Learning from asynchronous collaboration: Redistributing Power (Blog 2 of 3)

Posted by: NHS Horizons - Posted on:

Originally published by Tom Underwood – 18th November 2021

Written with Will Monaghan, Director of Operations, NHSX.

This second of three blogs on finding our team flow looks at how adopting asynchronous methods can complement and encourage a redistribution of power within the Horizons team. For some background on what asynchronous collaboration means, check out our first blog on the topic here.

Professor Bertrand Russell described power as “one’s ability to achieve goals”. In line with this, control over time plays a big part in determining where power sits within teams and organisations. Unsurprisingly, feeling powerless at work can be down to having little influence over our schedule (the example in this article on work boundaries provides an all too relatable an illustration).

By providing staff with opportunities to work asynchronously, we are allowing people to work when they want so they can get things done better in the time and way that suits them as individuals. This approach facilitates a redistribution of power within teams and organisations: by giving people a choice of asynchronous and synchronous methods, we are democratising time.

Will Monaghan, Director of Operations at NHSX shared his experience of how they’ve approached this through the practice of ‘planning together: “A cornerstone of working remotely and working at different times is having a clear plan of what’s needed. In NHSX we’ve found the easiest way to do this for each activity or project is to use Trello (other software is available such as Microsoft Planner). Here we can be clear about what’s not being done yet (backlog), what we’ve committed to do (activity list) what we’re all working on today (doing now) and what we’ve nailed (achievements/done). Having a clear team mission to work back from helps everyone to take some agency in how they use their time in moving towards our common goals and objectives.”

As Will’s experience suggests, the success of any team relies on being aligned as a group, to a core mission. Because of this, changes to the way a team currently works requires consultation and evidence behind the proposed change. Asynchronous work has democratic potential, but ways of doing it cannot be mandated. People need to be invested in any potential benefits.

Therefore, the move to more asynchronous practices needs to be based on open conversations around what works well and what could be improved about the way your team currently functions. This is partly because there will be elements of our service where asynchronous work clearly won’t work. You couldn’t conduct all clinical appointments between a specialist and a patient asynchronously, for example. However, whilst many of us our jobs are not like that, we act as if they are. If you are working on a policy or a plan it is obviously crucial that you involve others, but does it need to be in that moment?

We used an asynchronous debating platform, Kialo, to start this open conversation about how we use our time in the Horizons team. An additional benefit of holding asynchronous meetings using platforms like this, or Slack or MS Teams, is that they enable more equal opportunities for people to share their thoughts than in spoken settings. There is substantial linguistics research to show how power is reinforced in spoken conversation in the workplace, for example, through interruptions, speaking louder or in the directing of questions (see Holmes and Stubbe, 2015, for a classic example). Asynchronous discussion spaces on the other hand, whilst not immune to hierarchy in conversation, can mitigate some of the power-reinforcing aspects of spoken conversation.

We posed the debate statement ‘Horizons should be allowed to work 24/7’ to provoke radical thinking about how we use our time in the team and to get people to truly question our existing practices. This revealed both grievances and praise for the ways in which we are already flexible in our use of time. It also showed that there was a large variety of preferences, despite the small size of the team.

We noticed that people gave genuinely open reflections (some of which quite radical), which demonstrated that people felt safe and secure in this space, to explore what contributes to their best work.

Figure 1: This is a topological overview of our Kialo discussion showing the even distribution of perspectives around the topic. Arguments for the statement (and supporting pro/counter arguments) emanate from the green portion of the central circle whilst arguments against are represented by the red portion.

We used the data from the Kialo discussion to springboard further conversations in the team around when and how we work. These have led to numerous “sprints” – a rapid improvement technique used to experiment with different ways of working.

Successful offshoots from the discussion include: a 30-day sprint in which we committed to only sending links to live documents in emails (as opposed to attachments which are less conducive to asynchronous working) and a continued commitment to shortening meeting times where possible (to balance asynchronous with synchronous work time). These new behaviours have been sustained way beyond the end of the sprints and we think their success lies in part to people feeling safe and secure to contribute their thoughts on the Kialo platform (and other asynchronous methods provided).

We have also found that we can encourage better participation by using a blend of synchronous and asynchronous methods. For example, by starting a discussion or a debate asynchronously (such as with Kialo or a survey) followed by a synchronous reflection on the issues raised, we get issues ‘out onto the table’. Not only do we then get to the point quicker in meetings, but it also allows for greater psychological safety, participation and, as a result, productivity. (See the first blog in the series for references to current thinking on psychological safety in health and care).

This is just one reflection of how a blend of synchronous and asynchronous methods have resulted in better participation and coproduction of ideas within our team. This approach has facilitated a redistribution of power to enable more diverse voices in the team to be heard, fairer conversations and ultimately, better outcomes for our team’s experience at work. Conveniently, they have also been respectful of people’s time in ways we have already discussed by reducing the demand to contribute at long meetings in-person.

Such lessons have vital repercussions for how we work towards our desired future in health and social care. For example, the latest ICS policy guidance* mandates their success on a bases of inclusion, transparency and genuine partnership. Their ability to do this will, to some extent, depend on how they engage with the latest technologies for facilitating synchronous and asynchronous communication and connection between geographically dispersed individuals.

The onus is on all of us to strive to improve our engagement and understanding of these methods. We are only scratching the surface to identify ways to design conversations a/synchronously for fairness and radical change. All experiments and contributions to this effort are both welcome and crucial.


Power in spoken conversation

Integrated Care Systems

  • *Integrated Care Systems: Design framework (2021). These documents set out the headlines for how we will ask NHS leaders and organisations to operate with their partners in Integrated Care Systems (ICSs) from April 2022 and guidance in respect of what the employment commitment is, its application in practice and how it affects people. https://www.england.nhs.uk/publication/integrated-care-systems-design-framework/

Image: Marvin Meyer, Unsplash.

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