Evaluation of the NHS Thames Valley
and Wessex Leadership Academy
Transformational Conversations
Programme
Thoreya Swage
December 2015
Thoreya Swage Ltd.
Evaluation of the NHS Thames Valley and Wessex Leadership
Academy Transformational Conversations Programme
CONTENTS
Page
EXECUTIVE SUMMARY
3
INTRODUCTION
4
METHODOLOGY
4
FINDINGS
5
CONCLUSIONS
11
TRANSFORMATIONAL CONVERSATIONS SUMMIT REPORT
Appendix A 12
QUESTIONNAIRE
Appendix B 17
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Evaluation of the NHS Thames Valley and Wessex Leadership
Academy Transformational Conversations Programme
EXECUTIVE SUMMARY
This is an evaluation of the outcomes of the Transformational Conversations Programme
commissioned by the Thames Valley and Wessex Leadership Academy and run by the Bath
Consultancy Group during 2015.
The evaluation was undertaken in two parts:
1. An analysis of the results of questionnaires sent to 40 senior leaders who had
participated in the Transformational Conversations Programme
2. One-to-one in-depth semi-structured telephone or face-to-face interviews with selected
senior leaders
In addition, an analysis of the feedback collated from the Transformational Conversations
Summit (the reflective workshop) was undertaken and included in this evaluation.
In total 11 replies were received in response to the questionnaire and seven telephone/ faceto-face interviews were conducted. The key findings are:

A key impact of the programme was the opportunity to meet other colleagues in a similar
position, to network and to discuss issues and concerns in common in a safe
environment. This permitted 'time out’ from the workplace to reflect, review and learn
new and different approaches to their interactions with staff and other colleagues in their
own organisations

Participants reported that the preparation and practice of transformational conversational
skills in the programme enabled them, in the their day-to-day work to
o determine the type of interaction and conversation that would be most beneficial.
o deal with conflict situations
o provide motivational feedback
o actively improve the quality of the leadership conversations

Examples of the application of these transformational conversational skills included
changes in their own, as well as colleagues' behaviours, enhancing the progress of
projects that required re-direction, better team engagement and enhanced appraisals,
and structured meetings

Overall the feedback was positive in most of the areas that were covered in the
programme. There was a desire for more focus on specific areas such as, having more
transformational conversations practice, feedback on how to influence and interpret
wider systems) as well as psychodynamic processes, and presence and authority

There were a few exceptions where the input was considered to be of limited benefit,
such as the 360 degree feedback and coaching when it was felt that the information from
the former was not used and a few participants had had previous training on the latter
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
Feedback from participants' line managers included observations that behaviours had
changed as evidenced through different levels of conversations and clear preparations
for these interactions. There was less working in silos, and there was now a passion for
what had been learnt and how these skills had been applied in a practical way.
INTRODUCTION
This is an evaluation of the outcomes of the Transformational Conversations Programme
commissioned by the Thames Valley and Wessex Leadership Academy and run by the Bath
Consultancy Group during 2015.
The programme is designed to meet the needs of senior leaders who lead large teams,
directorates or divisions from a range of NHS, Social Care and Local Government
organisations. Currently three cohorts of senior leaders within the NHS in the Thames Valley
and Wessex area (a total of 40 participants) have been through the Transformational
Conversations Programme and fourth cohort began in October 2015.
The seven day programme, divided into three 2 day modules, is run over five to six months
culminating in a final reflective workshop designed to bring together all the cohort
participants to share their learning at a Senior Leadership Summit. The modules focus on:


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leadership challenges and authority; presence and impact; the leader as coach
increasing accountability and challenging conversations; transformational coaching
going beyond performance management; development conversations and fostering
talent
METHODOLOGY
The evaluation was undertaken in two parts:
1. An analysis of the results of questionnaires sent to 40 senior leaders who had participated
in the Transformational Conversations Programme
2. One-to-one in-depth semi-structured telephone or face-to-face interviews with selected
senior leaders
In addition, an analysis of the feedback collated from the Transformational Conversations
Summit (the reflective workshop) was undertaken and included in this evaluation (see
Appendix A).
The aim of the evaluation is to assess the outcomes experienced by the participants against
the original aims/learning outcomes of the programme. Areas for evaluation that were
covered included:

the participants own objectives for the programme
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
the effectiveness of the programme on the development of transformational
conversational skills of the participants to :
o assess leadership situations to determine the type of interaction and conversation
that would be most beneficial.
o deal with conflict situations
o provide motivational feedback
o actively improve the quality of the leadership conversations that take place
routinely

examples of the above skills and knowledge acquired through the programme applied to
daily practice
the impact of such transformational conversations on individuals, the team and the
organisation (i.e. actions taken and outcomes, e.g. better patient outcomes, improved
safety, change in behaviour, efficiencies, cost savings etc)
aspects of the course that were particularly helpful
areas where the course could be improved

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A copy of the questionnaire used in this evaluation can be found in Appendix B.
All the information collected via the survey and the semi-structured interviews was received
and treated with confidence and no organisation or individual is identified in this report
The evaluation was undertaken in October and November 2015.
The outcome of this piece of work is a report summarising the findings of the survey,
telephone interviews and the Transformational Conversations Summit.
FINDINGS
In total 11 replies were received in response to the questionnaire and seven telephone/ faceto-face interviews were conducted. The findings are summarised below.
Participants' objectives
Participants identified a number of personal objectives for undertaking the programme
ranging from suggestions made by their line managers to go on the programme, to reaching
a point in their career where they were facing challenges in the workplace where such input
would be helpful. Specific objectives included realising that some difficult conversations were
on the horizon due to organisational changes, wanting to go on a leadership course, learning
and practising transformational conversations and communication skills, being put forward to
do the course and wanting to work better across systems.
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Using transformational conversations skills to enable individuals to overcome
personal or organisational blockages that get in the way of performance and
transformation
Participants reported that the programme provided some time, space and structure to enable
them to prepare and practise strategies to address a number of issues in the workplace.
These included constructing a systematic approach to moving a project forward, addressing
poor behaviours by staff and setting a structured agenda.
A key benefit highlighted by a number of participants was the usefulness of preparing for a
conversation in that this provided a better, more thoughtful approach to conducting the
interaction, a change in behaviour, better organisation and clarity on what the outcome
should be. The resulting conversations were more direct and less 'woolly' and a tangible
outcome was enhanced staff engagement.
There were comments that the skills acquired improved the implementation of appraisals by
focussing on behaviours rather than objectives and supported the recruitment of staff based
on their values rather than skill sets, whilst other comments included the use of the different
techniques learned such as active listening in day-to-day communications.
One participant described how they applied the skills learned to have a conversation with a
colleague concerning the impact of the style and language of a report that the latter had
written. Although this did not change the report itself, the participant reported greater
confidence in undertaking future similar conversations.
Example: One participant used the techniques learned on the programme to prepare and
conduct a challenging job planning conversation with a colleague on how ward rounds,
domiciliary visits and outpatient clinics were managed. By thinking through the approach and
desired outcome, the conversation resulted in the job plan being altered, the colleague
seeing more patients in the outpatient clinic and a reduction in unnecessary domiciliary
visits.
Example: Using the structured approach to preparation and rehearsal for a difficult
conversation, a participant described an interaction with a staff member who was an expert
in their field, but was dysfunctional within the team environment and was known to have
occupational health issues. The long conversation, which was conducted using coaching
techniques, covered a number of areas including the staff member's hopes for the future and
how they were feeling. The outcome was that the staff member came up with their own plan
of action and after a period of sick leave, returned to work on a part-time basis and was
more engaged.
Deciding the type of conversation to have and which associated skills would be most
effective
There was a general agreement that the programme provided a constructive approach to
determining the type of conversation and associate skills to be used when managing specific
situations. There were comments about how helpful it was to have a better understanding of
the issues, deciding what outcomes were desired, having a number of options to choose
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from and what responses to anticipate. In addition, there was a better appreciation of other
peoples' feelings and alternative view points.
It was reported that the tools presented in the programme resulted in one senior manager
being able to have a clear conversation with executives about the direction of a project they
were handling, to another observing an engaged response by a team member on the subject
of learning from incidents who had previously been negative. A third had suggested a
positive approach to a ward matron who was about to conduct an appraisal with a nursing
colleague. The ward matron found this approach productive.
There was one comment that it was good to have a range of tools available, but deciding
which one to use was difficult as it was not clear if the participant had got this right. On the
other hand, another reported that they were now able to decide what type of conversations
to have with bereaved relatives, management colleagues and clinical colleagues.
Example: By selecting a specific conversational approach a participant set out to improve
the way group meetings were run which previously had an unstructured agenda where
decisions were not made. Through listening more carefully the conversation was steered
towards considering how the organisation of the meeting could be improved. It was agreed,
following research that members of the group use a decision-making tool to help with this
process. The tool, which requires each member of the group to rate options on a scale of 14, now leads to an objective discussion and has been utilised three times. Feedback on this
by the group has been positive.
Dealing with challenging situations e.g. performance, behaviour, differing priorities,
etc.
Participants reported that the programme provided a helpful inroad into dealing with
challenging situations and enhanced self - confidence in tackling the issues. It was
recognised that challenging situations could be faced through planning the conversation and
ensuring that they took place. This resulted in more honest communication and insight.
Trying different tactics were also found to be powerful.
One participant practised a conversation they needed to have with a colleague who was
difficult to manage beforehand during the programme. When the actual conversation
happened with the participant expressing disappointment in their colleague's behaviour, the
latter was surprised as they were not aware of the impact of their self-conduct.
Example: As part of the integration process in a trust a number of meetings took place
between two teams. At the beginning there was some mistrust between the teams resulting
in behaviour involving passing notes, eye rolling and sighing. The feeling of 'them and us'
was exaggerated by each team sitting at either end of the table in opposition in the meeting
room. The participant changed the table seating plan to mix up both teams in the meeting
which resulted in a reduction of the poor behaviour and improved engagement.
Example: a participant was able to apply the learning from the programme to implement
change in her team when she realised that information needed to be presented in different
ways to different team members. So when asking for patient notes to be completed
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electronically in the outpatient department this was presented to administrative team
members as an efficient way of recording, whilst for clinical team members the reason was
for purposes of enhancing clinical care.
Providing motivational feedback
The programme highlighted for many participants the value of motivational feedback and
how it could be used. Comments included the use of motivational feedback becoming
embedded in part of day-to-day language and changing the focus on what staff were doing
well rather than what could be improved. There were reports of motivational feedback being
used in appraisals, one-to-one interactions, emails and supporting team members who were
in challenging situations. Two participants reported that they made more effort to give
positive feedback following this programme. Another participant found that following a
suggestion that such an approach would be helpful to a member of her team in their daily
interactions with their staff own resulted in improved relationships. There were comments
that it was also important to explain in the feedback why specific actions and behaviours
were good or what difference this has made, as well as noting the positive impact of such
feedback on individuals and team performance.
Example: One participant used motivational feedback after they had observed that their
colleague was having difficulty in obtaining information from clinical colleagues for a
deadline. The participant suggested that their colleague could explain why the information
was needed to clinical colleagues rather than just requesting this. Following this feedback
the clinical information was forthcoming and the recipient of the feedback reported to be
pleased to have had that advice.
Example: In a meeting with her senior manager a participant used motivational feedback
when the conversation started off negatively concerning an aspect of her performance.
Rather than reacting hastily, the participant did not say anything immediately and then spoke
quietly expressing phrases such as, 'it's nice to meet face-to-face', the feedback is helpful'
and 'let's unpick what I've done wrong'. Within two minutes of the start of the meeting the
senior manager realised what was happening and said, 'let's start again'.
Having a better understanding about how to hold conversations which transform
across the local organisational or health system, e.g. effective influencing or
negotiation skills/strategies
There was agreement that the programme had helped with conversations across local
organisational or health systems, for example from improving in self-confidence when
speaking up and reflecting the views of the trust in multi-agency meetings, to listening
without judgement to colleagues, to applying some negotiation techniques. There were
comments that participants felt less defensive in such situations, were able to take on board
differing views and were able to promote working together to find solutions to issues.
One participant felt that more time could have been spent on effective influencing or
negotiation skills/strategies.
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Example: When finding herself in a situation that the local authority were requesting
representatives from the health sector for a number of meetings that they could not attend, a
participant initially reported reacting in a defensive manner. However, after being open with
local authority about the amount of time clinical colleagues could take out to attend such
meetings, the behaviour changed from being negative to asking how best to prioritise their
time.
Example: A participant described a different approach to meetings with commissioners on
Health Visiting services as a result of learning from the programme. Initially commissioners
were challenging the trust on poor KPI performance and were demanding that these be
achieved. The participant tried to change the confrontational approach by suggesting that
they explore what was happening to prevent the KPIs being achieved.
Aspects of the course that were particularly useful
A key area where the course was considered to be particularly useful was the opportunity to
take time out of the workplace to think, to listen to others and to reflect. As a result of this
experience one participant had applied this 'time out to think' idea to their own team even
though they may be overloaded with work..
The ability to try out and practise conversational techniques and models and
transformational coaching in a safe environment prior to the live situation was also valued.
The variety of tools provided more options when dealing with different situations, for example
the Barry Ostry model of an organisation as a system encouraged one participant to promote
more networking across the level they work at (the middle level). For two others, the three
circles of influence made them realise that they were not in the correct role or organisation.
The 360 degree feedback process was helpful to enable participants to see how their
colleagues viewed them. For example, one participant said that they had been through a
difficult period at work and self-confidence was low. The 360 degree feedback offered a
significant lift in morale and enhanced their drive to succeed.
One participant reported that, following the programme, they now used the four level model
of engagement in many of their interactions with colleagues.
The cohort set up enabled networking across different professions and organisations and, in
one situation, has encouraged one participant to maintain contact with colleagues within the
local healthcare network. There were a couple of comments that the same issues affected
everyone and it was good to share these.
Areas where the course could be improved
There was a desire for more focus on specific areas such as having more transformational
conversations practice, feedback on individual techniques, and more time on systems
thinking (e.g. how to influence and interpret wider systems). Other areas that would have
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benefited from greater examination included organisations and behaviour, psychodynamic
processes, and presence and authority.
It was acknowledged that the reflective logs were not always completed and there was a
suggestion that it would have been helpful to have a named partner to share reflections so
that they are articulated.
The 360 degree feedback posed some challenges at the beginning of the whole programme
in that it was difficult to use and a few felt that the information generated was not used to the
best effect. For example, this feedback would have been helpful to share with others on the
course so that they could have had a better understanding of each other and would have
helped with coaching.
There were one or two comments that the 'invest and sell' game did not work well, the role
play uncovered raw emotions which some found upsetting and that coaching aspect of the
programme was not useful as they had already done such a course.
A few considered that the course could have benefitted from being shortened as some parts
of the programme were felt to be repetitive and drawn out; this was in particular reference to
the last module. One participant queried whether the whole programme should be
residential, suggesting that this was probably only necessary for the first module, while
another said that it took the whole programme for the cohort to gel together.
General Feedback
Generally the programme was well received with a number of participants saying that this
had helped with their personal development as well as their team and organisation. One
participant, however, expected a 'higher quality' programme.
The programme was considered to be well run and facilitated by experts in their field. The
small cohort numbers were appreciated as this gave participants time to get to know each
other and share experiences and learning.
The comments from the line managers ('guests') who were invited to the summit have
reinforced this with some expressing a view that sending their colleagues on this course was
a worthwhile investment.
Specifically, observations were made that behaviours had changed as evidenced through
different levels of conversations and clear preparations for these interactions. There was
less working in silos, and there was now a passion for what has been learnt and how these
skills have been applied in a practical way.
They highlighted the challenge of how to translate the knowledge gained by the participants
to others in the organisation. There was recognition that the programme had produced a
group of people who could now be used as a resource for transformational change in their
capacity as role models and ambassadors.
Further comments and examples of specific projects undertaken by participants can be
found in Appendix B (Transformational Conversations Summit Report)
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CONCLUSIONS
Overall the programme was considered to be of great value to the participants who have
continued to apply the techniques learned to their daily routine and in their conversations
with staff and other colleagues.
These outcomes have been reinforced by participants' line managers who have observed
changes in behaviours and can now see the impact of the programme on key individuals in
the organisation in their roles as models for transformational change.
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Appendix A
Thames Valley and Wessex Leadership Academy
Transformational Conversations Summit Report
25th November 2015
As part of the Transformational Conversations Programme Thames Valley and Wessex
Leadership Academy ran a one day workshop on 25th November to bring together all the
participants from cohorts 1-3 to share their learning at a Senior Leadership Summit.
In addition the line managers (guests) of the participants were invited to hear their
experiences.
The summit objectives were to:



share individual learning from the programme and the impact this has had on individuals,
teams and organisations
identify and share the organisational patterns that both enable and transform
celebrate achievements
The morning session was spent sharing personal progress and preparing for the afternoon
when the guests were presented with the impact of the learning of the participants and the
biggest challenges to achieving successful transformation.
The day finished with an inspirational talk by the GB Paralympic sitting volleyball team
captain, Martine Wright.
Martine Wright speaking
about her experience and
how she feels lucky. Totally
inspiring
'I didn't die that day. I had a
choice, a choice to carry on.'
'it is not what happens to
you that makes a difference
but what you do with that that makes a difference'
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A few examples of learning
Volunteer project
New model of care for ophthalmology services
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Engagement and change
Comments from participants
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'the course helped me to think more broadly - to try a broader approach'
'using opportunities to obtain further information without the need for extra resources'
'I'm used to giving answers, now I've turned that around and I use a coaching approach
to encourage team members to find their own answers'
'the emails I am now getting from a staff member say 'I have done...' rather than
'could/should/would I?'
'I am more able to carry out challenging conversations rather than avoiding them'
'I have learnt to coach more effectively even though I am good at this already'
'preparation is important to facilitate the development of productive relationships'
'I've spent more time thinking about what I'm hoping to get out of a conversation'
'not coming in with a preconceived idea has really helped'
'now I try to go the extra mile with people and give more positive feedback'
'I've been challenging the status quo more. I ask what is within my remit. It's not about
being difficult but being constructive'
'it has been really helpful to understand why people are behaving a certain way - toppy,
bottom & middle'
'I've gone from a role having authority to one of influence and it's helped me unpick my
approach'
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
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'I had a conversation with her & I saw things from her perspective. She's since said that
we're working together so much better'
'I'm now using a different set of techniques to be effective. Coaching and mentoring has
also really helped me'
'someone said 'that's not the most logical thing to do.' Me: 'people are illogical' As a very
logical person it's a big shift'
'this has helped us recognise what we do well and can share across the trust'
'being prepared, understanding feelings, letting things land rather than too much back
and forth'
'It's not just about how we fix things but how we get people to fix issues themselves'
'It's about the power of presence, turning up & enabling self & others to listen without
solving. Enabling us to hear each other'
Challenges to achieving successful transformation
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'There isn't much cross-sectional working'
'The organisation is reactive - it reverts to type when under pressure'
'There needs to be clearer responsibility and accountability throughout the organisation.
It is weak at the moment.'
'We're learning our organisation can be quite reactive rather than taking time to plan and
reacting'
'We need to do things differently'
'There needs to be more talent management - succession planning is patchy'
'There needs to be a focus on training and information technology'
'We need to celebrate success'
'We need to be part of the solution'
'The learning needs to be transmitted across the whole of the organisation rather than
just part of it'
'Times are hard, it can be difficult to stick to our values'
'How do you get the balance between a challenging conversation and completely
demoralising people?'
'You can't just converse within an organisation but across. You also need to talk across
levels. Break down barriers'
'We need to encourage staff to manage change themselves and not fear losing their jobs
or disapproval'
Comments from Guests
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'I think it's amazing what you have got out of the six days. It was a worthwhile
investment'
'It seems that I've invested money wisely'
'It is clear that participants have gained much from the course and are able to articulate
the learning well'
'It is clear that it is important to create time and the participants have demonstrated
clarity of purpose'
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'The behaviours have changed. I can see this through the use of different levels of
conversations'
'People are thinking laterally, whereas before they had a tendency to work in silos. This
is beginning to have an impact on staff and patients'
'I sense that this course has come at a good time for individuals. It is important to have
conversations and to prepare for them'
'I see that this course has been a journey and the next stage is to put it into practice'
'There is a passion for what has been learnt and how these skills have been applied in a
practical way'
'There is a challenge now on how to translate the knowledge gained to others in the
organisation. Here is a group of people who can now be used as a resource for
transformational change'
'a great programme, creating role models and ambassadors'
'Reflection on work is active not passive. It's not about going to a dark room/time out. It's
creating space and moving forward'
'The busier and more stressed you are, the more you need to take time out to think'
'What's struck me is how my colleague has come back into the organisation, rolemodelled and shared her learning'
'This is change at a deeper level and when it happens it frees up time and energy'
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Appendix B
Thames Valley and Wessex Leadership Academy
Transformational Conversations Programme Evaluation Questionnaire
The aim of this questionnaire is to assess the outcomes experienced by the participants
against the learning outcomes of the programme.
1.
Did you find the programme helpful in:
1a.
Using transformational conversations skills to enable individuals to overcome
personal or organisational blockages that get in the way of performance and
transformation?
YES
NO
(please tick as appropriate)
If YES, please give an example from your workplace describing the impact on of
such transformational conversations on INDIVIDUALS, the TEAM and your
ORGANISATION, (e.g. actions taken and outcomes such as better patient / clinical
outcomes, improved safety, change in behaviour, service efficiencies, cost saving etc)
If NO, please explain why, (e.g. was this due to the programme delivery or challenges
within your team or organisation)
1b.
Deciding the type of conversation to have and which associated skills would be most
effective?
YES
NO
(please tick as appropriate)
If YES, please give an example from your workplace describing the impact on of
such transformational conversations on INDIVIDUALS, the TEAM and your
ORGANISATION, (e.g. actions taken and outcomes such as better patient / clinical
outcomes, improved safety, change in behaviour, service efficiencies, cost saving etc)
If NO, please explain why, (e.g. was this due to the programme delivery or
challenges
within your team or organisation)
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1c.
Dealing with challenging situations e.g. performance, behaviour, differing priorities,
etc. ?
YES
NO
(please tick as appropriate)
If YES, please give an example from your workplace describing the impact on of
such transformational conversations on INDIVIDUALS, the TEAM and your
ORGANISATION, (e.g. actions taken and outcomes such as better patient / clinical
outcomes, improved safety, change in behaviour, service efficiencies, cost saving etc)
If NO, please explain why, (e.g. was this due to the programme delivery or
challenges
within your team or organisation)
1d.
Providing motivational feedback?
YES
NO
(please tick as appropriate)
If YES, please give an example from your workplace describing the impact on of
such transformational conversations on INDIVIDUALS, the TEAM and your
ORGANISATION, (e.g. actions taken and outcomes such as better patient / clinical
outcomes, improved safety, change in behaviour, service efficiencies, cost saving etc)
If NO, please explain why, (e.g. was this due to the programme delivery or
challenges
within your team or organisation)
1e.
Having a better understanding about how to hold conversations which transform
across your local organisational or health system, e.g. effective influencing or
negotiation skills/strategies?
YES
NO
(please tick as appropriate)
If YES, please give an example from your workplace describing the impact on of
such transformational conversations on INDIVIDUALS, the TEAM and your
ORGANISATION, (e.g. actions taken and outcomes such as better patient / clinical
outcomes, improved safety, change in behaviour, service efficiencies, cost saving etc)
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If NO, please explain why, (e.g. was this due to the programme delivery or
challenges
within your team or organisation)
2.
Which aspect of the programme was the most useful to you personally
(e.g. specific
topic areas, networking, 360 feedback, reflective log etc)?
2a.
Why?
3.
Which aspect of the programme was the least useful to you personally?
3a.
Why?
4.
Could the programme be improved?
YES
NO
(please tick as appropriate)
5.
If YES, how, (e.g. are there any areas that are missing, activities that could be done, etc)?
6.
Any other comments?
THANK YOU FOR TAKING THE TIME TO COMPLETE THE QUESTIONNAIRE.
ALL RESPONSES WILL BE TREATED CONFIDENTIALLY.
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