Commensality – or bring back the lunch break

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Commensality – or bring back the lunch break

This post is from The King's Fund Blog

Mayo Clinic is widely acknowledged to be a high-performing academic medical centre delivering excellent care to patients. Established more than 150 years ago, it is a not-for-profit system led by doctors and based on multispecialty medical practice. At our annual conference, one of Mayo Clinic’s leaders, Steve Swensen, shared learning and found a receptive audience.

Steve explained that Mayo Clinic appeals to the intrinsic motivation of its 64,000 staff to provide the best possible care to patients. Decisions are made through consensus in a system he described as a democracy, not an autocracy. A key belief is that staff will perform to the best of their abilities if they are valued, supported and encouraged both to carry out their work and improve it.

Mayo Clinic acts on this belief by seeking to promote ‘joy in work’. It does so by building social capital and inter-connectedness between staff. A practical expression of this is the commitment to promoting opportunities to improve ‘commensality’, for example, by staff sharing a meal together. As an academic medical centre, Mayo Clinic has even carried out a randomised controlled trial to demonstrate the benefits of commensality.

Notwithstanding these efforts, staff stress and burnout are a challenge in Mayo Clinic just as they are in other health care organisations in the United States, albeit at lower levels. Research has shown that staff burnout is correlated with leadership behaviours at all levels. Five behaviours have been shown to be important in creating a climate in which burnout is minimised.

These are appreciating the contribution of staff, seeking their ideas, being transparent, showing interest in their careers, and being inclusive. Leadership development at Mayo Clinic focuses on embedding and enhancing these behaviours as part of a wider strategy to value and support staff. There are strong parallels with the work of Michael West and colleagues, which has highlighted the links between organisational cultures, leadership and staff engagement.

Steve’s talk was a reminder of the importance of ‘softer’ factors in explaining organisational performance. It was also timely in the light of the General Medical Council’s recent warnings about staff morale and the damaging effects of the junior doctors’ dispute. Creating time to talk – and doing so over a meal – are simple steps that may help in rebuilding trust and restoring fractured relationships throughout the NHS. One of the trust chief executives who heard Steve speak reflected that in her organisation a decision had recently been taken to stop providing refreshments.

Listening to the experience of Mayo Clinic I was reminded of a wonderful book by Arie de Geus entitled The living company. I discovered this book after meeting the author when I was working on secondment as director of the strategy unit in the Department of Health in the early 2000s. Arie’s writings reflect his experience in Royal Dutch Shell, and his argument that successful companies see themselves as living communities. They follow many of the same precepts as Mayo Clinic and often achieve similar exceptional results.

Arie told me that in any big and complex organisation such as the NHS, the answers to many of the challenges faced by the organisation are to be found within. The role of leaders is to discover these answers by working with staff and supporting them to make improvements. This simple but profound insight has continued to influence my thinking ever since, as in our work at the Fund on reforming the NHS from within.

So where next?

‘Bring back the lunch break’ may not be the most radical call to arms but in its own way it could be revolutionary. We are beginning work at the Fund to better understand the apparent disconnect between frontline clinical staff and trust leaders, even in high- performing organisations, and what might be done to bridge the divide. Creating time for staff to meet, and to do so in a spirit of collegiality and fellowship, could be part of the solution.

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