evaluating these types of situations. Fortunately, there may managers have had to make tough decisions

Our complicated relationship with pay and status by Naomi Muggleton

by Stephen Roper

T hree days before the first UK COVID-19 lockdown in March 2020, my wife and I were sitting in a hotel room in Cape Town desperately trying to find a rescue flight back to the UK. This made for a stressful few On the same day, my colleagues in the UK were finishing the fieldwork for a survey of 1,900 Midlands employers on their experiences of mental health and well-being. The timing of this survey was fortuitous, as it provides a robust pre-pandemic benchmark against which to judge the impacts of COVID-19 on mental health in the workplace. With the support of the University days, though many endured worse during the pandemic.

strategy is muddling through”

of Warwick and the Economic and Social Research Council (ESRC), we were able to repeat the survey in 2021 and 2022. This data provides a dynamic picture of how workplace mental health and wellbeing has changed over the last couple of years, as well as how employers have tried to cope with the challenges. This matters because of the personal and social costs of poor mental health and well-being, but also because of its economic cost. Pre-pandemic, the productivity costs of poor mental health alone to UK employers were between £42 billion and £45 billion, according to estimates by Deloitte. This includes the cost of mental health-related absence, at around £7 billion as well as presenteeism (when employees are at work but underperforming due to ill-health), at around £28 billion, and the

TO THE CORE

1. Before COVID-19, poor mental health cost UK employers up to £45 billion in lost productivity. 2. Levels of presenteeism and mental health absences fell sharply in 2021 despite COVID, but have since returned to pre-pandemic levels. 3. More firms now have a senior mental health lead and provide mental health training for line managers, but fewer have a budget for supporting good mental health. Half of UK employers offered staff support to maintain good mental health, compared to 90 per cent in the US. 4. The social and economic cost of poor mental health means firms should remain focused on mental health in the face of growing financial pressure and economic uncertainty.

It did not, for example, appear to be due to uncertainty about the basic nature of this type of decision- making (that pay-offs depend on past actions over a particular period), nor was it a lack of the information needed to grasp the structure and dynamics of the task in hand and calculate the optimal solution. Indeed,

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cost of employees leaving work, at around £9 billion. A recent update suggests

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88 How successful leaders stay on top of things by Maja Korica 92 Hounds of love

13 Five ways lean leadership can help to save the NHS by Nicola Burgess & Bernard Crump 16 Improving outcomes for care leavers by Graeme Currie

Decision-Making & Analytics

PROFESSIONAL STATUS, PAY, AND BEHAVIOUR

SUSTAINABILITY

FUTURE OF WORK

DIGITAL INNOVATION & ENTREPRENEURSHIP 29 When to go with your gut feeling by Deniz Ucbasaran 32 How can digital platforms beat their rivals? by Kalina Staykova

OUR COMPLICATED RELATIONSHIP WITH PAY AND STATUS

42 Revolution or retreat? The future of green energy after the invasion of Ukraine by Michael Bradshaw 48 10 years of CORE 50 Five reads to evaluate your CSR initiatives by Umar Boodoo 52 River rescue How Karan Rastogi is stemming the tide of religious waste poisoning the Ganges

56 Navigating your career Getting ahead in the age of home working by Jacky Swan, Eivor Oborn, & Ila Bharatan

by Naomi Muggleton

Inequality is driving status anxiety – and debt – among hard-pressed workers as they struggle to keep up with wealthier colleagues, which raises fresh questions about the merits of trickle-down economics.

How Claire Horton became a leading charity CEO

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72 The racial bias of stop and search by Neil Stewart

Leadership

Future of Work

MEET THE CHANGE MAKER

WORKING FROM HOME

C laire Horton is a appearance on Desert Island Discs , she revealed that, as a teen, she spent a dark and stormy night dancing barefoot to Kate Bush on a hillside in her best twirly skirt. Three decades later, she is no longer running up that hill, having reached the peak of her profession. The WBS alum was responsible for a spectacular revamp of Battersea Dogs & Cats Home before taking the helm of another internationally renowned institution – the Commonwealth War Graves Commission – where she aims to bring about a similar transformation. Her achievements at multiple charities have won her numerous heart-on-sleeve sort of woman. During a recent

How Claire Horton became a leading charity CEO Hounds of Love

awards and a CBE for services to animal welfare. Not bad for someone who left school at 16. Claire has two secret weapons she credits for her sustained success: honesty and a fine pair of listening ears. When she joins an organisation, one of the first things she does is speak to her staff individually. “I go in with a very open mind. I try to meet absolutely everybody I can,” she says. “In order to trust me, people need a sense that I am genuinely open to hearing what they say, though I have to manage the expectation that I am going to change everything first up.” Joining Battersea as Chief Executive in 2010, three years after her MBA, she propelled the iconic but then-struggling charity into years of growth. Against a backdrop of sector-wide decline in charitable donations, annual turnover at Battersea grew from £12 million to £57 million during her decade in charge. By then she was a charity veteran, but her first paid charity role in 1990 at the NSPCC came as a happy surprise. “Until then I had no idea that charities paid their staff,” she admits. Claire’s rise up the managerial ladder saw her named as UK Director of the Year by the Institute of Directors. And though she has since left Battersea, she continues to work on wider animal welfare issues. In both her paid and voluntary roles, there is a common thread of gently rattling cages. “The more you allow people to talk and share, the more confident they get, and the more they open up. That has to come from authentic leadership. “Over time – weeks rather than months or years – people get a sure sense that you are invested in them and committed

to excellence, finding out and fixing whatever is wrong.” She’s keen to talk about her MBA at Warwick, which she graduated from in 2007. But it was in her early career that she learned her toughest lesson after encountering shockingly bad management. “It was a masterclass in what not to do. A number of us were bullied by a new manager lacking any kind of empathy, who came in like a bull in a china shop and caused a great deal of hurt and pain to a lot of people. But I learned a lot.” She credits her parents with her work ethic and empathy – her mother, Mildred, was a trailblazer who worked as one of Lancashire’s first woman police officers to support sex workers and victims of abuse, and who went on to work in occupational therapy; her civil

Police as a cadet, but failed the eye test. “I didn’t even know then I needed glasses.” Two years later, after some volunteering and time studying business and management at technical college, she became a ‘special constable’ – a volunteer police constable – working alongside regular officers on the streets of Dudley for eight years. On the night Margaret Thatcher was elected, she met her future husband while on duty. After her son was born, her husband was injured at work and forced to retire from a job he loved – that’s when she left the police for paid work in the charity sector, jumping at the chance to fundraise for the NSPCC. “Recently, I wondered, ‘Should I have joined the Met, maybe I’d be taking a shot at the Commissioner role by now!’ But I don’t think I was that brave then. I’m not really one for looking back.” It was only much later in her 30s, as Chief Executive of the University of Warwick Students’ Union, that she began to wonder what she may have missed by never going to university. “I loved working with the students, seeing their ambitions and values, and being part of helping to shape their lives. At that point, I thought I might have lost out. But there I was running an organisation with a multi- million-pound turnover and a sizeable staff – I was doing all right without having done a degree.” Keen to formally learn the theory behind the practice, she began to see the appeal of a business education and, in particular, an Executive MBA – although she never dreamed WBS might accept her. “I thought I wouldn’t be

their spare time make their way to the bridge where they could gain essential navigational experience. This came at a personal cost – ships can be dangerous places and rest times are important. Some learned the rotas – knowing where the friendly faces were, and when, or knowing when staff might be more relaxed and open to helping cadets, and this made all the difference to their opportunities to learn. Some managed to prove their competence, which in turn led senior staff to call on them when under strain – and briefly do away with an onboard hierarchy. By working creatively with the onboard structures (such as rotas) cadets were able to turn what used to be barriers to learning into opportunities. We call this ‘stealth’ work – flying under the radar to get vital experience. How does this help today’s remote workers, gig workers and freelancers who have more autonomy but arguably fewer opportunities to learn directly from colleagues? Although we’ve looked at an unusual context, our research can be more broadly applied. As on board a ship, there are boundaries and structures in many workplaces that may hinder learning – not least, hierarchies, and constraints of time and space. All managers are under pressure and have limited resources. Technologies and staff change all the time. Those who changed jobs during COVID may never even have met their colleagues in person. In order to learn, newcomers need to be creative. They must think strategically about how they can carve out opportunities for casual encounters (online or face to face), identify supportive colleagues, create bonds, or observe directly how other staff operate. These types of encounters have

always been opportunistic – the celebrated ‘water cooler’ moments – but nowadays these opportunities may need to be manufactured, not taken for granted. As an individual, you can’t just stroll into places – be it the bridges on a ship, online meetings, or boardrooms – and learn your craft, no matter how much you may want to. Our research shows that the newcomers who coped best were those who found ingenious ways of identifying and getting access to the people and places they needed to progress, even if these spaces were ‘guarded’ by gatekeepers. They were prepared to sacrifice their personal time to be able to practise their task. In our research, the more passive the cadet, the more likely they were to flounder. Employers also need to understand that opportunities for new employees to learn from experienced colleagues (and vice versa) are diminishing. They need to identify what newcomers are missing out on if they are working remotely – and design programmes that build those experiences. In a changing workplace, employees and employers need to craft opportunities to learn their trade more strategically, rather than assuming that learning will just happen on the job. But this comes at a cost. Individuals may have to work harder and longer to get these vital opportunities, while their more experienced colleagues reap the benefits of hybrid working through a better work-life balance.

STRATEGY & ORGANISATIONAL CHANGE

by Jacky Swan, Eivor Obornm & Ila Bharatan Navigating your career

through busy lanes or into port, for instance. Classroom simulations can go so far, but doing this when feeling seasick, tired, lonely or under pressure is a different experience. On board, the captain and officers are responsible for ensuring cadets an opportunity to learn. Unsurprisingly, senior crew were often too busy, or under too much pressure, to allow the young recruits access to opportunities to acquire skills – particularly navigation. Instead, many saw cadets as ‘menial workers’, and their training was hit or miss. These cadets – usually one per ship – are having to learn their craft in an isolated, confined and sometimes fearful place. How did cadets respond? What we discovered surprised us – many managed to get around the obstacles blocking them from gaining vital experience on board. They did this through a mix of tactics. Some would complete a full shift of menial work, and in

FINANCE & MARKETS 74 Tweet talker The impact of Trump's outbursts on Twitter by Arie Gozluklu 78 Levelling up the UK economy post-Brexit by Nigel Driffield 81 Regulation or risk Is cryptocurrency about to balloon or burst? by Ganesh Viswanath-Natraj

R eager to learn? In previous decades, working life was more predictable, and newcomers would learn their profession or trade on the job, alongside more experienced colleagues. By contrast, work today can be a lonely affair. Navigating your own career is more hazardous – jobs are more fragmented, career paths are less linear, working may be largely from home or performed via emember your first day at work? Keen to meet new people,

technology, and opportunities to build social bonds and learn from others are more squeezed. Since the pandemic, the amount of remote working has soared. At the same time, the gig economy continues apace – for many, working life is solitary and disjointed. It’s harder than ever to learn from others. Where does this leave fledgling staff? We’ve investigated how new employees still manage to learn the skills they need to succeed, even when they feel isolated and sidelined. And we’ve discovered that they respond with a mix of ingenuity, guile and doggedness.

We’ve chosen a very specific scenario for this investigation – how merchant marine cadets fare when they are denied access to opportunities to learn. We followed a group of cadets for five months as they completed their shore- based training before being posted on board commercial ships to consolidate their classroom learning. Cadets are expected to spend time on the ship’s bridge, absorbing the complex tasks of navigation that are essential for their career progression to become officers. At sea, cadets need to put theory into practice, learning how to navigate a ship

engineer father was her mentor. “My mother always said ‘Do as you would be done by,’ and I believe and live by that. Don’t be mean to people when you’re managing them – lead by example, with clarity, strength and decency. “Support and empower people and teams as, if organisations are to thrive, you need supportive and inspirational leaders at every level – and I’ve had some of those, too.” As a 16-year-old, she was desperate to join West Midlands

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Sustainable Development Goals (SDGs)

credible without A levels or a degree. But I asked their

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Digital Innovation & Entrepreneurship

18 The final frontier:

DIGITAL INNOVATION

How can digital platforms beat their rivals? Competition online is fiercer, more

58 How can employers avoid the 'great resignation'? by David Allen

Collaboration at NASA by Loizos Heracleous, Christina Wawarta, & Sotirios Paroutis 22 Five ways to make HR more strategic by Achim Krausert 24 Shame on who? Why a scandal may not always spell disaster for an organisation’s reputation by Irina Surdu

dynamic, and less predictable. This is how to succeed in this cut-throat landscape.

by Kalina Staykova

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Future of Work

WORK-LIFE BALANCE

36 David McClelland’s Need theory 38 How can businesses combat fraudulent reviews? by Ram Gopal

HOW CAN EMPLOYERS AVOID THE ‘GREAT RESIGNATION’?

by David Allen

The so-called ‘great resignation’ has been one of the defining trends in the labour market since the COVID pandemic, but bosses can avoid it by making sure employees are embedded in and outside work.

62 Closing the gap

Working from home is no quick fix for disabled staff by Kim Hoque

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CONTRIBUTORS We believe that business should be used as a power for good. Our faculty of research and teaching academics is constantly striving for excellence in everything it does, from the latest ground-breaking research impacting society, to inspiring our students. Contributors to CORE magazine include research-active academics, who produce cutting-edge theories with real-world impact, and Professors of Practice, who bring their knowledge gained from successful senior business and industry experience.

MICHAEL BRADSHAW Professor of Global Energy E Michael.Bradshaw@wbs.ac.uk

KIM HOQUE Professor of Human Resource Management

NIGEL DRIFFIELD Professor of International Business E Nigel.Driffield@wbs.ac.uk

STEPHEN ROPER Professor of Enterprise E Stephen.Roper@wbs.ac.uk

LOIZOS HERACLEOUS Professor of Strategy E Loizos.Heracleous@wbs.ac.uk

IRINA SURDU Reader of International Business and Strategy E Irina.Surdu@wbs.ac.uk

UMAR BOODOO Assistant Professor in Organisation and Work E Umar.Boodoo@wbs.ac.uk

NICK CHATER Professor of Behavioural Science E Nick.Chater@wbs.ac.uk

GANESH VISWANATH-NATRAJ Assistant Professor of Finance E Ganesh.Viswanath-Natraj @wbs.ac.uk

NICOLA BURGESS Reader of Operations Management E Nicola.Burgess@wbs.ac.uk

CHRISTINA WAWARTA Associate Fellow E christina.wawarta@wbs.ac.uk

DENIZ UCBASARAN Professor of Entrepreneurship E Deniz.Ucbasaran@wbs.ac.uk

JACKY SWAN Professor of Organisational Behaviour E Jacky.Swan@wbs.ac.uk

NAOMI MUGGLETON Assistant Professor of Behavioural Science E Naomi.Muggleton@wbs.ac.uk

JERKER DENRELL Professor of Behavioural Science E Jerker.Denrell@wbs.ac.uk

BERNARD CRUMP Professor of Practice in Healthcare and Leadership E Bernard.Crump@wbs.ac.uk

SOTIRIOS PAROUTIS Professor of Strategic Management E Sotirios.Paroutis@wbs.ac.uk

KALINA STAYKOVA Assistant Professor of Information Systems E Kalina.Staykova@wbs.ac.uk

EIVOR OBORN Professor of Healthcare Management E Eivor.Oborn@wbs.ac.uk

NEIL STEWART Professor of Behavioural Science E Neil.Stewart@wbs.ac.uk

MAJA KORICA Reader in Management and Organisation E Maja.Korica@wbs.ac.uk

Find out more about our faculty and staff at Warwick Business School

GRAEME CURRIE Professor of Public Management E Graeme.Currie@wbs.ac.uk

ACHIM KRAUSERT Associate Professor of

RAM GOPAL Professor of Information Systems Management E Ram.Gopal@wbs.ac.uk

DAVID ALLEN Professor of Human Resource Management E David.Allen@wbs.ac.uk

ARIE GOZLUKLU Associate Professor of Finance E Arie.Gozluklu@wbs.ac.uk

Human Resource Management E Achim.Krausert@wbs.ac.uk

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Healthcare & Wellbeing

WORKPLACE MENTAL HEALTH

How has the pandemic affected staff wellbeing?

by Stephen Roper

TO THE CORE

cost of employees leaving work, at around £9 billion. A recent update suggests

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Healthcare & Wellbeing

this productivity cost may now be as high as £56 billion and says that “28 per cent of employees have either left in 2021 or are planning to leave their jobs in 2022, with 61 per cent citing poor mental health as the reason they are leaving.” Another study estimated the wider personal and social costs of poor mental health in the UK pre-COVID – intangible human costs and quality of life impacts, costs of health, and service care costs – at around £117.9 billion, approximately 5 per cent of UK Gross Domestic Product in 2019 ( McDaid et al 2022). The COVID-19 pandemic has brought about many changes to the economy and society, including in the workplace, and is associated with a sustained increase in mental health issues. Pre-pandemic, employee mental health and wellbeing was often a low priority. In 2020, 50 per cent of Midlands firms offered some support for employee mental health and wellbeing and 42.5 per cent had a senior-level mental health lead. However, only 27.2 per cent of firms had a mental health plan and 25 per cent had a specific budget for mental health support. In the same year, 30 per cent How have employers coped with COVID? of Midlands firms reported some mental health absence. Of this, 37 per cent was either long-term or involved repeated periods of absence. Crucially, among those employers which experienced some mental health absence, 55 per cent reported that this had impacted either growth, productivity, or customer service. Lockdowns and working from home through 2020 and 2021 created significant disruption

and changed working patterns for many of us. Press reports at the time reflected the mixed benefits of home working and the related pressures such as home schooling: many people traded savings in commuting time with a lack of social contact at work. For employers concerned with the mental health and wellbeing of their employees, lockdowns and home working created a range of issues. Emerging mental health and wellbeing issues became more difficult to identify and made responding to any issues more difficult than with traditional face-to-face working patterns. Detailed interviews with employers during 2021 reflected these concerns. Employers – even in smaller firms – often felt more distant from their employees and stressed the complexity of dealing with any emerging mental health issues in the context of the pandemic. “Long-term and repeated mental health absences are now back to pre-pandemic levels, despite under-reporting” Other responses varied. The proportion of Midlands firms having a senior mental health lead fell slightly in 2021 to 36 per cent, while the proportion of firms providing mental health training for line managers increased

marginally to 48 per cent. Despite all the challenges, reported levels of presenteeism fell sharply to 17 per cent. The recorded level of mental health absence also fell to 25 per cent of employers in 2021. Both may reflect a combination of disruption to working patterns as well as the underlying wellbeing of firms’ workforces. We also have some evidence that Government support measures for firms during the pandemic (such as the furlough and COVID loan schemes) may have helped to support good employee mental health and wellbeing. Extra financial support during this period may have helped firms to continue or develop their support for employees. What is mental health in the workplace like post-pandemic? Our newest survey was completed in May 2022, providing fresh insight into the views of Midlands employers on employee mental health and wellbeing. This suggests that for many firms, the much talked about ‘new normal’ looks very much like the old normal: 62 per cent of employers who had adopted remote working practices during the pandemic said they were now back to their previous employment patterns. Where some staff are still working remotely – which is the case in 38 per cent of those firms who adopted remote working practices during the pandemic – more than half of their employers have instituted hybrid working models. With the return to the workplace, reported levels of presenteeism (21 per cent) and mental health absence (27 per cent) have again increased. Perhaps more worrying, the reported incidence of long-term and repeated mental health absences are

now back to pre-pandemic levels, despite some likely under-reporting due to the continuation of hybrid and remote working patterns. Plus, there are very mixed signals about whether Midlands employers are now taking mental health more seriously. On the positive side, the proportion of firms with a senior mental health lead has increased (44 per cent), as has the proportion of firms providing mental health training for line managers (54 per cent). Less positive is a sharp fall in the proportion of employers who have a budget for supporting good mental health, now at only 16 per cent. The future of mental health in the workplace Workplaces represent a potentially valuable context in which to

implement mental health and wellbeing support. And as the figures suggest, the social and economic costs of poor mental health and wellbeing are huge. In our study, around 50 per cent of Midlands employers are offering employees some support to maintain good mental health and wellbeing. In the US, where the financial incentives for employers are very different, this figure is around 90 per cent. Our research study has been critical to understanding how the pandemic affected mental health and wellbeing in Midlands firms, and how this is impacting business outcomes. Recent funding will allow us to extend the work to employers in Ireland and Sweden, explore the role (and benefits) of line manager training in more

detail, and establish the business benefits of mental health and wellbeing support measures. Study results will inform the future development of mental health and wellbeing support for Midlands’ employers through the Midlands-wide Mental Health and Productivity Project (MHPP) and other partner organisations. Oh, and to end my tale, we got the last two seats on the last British Airways flight from Johannesburg before all flights were stopped. That story, at least, has a happy ending.

Find out more about our course Creating Value Through Workplace Wellbeing

Sustainable Development Goals (SDGs)

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Healthcare & Wellbeing

Create a happier and more productive workplace Discover how you can improve employee happiness, productivity and business performance, with our part-time course. Creating Value Through Workplace Wellbeing

INNOVATION IN HEALTHCARE

by Nicola Burgess & Bernard Crump WAYS LEAN LEADERSHIP CAN HELP TO SAVE THE NHS

Healthcare & Wellbeing

3 Lean by osmosis Many staff were redeployed to high-demand areas during the pandemic, so quickly getting up to speed with what was going on in the department was vital. This was helped by using Production Boards, huddles, and Standard Work Documentation. Production Boards give a visual display of the performance of the department, with a running score of key performance indicators. Huddles were usually done around the Production Board, with the quick stand-up meeting giving team members any updates and a briefing on the day ahead. Standard Work Documentation laid out the best practice process for various tasks on the ward. It meant even those with limited exposure to lean picked up the terms in ‘learning by osmosis’ as they heard them over and over again. These approaches were critical for staff who were redeployed and allowed them to quickly understand what was going Senior leaders all said, despite the many challenges presented by the pandemic, the clarity of the shared goal of ‘keep patients and staff safe, save lives’ really helped maintain focus and the urgency to respond. on in the department. 4 Clarity of purpose They all hoped such a clear message of purpose could be maintained beyond the pandemic. Indeed, several of the major process changes made are now regarded as long-term approaches by the trusts to service delivery; for example, accelerating the use of remote and virtual consultations. The partnership with Virginia Mason helped trusts prioritise what tools would work in the emergency, as some, like Rapid Process Improvement Workshops,

were less valuable in circumstances where the process to be studied was a radical departure from that which was followed in more normal times. 5 The speed of lean The pandemic proved Quality Improvement methods can be applied at pace. The Virginia Mason approach is described as ‘inch-wide, mile-deep’ and trusts were coached to take a measured approach that some criticised as being too slow. However, we recorded countless examples from the pandemic that challenged this assumption, where over a matter of hours and days, improvements were made using these key processes from Virginia Mason. For example, many staff were working in identical uniforms and PPE, so the simple innovation of wearing different-coloured hats for specific purposes helped identify who was who. Also, ventilation hoods worn by doctors working around COVID-19 patients needed to be sterilised with ultraviolet light. This was sped up safely and effectively at Surrey and Sussex Healthcare NHS Trust by putting the hoods on the same devices that turn disco balls so they could rotate quickly. This study was confined to trusts in the NHS-Virginia Mason partnership, but it was extremely helpful to see how the tools had been deployed with such great results. The sustained impact on staff over the long term of this period of rapid change and intensity is concerning, with the risk of burnout a challenging issue, especially as the focus begins to switch to the backlog of treatments arising from those that could not be offered at the height of the crisis. But the pandemic has highlighted how simplifying healthcare’s

management of the response and organised Production Boards that gave a visual way of seeing what was going on in the hospital at any one time. They also ensured dissemination of information up and down the line of command, which was vital as facts and data were changing hour by hour in the early stages of the pandemic. The POS worked with the executive leadership and clinical leaders to ensure listening and learning were carried out across the trusts, which allowed people to ‘connect the dots’. 2 The tools of lean Specific methods and tools from Virginia Mason became central for frontline staff during the pandemic. Prominent in all five trusts were: Plan Do Study Act (PDSA) cycles – A framework for developing, testing and implementing changes leading to improvements. It enables healthcare workers to test out changes on a small scale, building on the learning in a structured way before wholesale implementation. Setup reduction – A method

purpose and the unifying focus of the emergency can reduce some of the complexity of the system. Expertise has been at the centre of decision-making, with clinical leadership partnerships being made across the world, and this has been so important in guiding the direction of travel.

t the height of the second wave of the

its hospitals to stunning effect. We have been assessing how this partnership has worked since 2018. The report, now available online with an accompanying sketchnote, assesses to what extent, and in what way, did the trusts use what they had learned from Virginia Mason to combat the pandemic? Between June and September in 2020 we interviewed 40 people, from executives to clinicians and frontline staff; observed 20 hours of meetings; and analysed a vast number of documents to find five ways Virginia Mason’s lean principles were used in the biggest health emergency the UK has seen since the Second World War. 1 Quality Improvement In all five trusts, the use of Quality Improvement – a structured way to assess systems and processes to find performance gains – was central to rapid decision-making, strategic oversight and communication. In all five trusts, Kaizen – the Japanese business philosophy of continuous improvement – was adopted, with Production Office Specialists (POS) trained and deployed across the trusts to oversee command structures. They put in place daily

pandemic in the UK, the National Health Service (NHS) was conducting 1.3 million tests a day. That the NHS

was able to ramp up its pathology system so quickly in the face of a national emergency was down to the type of innovation that Leeds Teaching Hospitals NHS Trust was able to quickly organise. The Trust vastly reduced the turnaround time for testing COVID swabs by attaching Radio Frequency Identification (RFID) tags to track them through the system. It helped identify hold-ups and allowed the Trust to streamline the system and significantly boost the number tested each day. This is one example of the speed and collaboration that filled the evidence-void in healthcare to tackle the pandemic; where in a matter of weeks hospitals exceeded targets that were set many years ahead. And it comes from one of five UK hospital trusts that has been in a trial partnership with US health group Virginia Mason, which adapted lean principles pioneered by car giant Toyota in

of reducing the amount of time needed to change over to the next process. Predicting likely demand for stocks and setting a certain quantity and maintaining that level. Value stream mapping – The detailed mapping of processes to remove waste.

A strict hierarchy does not work in the emergency of a pandemic, with executive leaders, working closely with clinical leaders, being given more authority and autonomy locally, rather than having requirements placed on them from above. The challenge now is how the lessons of the pandemic can be taken forward into the new normal of our post-pandemic world.

These tools were deployed to help with many issues, such as Personal Protective Equipment (PPE) management, repurposing wards and departments, turnaround times for test results, and innovations for allowing communication with loved ones.

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Healthcare & Wellbeing

SOCIAL MOVEMENT

What can we do to improve outcomes for care leavers? by Graeme Currie

Warwickshire Partnership NHS Trust, Barnardo’s, and the National House Project. The aim is to ensure that innovative services that enhance the life course of care leavers are implemented, sustained and scaled up. Our findings highlight four key lessons that our partners have taken on board to benefit care leavers. The service innovations that we examined in our partner providers have widely given rise to some outstanding outcomes for care leavers. However, it is apparent that many of these innovations only enjoy fixed-term funding. Providers thus need to sustain the innovation beyond the fixed period. One solution is to embed it in mainstream children and young people’s services, showcasing the business case for long-term cost reductions on the basis that care leavers require less intensive social care intervention as they progress through life. Such an approach has aided Birmingham City Council and Birmingham Children’s Trust in sustaining their service innovation ‘Preparation for Adulthood’. For innovative services to have the greatest effect on life experiences, any intervention is best co-produced with care leavers themselves. The National House Project, a social enterprise, is exemplary in this regard. It works with local authorities to ensure that the housing care leavers move into is suitable for young people. This includes providing the services that care leavers need to support good health, education, and employment outcomes, but also their identity and attachment to the communities in which they live. A core element is that any group of care leavers moving into a house are allowed to co-design

that space and identify services, so it addresses their specific needs. Alongside this, the National House Project has cultivated an increasingly influential social movement of care leavers that advocate at national level for better care leaver services. In a similar vein, Barnardo’s ‘Triangles’ intervention puts care leavers at the centre when working with professionals – first to identify the problems care leavers face in their local setting as they transition into adulthood, then to design bespoke solutions and draw in the relevant agencies to resource these. The different services required by care leavers to smooth their transition to adulthood require integration of care across many organisational and professional boundaries. This includes social care, health, education and housing. Distribution of leadership across the myriad organisations and professionals involved, so that their efforts are aligned in a synergistic direction, helps ensure integration. In turn, this requires the alignment of performance measures to which organisations and professionals are subject, and the sharing of resources. Furthermore, it requires that different professionals, even if they do not share the perspective of others, at least understand how other parties perceive problems and solutions to care leavers’ transition into adulthood. It goes without saying that this invokes a needs for a significant cultural shift in what are long- established, siloed ways of working. Finally, as innovation is scaled up, we cannot assume the original intervention is cut and pasted with fidelity. A template-type approach is unlikely to work as an innovative service intervention moves from

one organisation to another. The metaphor that is most apt to describe the process of scale up is that of ‘translation’. Any service innovation is likely to be adapted, as it is adopted by different providers. For example, the intervention ‘Breaking the Cycle’ that originated in Birmingham is likely to be relevant in Coventry, but to land successfully it requires that local professionals and care leavers consider what needs to be adopted so that the intervention works, and what can be adapted to fit with the local context. Warwick Business School research focused on care leavers is ongoing, and the issues identified above are now being considered in service improvements for children and young people with Special Educational Needs and Disabilities (SEND). This is part of the wider RISE Partnership, which is hosted by the National Children’s Bureau and the Council for Disabled Children and funded by the Department for Education in the UK. Within this partnership I lead the development of a What Works Centre for SEND service improvement. Obviously that only started recently, but we are more than hopeful that its impact will improve services for the most vulnerable children and young people – a fitting objective for our Change Maker values at WBS. Our research must travel onwards and upwards if the life trajectory of the young people we seek to help is to do the same.

C are leavers typically accelerated and compressed compared to their peers in the general population. They are likely to experience multiple, bewildering transitions that evoke feelings of instability, powerlessness, unpreparedness, abandonment, and mistrust. At the same time, the services available to help them remain limited in capacity and remit, while inter-agency working is poor. Care leavers are then more likely to have a conviction, become a teenage parent, experience experience a journey to adulthood that is both homelessness, be socially excluded, or have mental health problems. On the other hand, they are less likely to achieve academically in school, attend higher education, or enter into stable employment. These poor outcomes for care leavers are troubling but are not surprising. Nor are they impervious to intervention. Our research, supported by funding from the Economic and Social Research Council (ESRC), involves working with a range of care providers, including Birmingham City Council and Birmingham Children’s Trust, North Tyneside Council, Leeds City Council, Coventry and

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