32. Dr. Bob Klaber - kindness matters!

Today, I‘m talking to Bob Klaber - a charismatic London paediatrician, building a global movement for kindness.

Like ‘Whose Shoes’, Bob is exploring a topic that could be seen as ‘soft and fluffy’, and bringing it centre stage. Bob’s kindness movement was featured at the Quality and Safety Forum in Gothenburg. I was delighted to contribute to one of the crowdsourced videos.

Lemon lightbulbs 🍋💡🍋

• Important to contextualise healthcare in people’s lives - find out what matters to them
• Share the power. Use healthcare appointments to codesign ways to maximise quality of life
• See things from children’s perspective, including language!
• Life aspirations are typically far more pressing than short-term medical considerations
• As a hospital consultant, find ways to make yourself accessible, not aloof!
• Everyday sexism is rife! Find ways to counter it
• #NoHierarchyJustPeople - sparking real conversations, breaking down  barriers
• Storytelling –  put something of yourself out there, show some vulnerability, let people know what you really care about
• Let’s act. Let’s move. This is urgent!
• Can you measure kindness? Should you  try? 🤷🏼‍♀️
• Think beyond the processes. Be clear what you want to achieve. Don’t just measure things because you can!
• Exploring feelings and experiences is deep and energising … and  hard work
• The tide has turned. There’s no place for leadership through bullying and shouting at people
• The most downloaded podcast episodes aren’t necessarily the  most influential!
• Kindness, #WMTY, patient stories - coming together as a big movement
• NHS must look outwards – patients, local residents, the wider community
• Coproduce the things that will make the biggest impact
• See things from different perspectives, recognise and acknowledge the tensions - can help us  move forward
• Be curious! Challenge yourself to be open-minded rather than thinking “Oh well, that’s how it is”
• Be like children.The ‘5 Why’s’ ? 🤷🏼‍♀️ Children ask 19 whys in a row!
• The human side of care: people join the monthly kindness sessions from Australia and New Zealand in the middle of the night!
• There are people from 30 different countries - a sense of collective power, collective learning, collective curiosity, give people a sense of hope and community
• Informal connections - the ripples are powerful
• There is value in feeling and experiencing the impact, rather than  having to measure everything 
• It ‘s important to reflect – but it doesn’t always need to be through formal channels. It could be on Bob‘s bike!
• Find the balance between reflection - and doing things!
• Find the things that matter most, that will have the biggest impact. Be deliberate
• Shoutout to Dr Mary Salama! #IntentionalCoffee ☕️☕️
• Relational meetings - find out what people are thinking – as opposed to transactional meetings
• Kindness goes beyond the individual  leader – build it into the organisation, into the  system

Links and resources
Prof. Marshall Ganz: The story of self, us, now: https://youtu.be/EfsfG3DkSuA

Crowdsourced kindness videos, shown at  Quality and Safety Forum 2022 - clip including Gill Phillips: https:/

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Please recommend 'Wild Card - Whose Shoes' to others who enjoy hearing passionate people talk about their experiences of improving health care.

Chapters

• 2:34 Bob tells us what is important to him – kindness and so much more
• 4:30 Contextualising healthcare in people’s lives - ensuring healthcare professionals support people to have the best possible quality of life, finding out what matters to them
• 6:20 Let’s share the power. Let’s codesign what time we have to get we have together to get the most out of it for you and your life
• 6:54 Working with children - seeing things from their perspective, including language!
• 7:10 Working with young people with sickle cell disease – life aspirations typically more pressing than short-term medical considerations
• 9:20 As a consultant, Bob does all he can to make himself accessible – not aloof!
• 10:39 Everyday sexism! And how to try and counter it – no hierarchy, just people.
• 13:12 ‘No hierarchy, just people’ is the key to sparking real conversations, breaking down the barriers.
• 14:46 Storytelling – you need to put something of yourself out there, show some vulnerability, let people know what you really care about
• 16:00 Let’s act. Let’s move. This is urgent…
• 17:25 Pledges for action. Can you measure everything? Should you even try?
• 18:26 What about measuring kindness?
• 20:00 Think beyond the processes. Be clear what you want to achieve. Don’t just measure things because you can!
• 20:07 Exploring feelings and experiences is not easy. It is deep and energising… and can be really hard work
• 23:20 The power of connections – linking with people who are doing great work in the same space, around the human side of care
• 24:32 The tide has turned. There is no longer a place for leadership through bullying and shouting at people
• 24:50 The podcast episodes with the most downloads are not necessarily the ones that should be most influential!
• 25:42 Kindness, #WMTY, patient stories - coming together as a big movement
• 25:59 The NHS is starting to look outwards more – not just with patients but local residents and the wider community. Coproducing the things that will make the biggest difference
• 28:11 Seeing things from different perspectives, recognising and acknowledging the tensions, can help us all move forward
• 29:25 Be curious! Challenge yourself to be a bit more open-minded rather than thinking “Oh well, that’s how it is”
• 30:05 The ‘5 Why’s’ - children ask 19 whys in a row!!
• 31:25 The kindness movement now has people from 30 different countries, who have found a sense of collective power, collective learning, collective curiosity
• 32:00 Connecting with like-minded people around this topic of kindness is giving people a real sense of hope, a sense of connection
• 32:55 People join the monthly kindness sessions from Australia and New Zealand in the middle of the night!
• 33:59 The informal connections, the ripples are very powerful
• 34:09 Sometimes there is value in feeling and experiencing the impact, rather than necessarily having to measure everything
• 34:55 It is important to reflect – but it doesn’t always need to be through formal, written channels. It could be on Bob‘s bike!
• 36:12 Finding the right balance between reflection… And actually getting on and doing things!
• 37:15 Find the things that matter most, that are going to have the biggest impact. Be deliberate.
• 37:33 Shoutout to Dr Mary Salama! # IntentionalCoffee
• 38:06 Relational meetings - to find out what people are thinking – as opposed to transactional meetings
• 39:20 Kindness goes beyond the individual kind leader – it needs to be built into the organisation, into the health system. A great note to finish on!

Transcript

Episode 32  -  Bob Klaber 

SPEAKERS

Gill Phillips, Bob Klaber

Gill Phillips  00:10

My name is Gill Phillips and I'm the creator of Whose Shoes a popular approach to co-production. I was named as an HSJ100 Wild Card and want to help give a voice to others, talking about their ideas and experiences. I'll be chatting with people from all sorts of different perspectives, walking in their shoes. If you are interested in the future of health care, and like to hear what other people think, or perhaps even contribute at some point, Whose Shoes Wild Card is for you.

Gill Phillips  00:40

 I've been really looking forward to recording today's podcast. I've only ever met Bob Klaber online, and I'm really looking forward to meeting him in person one day. He's charismatic and fascinating. And I'm delighted Bob, that you agreed to do this Wild Card - Whose Shoes podcast episode with me today. I'm so looking forward to finding out more about you. But from what I know already, you're a paediatrician. And I'd love to see you in action looking after those children that you care for. As kindness is at the centre of your work. I love joining your monthly sessions on a Thursday evening. Indeed, there is one tonight. It is a truly global group. It must have something very special when people like Cath Crock and Nicki Macklin join regularly from Australia and New Zealand at 4 in the morning. I love being part of this global movement for kindness, and seeing something that could be regarded as soft and fluffy, becoming centre stage. Indeed being featured shortly at the World Quality and Safety Forum in Gothenburg. How did that happen? I'm sure Bob can tell us more. So welcome, Bob, thank you so much for joining me. Can you tell me a bit more about yourself and what's important to you?

Bob Klaber  02:03

Thank you for inviting me, Gill, I think I'm going to take up a new thing of not letting other people introduce me, because I'm not sure I ever quite recognize the person you've described in any shape or form. So anyone listening, you know, prepare for some disappointment, I'm afraid - but it's lovely to be here. And it's great and really important I think to be spending some time thinking and reflecting and talking about such an important topic. And sort of moving into the doing and the action bit. And we'll maybe come to that. And what can I tell you about me? Well, yeah, kindness is a really important thing. And we'll get into that in some detail. I was sort of brought up I think with the ethos of be kind be helpful as two important things. I'm definitely a learner at heart, I absolutely love these sorts of conversations. And I have this wonderfully broad and varied role that really gives me an extraordinary opportunity to just keep learning, I learn a huge amount from my patients and their amazing families. That's been a key part for me. I absolutely love people and spending time with them. I think this wonderful combination that healthcare has around people and humans and humanity, but also being underpinned by science is really key. So, as well as working as a paediatrician, which the sad news in a sense is a relatively small part of my time, but I have a full time job on the executive team at Imperial College Healthcare, which is a wonderful trust in northwest London. A big place we play a big part in looking after the two and a half million people who live in in West London. We employ about 15,000 people and many of people listening might know St. Mary's or Charing Cross or Hammersmith, they are three big teaching hospitals. We also run an eye hospital, the Western and Queen Charlotte's maternity hospital, but really trying to do that in a way that really thinks about quality of care in its widest domains. So absolutely, making sure care is safe. And people have a really good experience of care but, but thinking beyond just this episode of care, thinking about anything we do in a health service is contextualized in people's wider lives and trying to be really good and thoughtful about that, but loads we can talk about later to get stuck into. But I hope that gives a little bit of an essence about the things that really matter to me.

Gill Phillips  04:26

I think that's a brilliant start, Bob and I love the way you were talking there about contextualizing healthcare in people's lives. And I guess that's what I've tried to do with Whose Shoes that it's not just about … I think one of the original Whose Shoes cards going back 14 years now, was that something around, it's not just a set of services, it's someone having a life and that was around social care at the time. And my big vision really has been trying to join things up around people who really don't give a monkey's about quite which service or which individual is providing which bit of their care, I think we had something about my back bone’s in Birmingham and my liver’s in Liverpool or something, you know, for people, for individuals, it's just getting kind people who help them with what they need, isn't it?

Bob Klaber  05:16

Itit exactly is and I remember … I should know the exact number, I'm gonna misquote the number, somebody better at maths needs to get a calculator out and do 24 times 365. But you get to some sort of number like 8620, something like that. And that's the number of hours in a year. And I did a little slide where I was thinking about maybe some of the families who come and spend two hours a year with me. And this pathetic, tiny amount of time and intervention. And it's very easy to think that that's all very important, contextualize maybe with 50 hours or 100 hours that they might spend with professionals in total contextualized, within 8620 hours a year of their wider lives. So our moments of intervention are really small in lots of ways. They're really insignificant in people's lives. That's not to say they don't and can't add value. But I think we've got to be much smarter and much more thoughtful about and actually, let's get honest and open. You know, Gill, do you think there's, maybe I should need to start doing this with some of the children, young people I look after to say, look, you know, we've got half an hour here together in the context of how can I be helpful? How can I be useful. And I think getting into sort of almost codesign of that moment in time together is a really sort of thoughtful way of doing it. It's not how we're taught traditionally, you know, the sort of power that the doctor sits with. There's a really interesting dynamic here about how we turn that on its head, I talk about picking the telescope up from the other side quite a lot. So it feels like a key part of my world at the moment.

Gill Phillips  06:52

That's really interesting. I think some of the work … I think you’d probably love some of the scenario cards, we've got working with children. So there's one that says the doctor keeps going on about history, but I want to tell him that I hate history. And I’m really good, I'm really good at maths!

Bob Klaber  07:08

Oh, I love that, wonderful. Well, my first experience of coproduction, going back 10, 12 years or 13 years ago was with a group of young people who we got to know because they had sickle cell disease. That was the piece that brought together. And we … it was the first bit we really, we were really true and open to sort of deep co-production and ask very, honest, open questions. But you know, let me admit and confess, we thought we knew what the answers would be. So we thought when we were asking what are the things that really matter to you, they will be worrying about how long when they're in the emergency department, how long it takes us to give them good pain relief, or those sorts of things. So very sort of medical measures, we didn't touch a single sentence on that stuff people were talking about, “I really want to be a lawyer, can I still be a lawyer, if I've got sickle cell disease?”, I'll always remember that. And it just completely blows your mind that we were faffing around on these, you know, not unimportant things, but in the grand scheme of things, unimportant things, and completely failing to pay attention to the things that really mattered, the things that were really worrying them. So, you know, great learning for me. All those years back is genuinely and deeply and with a real sense of curiosity, asking questions like “What are the things that really matter to you?”, in a really open way and being prepared to listen hard. And, you know, be surprised by the answer, challenge your own preconceptions about what people might come up with. So yeah, really amazing moment, I can remember. that conversation to this day.

Gill Phillips  08:44

And unless people feel that they know, whether they're children or adults, that they can actually say what's worrying them. So some of our cards, obviously are more serious, so it might be that, and someone trying to be kind. So, you know, “I'm going to put you to sleep now and you won't feel anything”. And actually, the dog was put to sleep the week before and just that wording and the terror, you know that someone's got absolutely no idea that that particular kind of juxtaposition has come together.

Bob Klaber  09:11

Yeah. And that's what uh, you know, it's such an important learning story. And I just think we've got to, we have to be so thoughtful about this. I can think personally and I'm sure people listening when we get this stuff wrong. I'm quite self-conscious of being six foot three and, you know, increasingly grey haired man who, you know, the engagement piece, I spend a lot of time sitting on the floor. It's why anyone who knows me well, I'm always pretty scruffy and very, very rarely wear a suit. You know, I think being a paediatrician that you know, the ties end up in baby's nappies, and you need to sit on the floor a lot. But seriously, I mean, if you think about the way our consultation rooms are set up, and I'm doing a lot of stuff related to my exact role around redesigning hospitals and all three of our wonderful main hospitals are falling down and need redesign. If anyone listening happens to have a couple of spare billion pounds to invest in that, please, please get in touch. But we're trying to think really hard about actually how do you design spaces where the power is shared. And you know, the idea of a doctor sat behind a desk with his or her name on the door, you know, and all their letters of great achievement behind it. It's just like, why on earth would you set up a consulting room in that space? You know, we need too set up listening rooms, not consulting rooms. So, you know, lots for us to think about and improve on that.

Gill Phillips  10:39

Oh, incidentally, I saw on Twitter yesterday, I can't remember exactly what context but someone was like, really?! And you got a name of a consultant, outside the door, blank to fill in the actual name, but it had “Mr.” Ready to fill in the surname. And hashtag #EverydaySexism. So that's an aside, but Wow.

Bob Klaber  11:00

We’ll, I yeah … I'm a big one. It's interesting, and not everybody's comfortable with this. And it's really interesting. I mean, I personally have found first names, just a really, really, really important equalizer around things. I don't let the medical students call me Doctor Klaber, I just don't think it's helpful on that. Trying to create psychological safety - now people have very fairly come back, particularly junior people, I've heard a number come back and say, Look, you know, I've worked so hard for that. And people don't believe I'm a doctor. And I always get accused as being a nurse. There's some really interesting sexism angles on it. And particularly, younger women who are highly qualified doctors, but don't get recognized as that because of everyday sexism in our society, and sort of pushed back a bit and said, Look, I need to call myself Dr. X, rather than my first name -  so I think that's a really fair and valid point. But I think wherever possible, we, we are all just human beings. I mean, if we really, truly believe in inclusion and equity, we are just human beings, we have to relate to people in that way. And I think anything we can do on that front is really key. And then, you know, you introduce this ‘not soft and fluffy’ piece Gill about kindness. And that is so right. This is the absolute starting point of, of safe, high quality care without a shadow of a doubt.

Gill Phillips  12:24

And I think we're so much on the same page with that, with our Whose Shoes workshop we've always had, like …come along in casual clothes, come along, and don't introduce yourselves around the table, don't wear your NHS lanyards. And then it's not about hiding who you are at all, but it's about as human beings coming together. And, you know, if it comes up naturally in the conversation, that you're a consultant at the hospital or you’re you know, whatever role you are, but on the other hand, if you get, people introducing themselves around the table, and it's like, I'm the chief executive, and remind me who, little person you are, then it cuts across everything, when you actually try and get people to open up and just talk to each other as human beings.

Bob Klaber  13:10

I totally agree. And, you know, it's largely irrelevant of what your role is, and how you behave, what are the things that matter to you, how you make other people feel around you becomes the really, really key things. I mean, yes, there are, there are still significant levers related to positional power of the chief executive can sort of get done. But I totally, totally agree with you, I think, and the really amazing leaders, they don't need to use that stuff. You know, there'll be moments when it's very helpful. And because of all the great listening they've done, then they're in a great position to change the direction of their organization, or their company, or their charity, or whatever it is they're doing, based on that listening. But your point is absolutely right. If you go into it with all this sort of baggage around you, all you're doing is putting a wall up for people to be honest and be true and be straight. And yeah, back to the same. We're just humans. Isn't that you know, when no one's more important than anyone else?

Gill Phillips  14:09

And interestingly, we've found that that works helpfully more so almost in the other direction, that people don't say join our conversations in their professional role, they join as people. So then it might come out that perhaps the chief executive’s worried about her own mum with dementia, or her child with learning disabilities, or, you know, whatever sort of personal issue. Again, people don't have to bring up anything personal. But people very quickly get drawn into the fact that these other people actually care as well. And then by sort of that levelling, that's how people can produce the solutions together.

Bob Klaber  14:46

Yeah.   And you’ve got me really thinking about stories and one of the bits of learning that I absolutely love and a wonderful friend on the east coast of coast of the states, Kate Hilton,  helped me to understand this, but this is Marshall Ganz’s work around public narrative and storytelling. And, again, I'm sure lots of your, your wonderfully thoughtful listeners will have picked this stuff up before but if not, do have a look. And this is this idea around self and around us and around now. So what Marshall Ganz talks about is, it's this idea of, it's not about what I've achieved and what's on my CV and all that stuff. That's just deeply boring. And you didn't really introduce me around that, and I wouldn't have let you anyway, it’s much more interested. To learn what I really care about, what gets me up from bed in the morning? What, what do I worry about? What, what am I passionate about? And what self us now is this idea that if you want to tell a really good story, you have to put a bit of yourself out there and say, what do I stand for? What do I care about? What really matters? And then the aspect is, how do we connect? So I guess part of what you and I try to do is put a bit of self out around , not what we've done and  all this stuff. But actually, what do we care about? What are we passionate about? And maybe that might connect with people listening? And then this sense of … now I love this ... this piece about urgency? And I think that's a really, really important thing. This is not a topic that I'm prepared to let get kicked down the road. “Oh, yeah. Well, you know, the trouble is the NHS is we haven't got enough money at the moment. …”. No, no, no, no, no, no, this is a starting point. This is not … this is an urgent starting point. We have to change how we're doing things now. And I think that sense of now, of urgency is really, really important. And I think, with the conversations we've been doing, we've been really focusing in on that piece about ‘let's act’ Let's move. This is urgent, let's do something now.

Gill Phillips  16:40

That's fantastic. And I think I've got to get you Bob to come along to one of our Whose Shoes workshops

Bob Klaber  16:47

I'd say I have a bicycle. I'd love to be there.

Gill Phillips  16:51

So, we've had right from the beginning and #FabObs Flo, my big partner in crime obstetrician at Kingston hospital, Florence, Wilcock has been very instrumental in pushing this even more, but right from the beginning of Whose Shoes we've had a kind of action focused approach. And I think very relevant to what you've just said, we kind of sowed the seed right the way through the workshop that people have come along, not just because they want to improve things, and they can pick out what needs to happen and what ‘they’, whoever they are, need to do, but actually, that they individually are passionate about something. And I wouldn't know what that is. But to think throughout the workshop about what it is that they individually can do. I've been doing this for 14 years now. I think the idea of pledges has caught on a lot more since. And, you know, can be a bit naff, possibly, you know, and I've always said, I'm not interested at all. And this has been a bit maverick in terms of perhaps measuring and NHS England and so on, in how many pledges, what does that mean? But it's trying to find out and follow up afterwards, what's happened as a result of the pledges, and to support people in delivering those pledges, and then with social media to try and connect them to other people who are already doing amazing things. And then Fab NHS Stuff who can share things. So you don't start with a blank page. And you can see people … you can see them come alive in terms of, “I can actually do something here!”. And it might be very small. But then the small things add up.

Bob Klaber  18:24

I could listen, I totally agree. We've got into some really super interesting discussions around measurement. So let me be clear on a few things that I think … so you can absolutely measure kindness, you can absolutely measure relationships, you can measure trust and things. The sorts of things that you and I know from the work we've been doing are absolutely key ingredients to the sort of change we want to go and see. The next interesting question is to what extent …  how useful is it to spend time, energy and effort measuring these things. A really fantastic couple of social researchers came and helped us. Simon Brownlee related to work that we had done with the Carnegie UK trust around measuring kindness. And Simon came around one of the workshops and I think what I loved about his challenge, he said, “Look, before we get into the detail of how you measure kindness, there's a really important question of do you actually want to?” And I, you know, we didn't really, we kicked that around very hard. And I think, you know, we have a healthcare system in England, in particular, but actually more widely in the UK. That is focused -  just above my head you're you know, you will this will be voice out there. But you will … I've got the pleasure of talking to each other with video too … is Julia Unwin’s wonderful work about the rational and the relational. And we've had this strong bias to measuring the rational stuff. Now that's been really important. following Mid Staffs and all of the terrible things there was very key but we've completely forgotten about this importance around the relational so there’s this strong and gross bias towards processes that are easily measurable. And people are too disinterested in whether the processes actually connect up to real meaningful outcomes that actually matter to patients, because they're too busy counting the processes to your point. So as you say, I don't care whether there's 100 pledges or 1000 pledges or 10,000 pledges, if they don't, or at least some of them don't connect to meaningful change that matters to the people who we're here to serve, forget it, it's a pointless process count, so I completely agree with you, we have to really, really think hard about And the trouble is, the measurement story has got so much power to it. And it's where the money sits. And it's when people are always talking about metrics and things without really thinking through. So what I learned from all my improvement training, so the first thing you’ve got to be clear about is what do you want to achieve? So there are countless measures and metrics and dashboards sitting around in the NHS with absolutely no clear connection to what they really want to achieve. So question one is, what do you want to achieve? And the second thing is about what are the sorts of activities and things that logically or through evidence will get you to what you want to achieve? And then comes in the measurement bit? How will you know you're on the journey? How will you know you're making progress? How will you know that some things are really working? And some things really aren't? So yes, you absolutely need measurement. But boy, we spend a lot of time and taxpayers money measuring the wrong things.

Gill Phillips  21:26

Absolutely. And whenever if someone approaches me and says, they're interested in a Whose Shoes workshop, and I've just got such a radar for spotting tick boxes, and sometimes when something gets a bit more successful, the danger is that it can become, “We need one of those Whose Shoes thingies” you know, and I don't want to go there. Because it's a grassroots, it's a passionate it's about wanting to achieve something. So that's always my first question. Well, what is it you're trying to achieve? Rather than going in with a tool, because ultimately, it is just a tool?

Bob Klaber  22:00

Well, it is, although I think, you know, and I need to come and experience, one of one of the workshops is that I bet my bottom dollar, I'm sure it will be very energizing, I bet it's really hard work as well, and is deep. And one of the things that I've been, I still have some fun, I can think of a group. So I quite regularly do, or very regularly do, a session with a really wonderful programme that actually has been set up within the trust that is pitched to people early in their consultant careers. And it's a leadership development programme . And there's a wide program and some really super things on it. And some great really fab people come and talk and run workshops and do interactive things. I think it's excellent. And the team who've run it should be really proud of it. They get me for an hour on this sort of kindness bit. And I always started with a bit of, you know, expect you're you're expected this is the bit to sort of put your feet up. Yes, it's like you've had pretty heavy morning and you get to the country, this is going to be the hardest and most heavyweight and most difficult hour of the whole course. We're going to really, really go hard and things like that people look at me gay or you're bluffing. Are you sure? You get to the 40 minute mark, and people are really feeling it. This is a really heavyweight, you know, this work that. And I think it's really important to say, isn't it, there's, you know, you're in my networks and conversations that we've had with people. There's a lot of really wonderful people doing some really, really interesting work in this broader space really linked, linked to the human side of care. And that would be a sort of a common thread. And I think one of the things that's rather wonderful about it is people are, I think very generous and keen to connect. There's not, there's not lots of elbows out going on what I'm doing is more important. No, no, I think there's a deep belief that this sort of collective movement, and I think movements are really helpful. But this is the direction of travel without a shadow of a doubt. And, you know, there's a bit of I'm trying to create a bit of jeopardy here as well for people who are sort of still trying to hang on to a different way of a different way of working that involves bullying that involves shouting at people that involves deep strapped hierarchies that that stuff has gone well, it's not completely gone. But it is a successful way to run a healthcare system has absolutely been fundamentally disproven. There's some bad habits that are still wearing away out there. And that's the stuff that we need to try and get on top of.

Gill Phillips  24:31

So important and, and coming back a little bit to what you were talking about before and, you know, changing norms, I suppose. And, you know, the concentration on data and things that are kind of easier, rather than in inverted commas, softer, fluffier, less measurable things, one of the podcast episodes so far that I'd love you to connect with. And I think, you know, I look at statistics and sometimes the ones that are think should be the most influential aren't. And miles Sibley and the work he's doing with the patient experience library. And the evidence that he's building behind the fact that patients stories and just listen to that language, the anecdotal patient stories, compare with the medical reports. And as a patient, I might make a complaint. But you make a serious incident report or just the language that sits behind it. And he's collected 70,000 documents. But he's also, you know, strikes me as a really clever guy who can actually not just say, this needs to be different, but why. So I think the link with kindness, and what matters to you and patient stories, it's coming together as a big movement, isn't it?

Bob Klaber  25:48

It certainly is. And I think organizations are really starting to do things differently. You know, we, we're an organization that historically had just not been interested or curious, in this, we did a big and deep piece of work around looking at our values. And you know, which started, was co-produced, you know, I was involved in running well over 100 workshops with over 2000 staff really asking the question, what matters?  What are the things … what should this organization be about? I think on reflection that we didn't always get that right, we realized we were doing more about values and less about behaviours, we merely moved on to a sort of focus in and around behaviours. And what's really interesting with just my wonderful colleague, Michelle Dixon, who's our Director of communication engagement, where she's setting up with help from a wide group, essentially a focus on user insights. So users not the best word, but what we're trying to … what we mean by users is really everybody who's involved in our services. So that's our direct patients, but that's our local residents. That's local charity, business council partners, other NHS partners, that's all of our staff, we're really trying to be quite systematic about how do we learn from the insights of the people who are coming into contact with us as an organization in any shape or form? And how do we use that to systematically drive improvement? That's a very, very different way of looking at things. And to your point, we're really trying to give equal weighting to all sorts of different sources around it, rather than … I think it's just laziness on the measurement bit, this idea that things are easy to measure, you know, we've got the data already. So that's the stuff. It's just laziness, and it shows a lack of understanding of the logic that we talked about is be clear about what you want to achieve. And that should be linked to the things that most matter to our patients are things that are going to make the biggest difference to our local communities or local citizens, and then co-produce, what are the things we're going to try and test to try and improve them, and then the measurement comes , so just the fact we've got the data is irrelevant. But yet people seem to jump on that all the time. So I'm pretty ruthless at spotting that lack of logic and calling that out.

Gill Phillips  28:09

Brilliant. I love it, it takes me right back. Actually, I'm right back there, working for my local authority before I jumped ship and set up Whose Shoes, and I was working around quality improvement and performance. And suddenly outcomes became the buzzword. And I had this guy telling me I needed to report on outcomes. And I just had this gut feeling that something needed to come before the outcomes. Yes, we were just in two different worlds. And I didn't know you know, and it was the same with my early work around personalisation. And seeing senior people, you know, suddenly it was the buzzword in social care, and talking about choice. But actually, how does that work in a completely risk averse society? And that's really where Whose Shoes came from, like, looking at these tensions, and trying to call them out, like you're saying,

Bob Klaber  29:01

Yeah, and they are … I think I just pick on the word tension around stuff. And I think, I think these things are tensions, and they're really real. And I think sometimes it can sound can’t it that this conversation can sound like a bit of an assault on, you know, the people who are working on in a performance management setting or dealing with contracts or things but I think, Well, I think we both strongly argue that to say, you know, let's be curious about that tension. Let's try and understand it better. Let's try and look at things from different angles. Let's be much more open and curious. I mean, I think the word curiosity and being curious is really, really important. You know, I'd really encourage people to just just try out this idea that maybe all of us just, you know, aren't quite so sure about what the answers are that we might think they are just to hold a slightly more curious space. Challenge yourself to think about some of the things you've thought about as just being Oh, well, that's how it is. Why? Why do they actually have to be? Of course hanging out with kids … children are actually brilliant at that. You know they do. We learned that we in management improvement programmes and courses about things like ‘ask the five why's,’ I mean, I've watched children ask 19 whys in a row. You know, they're brilliant at that developmental curiosity and work beats that out of us somewhat. So I'd really encourage people to go and get themselves a little bit more curious.

Gill Phillips  30:32

I'm quite proud of that. Because I wanted to come on to the fantastic videos that you're putting together about kindness, crowdsourced by all the different people. And amazing how different people are coming up with different aspects of kindness to showcase at the conference, the quality and safety forum. But my little clip, and thank you so much for including it, was around being curious.

Bob Klaber  30:56

Yeah, exactly. Well, listen, and you're so right. And just on that, I think, and I touched on the word about generous, and I introduced the importance of learning about who I am, and what I really care about. And the wonderful thing about this work is, you know, you're very clearly I mean, I've sort of found myself sort of being accidentally finding myself a little bit on the tiller of this sort of boat. But the truth is, it in lots of ways, it's nothing really to do with me, there is a convening of a whole group of extraordinary people. And as you say, you know, we've got people now from 30 different countries, who have found a sense of collective power, collective learning, collective curiosity from spending a bit of time together, lots of little touch points, I absolutely love I mean, you know, if I had more time I’d do a PhD on the connections that it's triggered off. And, and I think it's just that great sense of generosity that people have to share, to learn, to, to really want to do everything they can to make things better. And I think a recognition, you know, when you think about everything that's going on across the world at the moment, and where we are, whatever angle you're interested in taking, whether it's around climate, whether it's around economic development, whether it's around the fact that people still die of diseases, they shouldn't die of, whether it's about war, I mean, really sort of take your pick on it. I think, coming together around this sort of work gives people a real sense of hope. It gives people a sense of connection. And that's feels really, really, really important. And we got we mustn't overstate the impact. But I think recognizing that being connected, being part of it goes back to this human thing. Being part of a movement, being part of society, in that way, gives us great strength and great courage to go and do all sorts of amazing things. And you know, you mentioned our incredible friends down in the southern hemisphere, I mean … I'll be doing it again, at six o'clock UK time tonight, wondering what on earth they're doing at 4 o'clock in the morning, I feel like sort of sending someone round their door to knock on the door, and as they go to bed, don’t be ridiculous. But they contribute so much. And, you know, I of course, love having them there. So, yeah, there's something about that sense of community. And I guess, researchers, much smarter than me, have written lots of wonderful things about communities of practice, and, and movements and how - but very fundamentally, it is this human thing about let's let's look after each other, let's be kind to each other, let's be generous to each other. Let's stay curious. Let's keep trying to learn. And that to me, it's most likely to lead to a sort of happy and productive life.

Gill Phillips  33:42

And it's fun too I think, I'm absolutely rubbish at measuring things. And it's not what I set out to do. And, you know, hopefully somewhere along the line that catches up in some way, whether it's through shared stories, or whatever, I'm more into the sort of storytelling - but your PhD would need to pick up some of the informal connections. So for example, I've had a chat with Cath Crock from the Hush Foundation. I was absolutely, as you may remember, fascinated by Nicki Macklin with her ‘Needles and Noodles’ and how that linked with Miles Sibley and his patient stories. So those ripples, I think, I don't know how to measure them, but I can feel them. And that's important.

Bob Klaber  34:23

Well, and listen, I think you're onto something there. So, you know, there are ways to measure them. But again, our bias is we go to the technical, we surround it with a whole load of things. So I love your piece about feeling them and what's the value in feeling them and, and doing something with them and energizing them or talking to me about them or, or giving you enough courage and motivation to go and act on something or to make further connection. So I think, again, going back to that provocation that Simon gave us, like, why do you really want to measure. there's a transactional cost to measurement. You can put stuff in the way of it and cloud it in a way. And it's probably the reason you're not wildly good at it. Gill is, you know, it's a bit like … there's people who could go home every night and write ... the doctors get asked to write a reflective portfolio. What's happened today? Well, if I think about it, I reflect often on the bicycle about all the different things going on in my head and will sense make that stuff. Thankfully, as I'm on my bicycle, I'm not there with a pen and paper or trying to write it down. So I'm rubbish at writing down. But when I think about it, I definitely reflect and I'll bounce things off people and talk, so fit eels like my reflective practice is good. My documentation of reflective practice is absolutely terrible. So, yeah, that's maybe something for me to improve on

Gill Phillips  35:40

Or not.  And as I said, I've just done a ‘what matters to you’ podcast. And I said, within that, that …….. now I've completely lost my train. So we'd have to edit this. We were, we were so in the flow. And I got really excited about something … but I've got no idea … so much going on in my head in these sessions …

Bob Klaber  36:02

I can imagine. I can imagine … how you keep… You know, you invite characters like me, and try to keep things on the vaguely straight and narrow, is near impossible. 

Gill Phillips  36:11

I suspect that … I was trying to do a crowdsourced podcast bringing in different voices in terms of what matters to you. And I, yeah, so that I think perhaps it was around, it ended up as a bit of a stream of consciousness. And I don't know how it landed for other people. But I think the key point for me was that sometimes some of the biggest stuff that I've done, I've ended up with zero record of it, because I've just been too busy. Whereas, you know, when you're a bit less busy, you've got more time to kind of make the most of the things you've done, perhaps make the little video, share the stories, write the blog, you know? Yeah, that was my point.

Bob Klaber  36:48

Yeah, yeah. Well, it's a really interesting piece. And again, it's a bit we haven't been great on - the kindness conversation around that, because it's felt like putting the energy into convening and facilitating, you know, as there's a lot of sort of voluntary efforts here from people. So we've definitely been much less good as we could be at the sort of capture piece around it. So yes, stuff to think about. But I think, again, being guided by what are the real value activities, what are the things that are going to matter the most and make the most impact? There's something about being quite deliberate about that. I like the word deliberate. You know, there's some wonderful spontaneous things that happen. But being deliberate about what you're doing also feels quite important.

Gill Phillips  37:33

So … linked to this is Dr. Mary Salama, who I don't know if you know …

Bob Klaber  37:40

I've been lucky enough to go and visit her in Birmingham. Yeah, yeah …

Gill Phillips  37:43

Well, we have set up … Mary and I … intentional coffee… hashtag #IntentionalCoffee,

Bob Klaber  37:44

I love that!

Gill Phillips  37:45

Would be that deliberate, you know, the kind of person … like today, Bob, that you come across, and you're interested, and you'd like to find out more about. Actually, rather than a random coffee, make that effort and, perhaps be a bit bold to invite somebody and see where it goes?

Bob Klaber  38:06

Well, we teach in our improvement work about something called a relational meeting, which the community organizers, (there will be community organizing experts listening to this, I have no doubt) but it's one of the key tools that community organizers have in their toolbox. So it's absolutely intentional. But it's not transactional around, Right, Gill,, can we meet because I want to look at the end of year this and we've got to do planning for quarter 4four, or, you know … that's a transactional meeting. This is about, you know, tell me about what you're thinking, and how are you feeling? And what are the things that really matter to you, but as you said, can absolutely have intention.

Gill Phillips  38:49

So I'm conscious, you've got to go, Bob, I really don't want to keep you …

Bob Klaber  38:53

Something much less interesting…

Bob Klaber  38:54

Listen, I'm very lucky, I do lots of really interesting, really, really interesting things. My next meeting is about,… we were doing some exploring around how we could do much more employment of local people. So thinking about our role as an anchor, as an organization. So that's where I'm off to next.

Gill Phillips  39:09

That is very interesting. Yeah. Connecting with the community, isn’t it?

Bob Klaber  39:13

Yeah, very interesting. And, you know, with the community, it connects with the community, and hey, this thread about understanding about the things that really matter to people, this thread about kindness, you know, so I'm really interested, yes, you know, how you can be a kind individual or a kind leader, but actually, how do we behave in that way as an organization as a healthcare system? Absolutely key. So I think, you know, the culture of the organization we're trying to run here, we're really trying to think very hard about about that at the organizational and system level as well, which is really exciting.

Gill Phillips  39:45

Well, I'm sure we could talk all day.

Bob Klaber  39:49

I have no doubt. I think probably both of us. Yes, exactly!

Gill Phillips  39:53

So I'm sure there are loads of things we haven't covered Bob, but what we have covered has been very real and spontaneous. Thanks for jumping in and making time for it. I'm really grateful.

Bob Klaber  40:03

It's an absolute pleasure and always, always happy to talk more and take more and indeed do more. So, listen, I look forward to see you later on the conversation. Thank you.

Gill Phillips  40:12

Thank you so much, Bob. Okay. Bye.

Bob Klaber  40:15

Bye bye.

Gill Phillips  40:16

I hope you have enjoyed this episode. If so, please subscribe now to hear more of these fascinating conversations on your favorite podcast platform. And please leave a review. I tweet as @WhoseShoes. Thank you for being on this journey with me. And let's hope that together we can make a difference.