What Future Now?s... · worksheets and slide deck NHS boards are - by their nature - a challenging and intellectually rigorous audience. ... but are only now being picked up in practice

What Future Now?Facilitator’s Guide -Sustainable Health Service Workshop for NHS Trust Boards

2 NHS Sustainable Development Unit - What Future Now? Facilitator’s Guide - Sustainable Health Service Workshop for NHS Trust Boards 3 NHS Sustainable Development Unit - What Future Now? Facilitator’s Guide - Sustainable Health Service Workshop for NHS Trust Boards

Leadership for Sustainability

This is a Resource Pack for NHS leadership bodies and commissioners, and those involved in delivering NHS board development sessions.

It contains advice, recommendations and practical resources for running a workshop on sustainable development, specifically with NHS Trust boards.

It will help you design your workshop, engage NHS boards with the subject matter and what it means for their Trust, and develop actions. It contains:

• Introductiontotheworkshop: aims and objectives, context, preparation• Tipsandadviceondelivery:

recommendations from practice• Casestudysample: inspiring case studies from business • On-the-dayresources: worksheets and slide deck

NHS boards are - by their nature - a challenging and intellectually rigorous audience. If you are planning a workshop of this sort, the NHS Sustainable Development Unit can offer further advice.

Introduction

IntroducingNHSboardstosustainabledevelopment&sustainability

PurposeEnable NHS Trust boards to have the confidence, understand the case, and start to take a leadership role for sustainability.

AudienceThe workshop is intended for boards wishing to improve their performance on sustainability:

• Increasesustainabilityrepresentationatboardlevel

• Addressenvironmentalperformancesothatitcontributes to action on QIPP

• Systematicallytakeaccountoffuturetrendsinstrategic planning

• MakethemostofopportunitiesfortheirSustainableDevelopmentManagementPlantocontribute to the Trust’s strategic or business plans.

Aims• ExplorehowProviderTrusts can use

sustainability to address their challenges in putting patients needs at the core.

• ExplorehowCommissionerTrusts can use sustainability to secure the most appropriate services for addressing health needs.

Objectives• Clarify‘sustainabledevelopment’and‘sustainability’inpracticalterms.

• Explorethehealthcarecaseforapplyingthem.• Takestockofcurrentsuccesses,areasof

leadership & missed opportunities.• Findsmartopportunitiesforimprovement.• Identifyprioritiesforaction.

Outputs• Boardsseetheneedforfurtherfocuson

sustainability• Theyhaveidentifiedactionstotakethis

agenda forward at board level.

Whatfuturenow?


Workshop Introduction

Fiveprincipleshavebeenappliedinthedesignofthisworkshop

1.3DsustainabilityExplore three dimensions of sustainability and sustainable development: a futures perspective, engaging widely to connect across agendas, and being authentic by driving ways of working from a strong values basis.

2.KnowledgeCombinenewinformationwithspacetodebateand interpret it - to allow boards to develop their own understanding of how sustainable development can complement what they do.

3.ReflectionOffer time to step back and consider the implications of the discussion for individuals’ roles,fortheboardandfortheTrust.Asboardsare incredibly busy, the workshop offers a rare opportunity to take stock.

4.CollaborationUse exercises to promote real collaboration during the session and emphasise that sustainable development is about finding more effective ways to collaborate, as well as taking action in specific areas.

5.ActionGround conceptual and strategic debate about sustainable development and sustainability with concrete examples. Guide participants to act as a consequence of what they’ve learnt, and to review progress.

1. Improved understanding and confidence on sustainable development.

2. Greater familiarity with the business case and raises useful questions about how decisions are reached - and how to improve robustness.

3. Sustainabilityrepositionedfroma‘niche’issuetoamatterof‘commonsense.’

4. Builds platform for action by moving the debate forwards.

5. Tailoring for commissioner/ provider boards focuses discussions on real priorities and allows different boards to explore a strategic approach.

6. Roleplaysoffera‘safe’spacetoextendknowledge and understanding.

7. Opportunity for boards to step-in to case studies to explore what’s desirable and achievable, and stretch their ambitions .

8. Space to reflect on the board’s role in leadership for sustainability.

9. Surfaces opinions, judgements and held values to release inertia.

10. Discussions help boards find their own language and narrative for sustainability - enabling them to take a proactive position.

Workshopdesign Summarybenefitsforboards

‘Itdidn’ttakeuslongtoidentifytheopportunitiestobuildsustainabilityin.There’salotwecoulddo,atnogreateffort,tousesustainabilitytoimproveour use of resources.’



1. Creatingstretchfordifferentboardswhosethinking/ culture are different

2. Ensuring boards that are further ahead reset rather than collapse their ambitions, when they find out they’re doing comparably well

3. Building consensus around actions when there may not be time for a full analysis of possibilities and options

4. Managingstrongopinionsonclimatescienceby focusing on the impact of climate change and decarbonisation - rather than the science

5. Addressingpreconceptionsthatsustainabilityis about the environment

6. Justifying three hours of the board’s pressured time on this subject

7. Creatingasbespokeaworkshopaspossibleto have the biggest impact

8. Sourcing current, practical examples to make a convincing case

9. Achievingcredibility/expertiseoncontenttohold the board’s interest

10. Supporting boards not just to recognise the need to take a more strategic approach to sustainability - beyond projects - but to do it

Challengestobemanaged

‘I’mnotsurethecaseisproveninthecurrentframeworkofNHSincentives.’



WhatdosustainabledevelopmentandsustainabilitymeanfortheNHS?

Anewagendathat’sgraduallybuildingmomentum Ideas about sustainable development and sustainability have been around for a long time, but are only now being picked up in practice by the NHS. This means the definition and understandings of how they relate to the NHS are new and not always clear. Boards can be confused about this agenda.

BepreparedtoadjustyourownunderstandingbeforeyoustartIt’s a good idea to test your own understanding before you start. When we talk about sustainable development and sustainability in this resource pack we aren’t only talking about environmental issues like recycling, cutting carbon emissions or using less plastic bags. These ideas are part of a global movement that wants to find ways to improve human wellbeing without degrading the earth’s resources. We will have achieved ‘sustainability’whenwehavesuccessfullybalancedthisglobalequation.‘Sustainabledevelopment’ is the journey to get there.

SustainabledevelopmentintheNHSThe UK approach to healthcare has grown organically over the centuries, and the outcome is the product of both incremental development and countless strategic initiatives, with different motivations affecting institutions and subsystems within the whole. It was not designed to anticipate climate change, food insecurity or a range of diverse and competing new pressures.

Sustainable development is a frame for looking at the system as a whole and considering the social, economic and environmental conditions in which any approach to healthcare must achieve its outcomes. By working from the big picture to the grain of the system it’s possible to anticipate risk, find opportunity and plan a path to a more effective service.

SustainableDevelopment

Youwillfindmoredetailonthisintheaccompanyingpages.

HowcanNHSTrustsandboardsshowleadershipforsustainability?

BydoingmoresustainablethingsTo become more sustainable, NHS Trusts need to cut out the unnecessary consumption of resources and shrink their waste by enabling as much of it as possible to be recycled or reused. They need to shift focus onto preventative care, and seize missed opportunities to boost the wider determinants of health, through better working conditions for staff and carbon reduction. The main action areas are: transport, procurement, new buildings, employment & skills, community engagement & facilities management.

ByactinginmoresustainablewaysAswellastakingactionintargetedareas,Trusts also need to adopt a more joined-up and strategic approach to business as usual - and to act for the long as well as for the short term.

CharacteristicsofanNHSboardthatisshowingleadership

Aboardthat’sshowingleadershipforsustainability:

• Balancesstrategicandoperationalleadershipwith dedicated agenda time

• Isdrivenbybusinesscaseforsustainabledevelopment not just by compliance

• Hasincorporatedsustainabledevelopmentas part of the business case, action for QIPP [Quality, Innovation, Productivity and Prevention],WorldClassCommissioning,TotalPlaceandtheLocalAreaAgreement

• Considersarangeofsocial,technological,economic, environmental, political and values-based future trends, to shape strategy

• Isleadingcross-boundarycollaborationsinthehealth economy.


Tips&AdviceforDelivery

Time(hours)

0.00

0.10

0.20

0.30

1.00

Whatfuturenow?SessionAgenda

Session

Introduction

Aimoftoday

Bigissues

What Future Now?

Businesscase

Activities

Introductions around the room

Whatdowewanttoachievetoday?[10 minutes]Askparticipantstoturntothepersonnexttothemanddiscusstheirreactionstothe‘aimoftodayslide’[3 minutes]‘Explore how [name of trust] Trust can use concepts of ‘sustainable development’ and ‘sustainability’ to overcome its challenges and improve core business performance.’What would you like to get out of today? [scribe reactions]

BigIssuesexercise[10 minutes]To ground and focus the discussions, let’s briefly take stock of the key issues for you - [name of Trust] over the next 5 years.What are the key business issues keeping you up at night?

‘SustainableHealthService’presentation[30 minutes]Presentation on global sustainability issues, why it makes sense to use sustainable development as a lens for NHS core business and the case for sustainability leadership at board level.Q&A

Exploringthebusinesscase[20 minutes]Short presentation to explore how others are doing this. Expose the leadership gap: there’s significant first-mover opportunity here.Discussion-reactiontocasestudies.Couldyouimagine doing things like this and why? How do these examples speak to the case for action?

Resources

See accompanying slide deck






Time(hours)

1.20

1.45

2.15

2.25

2.55

3.00

Whatfuturenow?SessionAgenda

Session

Makingithappen

BREAK

Makingithappen

Makingithappen

Actionplanning

Activities

Preparingtherole-plays[20 minutes]Introduce the role-play situation and individual role-play activities. Divide participants into groups of 4 or 5 people to work on a different role-play exercise each.Movefromgrouptogroup,offeringsupportandasking questions to broaden/deepen the discussions as needed.

Comfortbreak[5minutes]

Roleplayexercise [30 minutes]Each group makes their pitch and is questioned by otherparticipants.Makepassingreflectionsoneachpitch to notice how the case for action was made. [This timeframe is based on three groups pitching].

Reflectionsontheexercise [10 minutes]How did it feel talking to the business case like that - ask for their reactions? Which arguments - and which pitches - are the most convincing to tell? Which are the most convincing for the audience? This was a hypothetical - would these propositions get your attention for real in 2010? If not, what would make them compelling?

Actionplanning [25 minutes]1) Individuals reflect on their own role [non-execs] and areas of responsibility [execs]What’s one thing you could do to put a sustainable development lens into practice - to realise the benefits?2) Share and cluster these as a group3) What are the most significant things that you, as a board, could do?4) What are the top five actions to take forward as a board?5) How will you hold yourselves to taking these forward?

ReflectionsonthedayWhat have you taken away from today?

END

Resources

See resources in Resource Pack





Usingthisagenda

This is a template agenda that you may want to adapt to fit the objectives of your particular session.

Look for timely opportunities to run a review session like this.

Boards will find it easier to justify the time spent and will be more likely to take forward the actions if the session is held at a useful point e.g. it can help redevelop their Sustainable DevelopmentManagementPlan.

Astandalonesessionisn’ttheonlyoption.Itcanbe effective to integrate a review of sustainability performance - or to consider aspects of that performance - as part of mainstream board development.

Successfactors

• Ensureintellectualrigorbackedbypracticalexamples of the health case in action [or alternatively the business case in action outside the sector]

• Inspiretheboardthroughwhattheirpeersaredoing: leaders in business as well as health and public sector

• Offerbothsidesoftheintellectual&mediadebate and move quickly into what this means for NHS

• Drawon,&reference,evidenceforyourarguments

• Offerflexibilityofformat-andbite-sizedoptions - to allow boards to fit the session into their schedule.

• Adapttheinterventiontofitwithboard’sknowledge and challenges: do your homework

• Designtheinterventiontohelpboardsimprove their cohesiveness by building in-group work.

• Positionsustainabilityasaforwardopportunityrather than a series of negative impacts to manage.

• Offer‘instances’or‘scenarios’toallowboard members to step into real situation to explore the case, options and rehearse the sustainability challenge to decisions.

• Setaclearscopeforthesession:whattheboard themselves can do, to focus on their sphere of influence and identify what needs to be delegated

• Interveneona‘wholeorganisation’and‘wholehealtheconomy’basistoopen-uptheopportunity agenda.

• Tosecureagendatimeandmanageexpectations, make clear the rationale for an exclusive board session: that it is stage one of an engagement process

• Includespaceforpersonalandcollectivereflection as boards rarely have the opportunitytotakeastepback.Asastrategicagenda, having space to think underpins leadership for sustainability.

Adviceforfacilitators



Adviceforfacilitators

Tips:dosanddon’t

• Consensusonintellectualdebateisn’tapre-requisite for action: board’s role is to be the challenger so the culture is based on debate between opposing perspectives.

• Don’tassumeinactionisalackofawarenessor unfamiliarity with the agenda - the gap is often an implementation gap.

• Don’tassumeboardswillcreatespaceto follow actions through: operational management issues often squeeze follow-up of the agenda.

• Don’tmakeanyassumptionsaboutthelevel of understanding or knowledge about the subject: individuals’ perspectives vary considerably.

• Don’tattempta‘onesizefitsall’intervention:do your homework about the board and its activities.

• Don’tassumeboardsareinformedaboutwhat’s happening in their Trust on sustainable development.

• Ataminimum,suggestboardspreparebyrefreshing what’s on the ground. Ideally, offer a preparatory paper to hit the session running.

• Useexamplesofsustainabledevelopmentmanagement plans and other strategic documents from other Trusts and organisations to challenge the board on their ambition.

• Ifyou’renotanexpertonsustainabilityissuesyourself, invite input from leading practitioners - and draw on film footage where this is available

• Openingpresentationordiscussionisimportant for gaining buy-in to actions: it needs to be convincing and to respond positively to challenges from the board.

Format

• Severalshortinterventionsratherthanone,long session: to engage the board, track actions and help get over the implementation gap.

• Horseshoe-shapedroomlayouttopromotecollaboration and informal discussion.

Musthaves

• Inordertocarrythediscussionsintoactionit’scrucial that there is a champion, enthusiast or tasked individual on the board who will take the initiative to cement the session into action.

• Thisisn’tnecessarilyaformalrole[althoughit could be]. This individual would share responsibility with their counterparts for implementing any particular actions - and would carve out the space to make this happen.



HowcanI… HowcanI…

positionsustainabledevelopmentasanagendaworthlisteningto?

Tips

• De-politicisesustainability&sustainabledevelopment by giving a balanced view on the media debate.

• Bespecificaboutrelatingtheseconceptsspecifically to health care and to the NHS, and to local rather than global health issues.

• Usecasestudies-filmclipsideally-toillustrate examples of the case for sustainability in action. Examples from outside the sector are as effective as NHS examples - and more so for Non-Executive Directors.

• Positionitasanagendaforactingstrategicallyto shift to preventative care & for making more effective use of resources.

• Helpboardscutthroughtheconfusionaboutexactly what sustainability and sustainable development are, by relating them strongly to the NHS.

Whatnottodo….

• Don’tgiveboardsexactlywhatthey’reexpecting to hear: surprise them by not talking about recycling and transport first.

• Don’texpectboardstohaveanoverviewofTrust’s sustainability projects and performance. It could be worth producing a background paper or asking the board to investigate this before your session.

• Don’tmixupyourtermsasthiscanaddextracomplexity around this agenda. Distinguish between climate change (greenhouse effect), sustainable development (overarching frame for development and environmental protection (relating to the earth’s natural resources).

runanexercisewithboardstofamiliarisethemwiththebusinesscase?

Tips

• Boardswanttogetpracticalaboutsustainabledevelopment and sustainability in order to understand the possibilities.

• Iftheboarddoesn’thaveastated‘position’or implicit understanding of the case for sustainability, work with them to come up with a statement and use this as an exercise for working through the case for sustainability.

• Usecasestudies-filmclipsideally-toillustrate examples of the case for sustainability in action. Examples from outside the sector are as effective as NHS examples - and more so for Non-Executive Directors.

• Offeringrole-playscenariosforboardscanbe a way to step-in to hypothetical (and realistic) opportunities for action, and debate them from business, health, leadership and community-facing perspectives.

Whatnottodo…

• Becarefulwhenintroducingcasestudiesthatdon’t contain business case information. This will reinforce implicit messages for Trusts that sustainabledevelopmentisa‘responsibility’nota‘business’agenda.

• Befrankaboutthenewnessofsustainability

in the NHS - don’t give the impression the practical case is fully developed. Draw examples from other sectors to illustrate the untapped potential in the NHS.



HowcanI… HowcanI…

adaptthisresourcepacktorundifferenttypesofboardworkshops?

Tips

• Doyourhomeworkontheboardasitismoreeffective to be grounded by the board’s real circumstances.

• Usethecorporatebenchmarkingframeworkincluded in this Resource Pack to assess how strategically the board is using sustainable development. This will help you target the objectives and design of your session.

• Splityoursessionupintwoifyoucan.

• Thefirstsessioncould(recommend90mins):- gain sign-up for making the five leadership

for sustainability principles integral to development programmes for the board.

- agree to a review/ action planning session. - set the objectives for the session and what ‘good’willlooklikeasanoutput.

• Thesecondsessioncould(recommend120minutes):

- gain consensus around board level actions.- gain agreement on the detail that will be

necessary for action to be taken (e.g. names and dates).

• AdaptandaddtotheroleplayexercisesinthisResource Pack to match the board’s interests and focus, or for use in different settings.

Whatnottodo…

• Runasessionwithouttestingyourassumptions first: don’t assume a lack of awareness or engagement.

• Someboardshaveconsideredsustainabilityand have difficulty justifying the resource to put this into action. For these boards, focusing on the business case will be very helpful.

workwithboardstoreallyunderstandsustainabledevelopment?

Tips

• Usereflectionexercisestoenableboardsto reframe the debate for themselves to encourage critical analysis and ownership.

• Boardsareoftenimmersedinoperationalmatters.Creatingspaceforthemtostepbackis vital to see how sustainability can contribute strategically to what they do.

• Alotofcommunicationaboutsustainabledevelopment and sustainability is a one-way flow of information and can put across the message that they are ideas boards should act on rather than ideas that are attractive enough to be actively chosen. Use small group work to increase interaction, ideas development and engagement.

• Lookingattheimplicationsoffuturedriversof change for health such as those referred tointhe‘FitfortheFuture’publication-canbe a way of engaging boards with sustainable development.

Whatnottodo…

• Don’tofferboardsjustonesideofthedebateas your audience is likely to have firm views and this may lose their interest.

• Beopenandacceptingofdifferentperspectives at the global level and use this to createa‘matteroffact’discussioninrelationto the NHS.


CaseStudies

Sourceofcasestudies

NHS Trust boards tell us they want to inspired by leading practice.

AgrowingnumberofNHSTrustsareusingsustainability to help create value for staff, patients and communities and examples of this are constantly being updated. Here are the best websites for sourcing up-to-date NHS case studies:

• NHSSustainableDevelopmentUnit http://www.sdu.nhs.uk/page.php?area_id=7

• SustainableDevelopmentCommission http://www.sd-commission.org.uk/pages/

health.html

• ShineSustainableHealthcareNetwork http://www.shine-network.org.uk

To give boards a taste of what’s possible and desirable, this Resource Pack looks to the business sector - and particularly to retail - for some of the best examples of leadership for sustainability in action.

Allofthebusinessesreferredtoherearetakingastrategic approach to sustainability (see Resource 1 in this Resource Pack). This means sustainability isnolongerlookedafterbytheirCorporateSocial Responsibility teams. These businesses are using sustainability to help shape and drive core business.

AsmanyNHSTrustsseesustainabilityasasidelinepriority - and are taking an incremental approach - these examples illustrate the potential for using sustainability as a corporate agenda.

Exampleoftheshiftingleadershipperspectiveonsustainability:

CaseStudy1-Tesco

‘Welistenverycarefullytowhatourcustomerswant and we try our

hardest to satisfy them.’

SirTerryLeahy-CEOTesco-2004

‘ForTescoarevolutioningreenconsumptionis a fantastic opportunity… to satisfy a new

consumer need, and grow our business. That is the goal of a sustainable business. It is, I believe, workthatourcustomers

wantandexpectustolead.’

SirTerryLeahy-CEOTesco-2009

Source: Forum for the Future (2010)

http://www.sdu.nhs.uk/page.php?area_id=7

http://www.sd-commission.org.uk/pages/health.html

http://www.sd-commission.org.uk/pages/health.html

http://www.shine-network.org.uk


CaseStudies

CaseStudy2-Kingfisher

Exampleofusingsustainabilityinvisionandstrategy-setting:

Kingfisher, a leading home improvement group with an international reach, has a clear ambition to fully integrate sustainability into business thinking. The company wants to be the one that customers choose for sustainable home improvement products and services. In 2007, it set about developing a vision and long-term sustainability goalsusingForumfortheFuture’sFiveCapitalsmodel.

AprocesswasdesignedtotakeKingfisher’sexecutive committee through the strategic implications of future social and environmental trends,confirmingthat‘businessasusual’wouldnot equip the company for these changes. With this in mind, Kingfisher developed a set of strategic sustainability goals that enable it to be prepared for, and capitalise on, opportunities presented by the growing market for sustainable products and services.

Kingfisher has the challenge of coordinating its sustainability activities and maintaining leadership across a diverse group, with operating companies around the world including B&Q in the UK andChina,andCastoramainFrance,PolandandRussia.Its‘StepstoResponsibleGrowth’management system helps its subsidiaries at different stages clearly understand the way forward and what is expected of them. Kingfisher is now working on embedding the detailed actions that will deliver its vision.

Source: Retail Leadership, Forum for the Future (2008)

CaseStudy3-Marks&Spencer

Exampleofsuccessfuluseofsustainabledevelopmentasaframeworkforbusiness:

‘Webelievethatforourbusinesstodeliverlong-term value for its shareholders, it must be environmentally and socailly sustainable. Over the past two years, we’ve found out that leading on sustainability issues not only differentiates our business and drives sales, but also makes us more efficient. In January 2007 we were prepared to invest£200moverfiveyearsinPlanA-twoyearson it has already become cost positive. Not only is this the right thing to do, it also makes complete business sense.”

SirStuartRose,Chairman,M&S

M&SlaunchedPlanAinJanuary2007,settingout to achieve 100 commitments in 5 years. It’s now extended this to 180 commitments by2015, with the ultimate goal of becoming the world’s most sustainable major retailer. Through PlanAM&Sisworkingwithitscustomersandsuppliers to combat climate change, reduce waste, use sustainable raw materials, trade ethically and help its customers lead sustainable lifestyles.

FormoreonPlanAandtoviewthe‘storysofar’video go to:

http://plana.marksandspencer.com/about

http://plana.marksandspencer.com/about


CaseStudies

CaseStudy4-Cadbury

Exampleofpubliccommitmentonenvironmentalperformance:

‘PurpleGoesGreen’isCadbury’senvironmentinitiative. The confectionary company made a public commitment in 2007 to significantly reduce the environmental impact of its operations and transform its manufacturing processes as well as its assets.

The first brand in the food-manufacturing sector to declare absolute targets for carbon emissions reduction,CadburywillhalveitsnetCO2emissions by 2020. It aims to improve the energy efficiency of its manufacturing processes and to buy an increasing proportion of its energy from renewable sources. On the same timescale it will ensure that all of its facilities implement stringent water-use reduction programmes. In some cases it will use water catchment to transform thirsty manufacturing plants into net water generators.

The company has also put in place short-term goals for reducing the volume and impact of its packaging and outlined a ceiling for product-packaging ratio. The company will aim for a 10% reduction in standard packaging and a 25% reduction in seasonal packaging by 2010. It has also committed to making 60% of packaging biodegradable, 100% of secondary packaging recyclable, and to source all paperboard packaging from sustainable forests by 2010.

In addition to making its own commitments, the company is looking to forge alliances, positively influence others within its value chain to tackle climate change, and unite the food manufacturing sector under a common sustainability agenda.


CaseStudy5-GeneralElectric

Exampleofproduct/servicedevelopmenttomeetunmetsocialneeds:

General Electric launched their Ecomagination initiativein2005,aimingto‘meetcustomers’demand for cleaner and more energy-efficient products and to drive reliable growth for GE.’ GE set an ambitious target to increase annual revenuefromproductsthat‘providesignificantand measurable environmental performance advantages’ to £20 billion a year. Supported by large-scale research and development, the Ecomagination portfolio included more than 80 products by 2009, ranging from engines to healthcare products.

Attheendof2009,GEreportedthattheyhadmade $59 billion from Ecomagination since its launch - $17 billion in revenues in 2008 alone.

Vice President Lorraine Bolsinger told shareholdersthatGEhas‘neverhadan initiative that has generated better financial returns so quickly.’

http://ge.ecomagination.com/

Source: Forum for the Future (2010)

http://ge.ecomagination.com/


CaseStudies

CaseStudy6-IDG

Exampleofcollaborativeengagementwiththesupplychain:

The relentless pursuit of efficiencies in the retail supply chain and increasing centralisation of warehousing has resulted in a complex structure of national and regional production and distributioncentresacrosstheUK.Againstthisbackdrop, it is not uncommon for trucks to make empty journeys back to the warehouse following a series of deliveries.

IGD, a cross-industry forum, has been working toreducethese‘empty’milesthroughitsEfficientConsumerResponseinitiativedesignedto drive collaborative distribution practices, resulting in its members setting a voluntary target of removing 50m miles across 2007/8. This initiative brought together suppliers and retailers that had a good geographical fit in terms of distribution, despite often having no previous commercial relationship. Initial meetings, based ona‘speeddating’model,allowedparticipantsto identify those organisations with synergies in transport networks with which to explore future partnership opportunities.

Aligningdistributionnetworksrequireshighlevelsof trust between partnering organisations, which must overcome procedural, physical, health and safety obstacles. In spite of the difficulties, this approach has managed to identify opportunities resulting in a potential reduction of two million miles a year through maximising efficiencies.

Through just one identified collaboration between Tesco and Unilever, over half a million ‘empty’mileshavebeenavoided.Health&Beauty brands such as Dove, Lynx and Sure were previously delivered directly by Unilever to Tesco. Now, returning Tesco vehicles pass through Doncaster and pick up the products. Both organisations needed to overcome procedural barriers, but have ultimately realised both environmental and financial benefits.

Source: Retail Leadership, Forum for the Future(2008)

CaseStudy7-InterfaceFLOR

Exampleofanapplied,workforcedevelopmentprogramme:

Asapioneeringflooringbusiness,InterfaceFLORhave been engaging employees on sustainability since1994.AccordingtoRamonArratia-Sustainability Director - building sustainability awarenesscangive‘freshinsightsintostreamlining processes for greater efficiency and re-tooling products so they are most cost effective… in short sustainability makes great organisations even greater.’

It has created a multi-level training programme to ensure that all employees understand the companyvision,MissionZero.Itiscalledthe‘FastForward to 2020 Learning Programme’ with an aim of ensuring that there is sufficient knowledge surrounding the vision in all areas of the business.

Allemployeesgothroughabasictraining,called‘Level1’.Allmanagersofthecompanyandallmarketing, sales and customer support employees completethenextlevel,‘Level2FunctionalSpecialisation’, focusing on the relationship betweenMissionZeroandtheir13specificjobroles. The senior management levels within the organisation complete the highest level of training,‘Level3CriticalAnalysis’,wheretheylearn more about the context of sustainability issues in relation to InterfaceFLOR’s vision and implications of it for the internal organisation.

AllSustainabilityAmbassadorsareeligiblefor the three levels of training. Sustainability Ambassadorsarethoseemployeeswhofroma personal development point of view have an interest in the topic of sustainability, which is key tothemission.IntheirroleasAmbassadorstheywill be inspired to become and stay a driver of the vision within their own circle of influence, either by learning more about the topic or actively applying their knowledge in the organisation by engaging or initiating sustainability-related projects on a voluntarily basis.



CaseStudies

CaseStudy8-Sainsbury

Exampleofengagingwithstakeholderstogenuinelyshapedecisions:

Sainsbury’s Supermarkets is able to demonstrate how it engages with external and internal stakeholders in the UK in a systematic way across a variety of issues. Non-government organisations and campaign groups are asked to contribute to policy and strategy development in relation to key issues such as the sourcing of fish or timber. The retailer also engages external groups to generate future ideas and to better understand expectations of its own responsibilities. Focusing on core business, discussions with the FoodStandardsAgency,theBritishNutritionFoundationandtheNationalConsumerCouncilhaveinformedSainsbury’sApproachtofoodandhealth issues.

Pressure groups and special-interest groups are invited to regular high-level dinners linked to the five pillars of the company’s corporate responsibility(CR)strategy,todiscusscontent,approach and emerging issues. Recent attendees haveincludedadiverseaudiencefromWRAP,theBritishMedicalAssociation,toFriendsoftheEarthandtheMetropolitanPolice.

The customer is a key stakeholder for the retailer, recognisedbythemonthly‘MakeaDifference’days held in-store. Staff engage shoppers in a dialogue on important and emerging sustainability issues: topics have included fair trade,FSC-certifiedpaper,andenergysaving.

Internally, Sainsbury’s engages its full workforce inworkingtowardsitsCRgoals,especiallyinrelation to its community work. Employees are encouraged to be active in their local communities, and to nominate and work with charities to raise funds. The company organises an annual Local Heroes award ceremony to celebrate the employees who have made the most difference.


Unilever

Insightintoexemplarysustainabilityreporting:

Unilever has been recognised as a leader in the field of sustainability reporting, receiving anawardfromtheAssociationofCharteredCertifiedAccountantsin2007.

The focus of reporting is on the impact of core business activities: how its business affects the environment, society and consumers; how Unilever is addressing global sustainability challenges such as climate change and examining howitsoperationsbenefitstakeholders.Casestudies, employee profiles and speeches are presented separately to bring to life elements ofits strategic approach rather than forming the reporting content in isolation.

Aclearpictureofcurrentsustainabilityperformance is contrasted against past behaviours and future goals through a comprehensive array of KPI data. This spans a number of years with some data sets starting in 1995 and continuing, through targets,until2011.Againstitseco-performanceKPIs, headline information is presented in an absolute and normalised format (i.e. per tonne of manufactured product) allowing the audience insight into the speed at which efficiency is improving and the extent to which this is commensurate with the scale of Unilever’s growth.

Acknowledgingthedifficultyinaddressingitsimpact on economic development, Unilever has conducted studies to consider how its presence in emerging markets creates and distributes wealth, formally measuring economic impact on jobs, incomes and social benefit to employees.



Resources

Corporatebenchmarking

Fig1:Thespectrumofpublicsectorleadershiponsustainabledevelopment

Organisations at this level don’t ‘get’sustainabledevelopment. Leaders don’t see it as a priority; it rarely features in policies, plans, resourcing discussions, training or development activities or evaluation, and where it does it is undermined by other activities or priorities. Such organisations are now rare. But they are increasingly likely to be in breach of regulation and other legislative requirements, and badly prepared for potentially financially punitive regimes such as the CarbonReductionCommitment.Theresulting reputational risk will impair their ability to work effectively with partners and the communities they serve.

Organisations at the compliance level understand the legal requirements, and fulfil them as faraspossible.Acorporate strategy on sustainable development may exist, but it is poorly integrated with other strategies, and environmental, social and economic objectives are developed separately from each other. Where these objectives clash, trade-offs are made arbitrarily, often at the expense of the environment. Consultationwith stakeholders tends to be on the ‘decide,announce,defend’ model and is done to fulfil legal requirement rather than to shape activity.

Organisations at the incremental level are taking sustainable development more seriously, but still tend to see it as one of a number of competing priorities. Sustainability principles are being brought to bear retrospectively on existing policy and strategy, and fed into leadership development work in a similar way.

Sustainable development is at the heart of strategy in many public secto bodies - which we identify as being at the strategiclevel.Mostpolicies articulate their contribution to sustainability outcomes, most senior staff and politicians understand this priority, and serious attempts are made to reflect this approach in the allocation of resources. Leadership development, performance management, and internal and external communications all reflect this approach. But the organisation is still in cultural transition - and political change or turnover of key staff would still leave sustainability commitments vulnerable to revision.

Sustainability thinking is hardwired into the culture of the organisation, and the values implicit in sustainable development are reflected in everything from staff mindsets to resource planning. Sustainabwility principles are at the heart of the business model for delivering public services. Tensions still exist - between short and long-term priorities, and between the scale of the challenge and the resources to tackle it. But systems thinking ensures the organisation avoids perverse or contradictory action in different service areas, and looks upstream to tackle problems more efficiently at source.

MostNHSTrustsaresomewhereonthespectrumofleadershipforsustainability,above.FurtherdetailonthisandhowTrustscanmakeprogressisavailableinForumfortheFuture’spublication‘steppingup-aframework for public sector leadership for sustainability’ (www.forumforthefuture.org) This Pack is aimed atboardswhoareinthe‘atrisk’,‘compliance-led’and‘incremental’levels:seekingtoshiftboards’perspective to the strategic level.

ATRISK COMPLIANCE-LED INCREMENTAL STRATEGIC SYSTEMIC

http://www.forumforthefuture.org


Resources

RolePlayScenario1-Leadingthefieldin2015

This is a fantasy exercise that allows boards to suspend their scepticism and meaningfully explore the case for sustainability leadership. It’s also an opportunity to practice bringing sustainability into the business case.

[Name of the Trust involved in the board session] will win the first ever award for ‘LeadingNHSTrustforSustainability’in2015.Competitionforthisbrandnewaccoladewillbe fierce - but you will be well ahead of your peers.

In your press release, you will trace your achievements back to a landmark board session that took place in 2010. The discussions at this meeting cemented your ambition to become a leader on this agenda. Andcrucially,youcommittedtalktoaction.

WhenaskedforcommentyourChairwillsay,‘WecameupwithourowntakeontheM&S‘PlanA’.Werealisedthebestwayofmeetingour obligations was to be comprehensive about it. The net result is good for patients, communities and our cost base. In this exercise we’ll:

1. Enact the board session by re-pitching several of the ideas.

2. Reflect on how convincing the arguments for leadership are.

3. Step out of the scenario to consider the real implications.


Resources

RolePlay1a

‘Sustainability360takesinourentirebusiness - our customer base,

our associates, the products on our shelves,the commodities we serve.’

Task

You are a small, executive team that has been asked to research and write a ‘leadershipstatementofintent’ for sustainability for the Trust. Your task is to pitch and achieve the board’s sign-up to this statement.

If you are successful, it will appear on your website and steer all of the Trust’s future policy and action on sustainable development. 1.Comeupwithastatement

that sets out a practical interpretation of sustainable development that makes sense for the Trust, with reference to your core purpose.

To get you started, here are two examples from the retail sector:

Context

In your landmark meeting, [insert name of participating Trust] agrees a clear statement about what sustainability means for the Trust. This allows you to integrate sustainability into strategy, plans and the business case - and use it to shape operations and services as well as partnership work on public health.

2. Nominate two people to justify your choice of statement to the board in terms of what it will enable you to do differently or better. You will have three-minutes to make your pitch.

3.Asagroup,preparefortheinterview by discussing and developing arguments

Toprepareforyourinterview,youmightwanttothinkaboutthefollowing:

• Whatarethepositiveimpacts of this action for population health?

• Howcouldthisactionsave resources that can be redirected back into patient care?

• Howcouldthisactionpromote immediate health - for example, obesity, physical activity, road trauma, mental health, air pollution?

• Howcouldthisactionofferreturns on investment in the future, for example, through resilience, and business continuity?

‘Toensureourcontinuedsuccessto2030we will recognise - now - the possible

outcomes of the global crisis we face and embed this recognition into our strategy

and business processes.’


Resources

RolePlay1b

Task

You are a small, executive team that has been asked to investigate this opportunity and recommend a course of action. You have concluded that there’s a good business case and will recommend the board agrees to a pilot initiative, to test proof of concept.

Your task is to pitch why it makes sense for [insert name of Trust] to comprehensively adapt its [insert Productive Careinitiative] to include environmental wastes like energy and water. Your objective is to secure sign-up to the pilot exercise.

1. Prepare a compelling, three-minute presentation that pushes the board’s buttons.

2. Nominate up to two people to make your case in a pitch to the board.

3. Asagroup,preparefortheinterview by discussing and developing arguments.

Context

Asnewperformancedrivers-liketheCarbonReductionCommitment-make energy and carbon reduction important business issues, health services are looking for ways to drive down environmental inefficiencies as part of service improvement initiatives.

In your landmark meeting, [insert name of participating Trust] agrees to incorporate energy and water reduction as part of ‘ReleasingTimetoCare:The Productive Series’. The methods used in this service improvement programme are well suited for this because they already look at service systems to remove waste.


• Whatarethepositiveimpacts of this investment for population health?

• Howcouldthissaveresources that can be redirected back into patient care?




Resources

Roleplayscenario2-[NameofBoard]meetsDragons’Den

This is a fantasy exercise that allows boards to suspend their scepticism and meaningfully explore the case for sustainability leadership. It’s also an opportunity to practice bringing sustainability into the business case. Boards often have fun with this exercise. It’s important to close it by explicitly stepping out of the scenario - to distil the serious implications. To add an extra incentive you could come up with a credible-sounding prize fund or source of match-funding that’s up for grabs for the project or action that gains the most votes. Tallying the votes - while allowing the board to have a bit of fun with the exercise - is a useful reference point to come back in the reflection.

[Name of Trust involved in the board session] is going to explore the case for action for a series of sustainability initiatives. You’re going to split into groups of 3-5 to examine a series of potential projects and actions, then pitch them back to the board. In this exercise we’ll:

1. Pitch and probe the sustainability initiatives as a board.

2. Take a vote on the most convincing arguments for leadership and action: which project or initiative would win our investment?



Resources

RolePlay2a

Task

Youwanttoinstalla3MWwind turbine on your estate. Your options analysis points out higher returns if the Trust takes on the development itself - rather than leasing the land. It recommends you self-finance the project because lender interest is more limited for single turbines. To open-up these higher returns, the Trust is prepared to take on the sensitivities in the project: like variability in wind speed. The Trust has ring-fenced a £3.3 million capital investment and wants to proceed to a planning application. The report estimates an output valueofabout£100/MWhfrom the turbine and a post tax payback period of 5.1 years. It predicts a net free cash flow of £640K in year 1, based on avoided costs of importing power to the site.

1. Prepare a compelling, three-minute presentation that will persuade the board it should invest in a wind turbine.



Context

While some micro-renewable energy installations can be dismissedas‘greenwash’,there is an increasing range of business models that successfully generate revenue from renewable energy. Beneficiaries in these models may or may not be the same organisation: the consumers of energy who get a competitive price, the energy seller who makes a profit and landowner who receives leasing or royalty-based contracts. Forexample,LowCarbonWest Noble, leases land or roof space for solar panels, then sells the energy back to the grid. This model creates a revenue stream to fund energy efficiency projects in the community. The investment portfolio is part owned by community shareholders who share all the associated risk.



• Howcouldthisactionsave resources that can be redirected back into patient care?




Task

You are a small executive team at [insert name of Trust] that has been asked to investigate the case for establishing a reinvestment fund to promote energy and carbon cutting investments. You will recommend that the board sets up a fund.

1. Prepare a compelling, three-minute presentation that will persuade the board

2. Nominate up to two people to make your case in a pitch to the board

3. Asagroup,preparefor the interview by discussing and developing arguments.

Context

Asmanyopportunitiestosavecarbon are cost-effective, public sector organisations are starting to look for finance models that can save them both money and carbon. Smart finance models can open-up new sources of capital and make existing capital work harder by creating financial returns that can be reinvested. Salix reinvestment funds are one example of this. Salix Finance is now inviting applicationsfromNHSTrusts.ASalixscheme sets up a self-regenerating, ring-fenced fund for energy saving projects that boosts the resources available for a Trust. The fund issues interestfreeloansfor‘highcarbonsaving projects’ that are repaid from utility bill savings over five years. The first pilot at Frimley Park NHS FT has focused on technological investments like boiler replacements, installing reflective panels on external walls behind radiators and installing lightingcontrols.Aswellasunlockingcost savings, the scheme has improved energy-monitoring systems and highlighted energy expenditure as a business issue. With Salix funding of £50K, Frimley Park has a total fund value of £100K and estimates this will realise £25K of annual energy savings, which is an annualC02savingof251t.

Resources

RolePlay2b


• Whatarethepositive impacts of this investment for population health?



• Howcouldthisaction offer returns on investment in the future, for example, through resilience, and business continuity?


Resources

RolePlay2c

Task

You are a small executive team at [insert name of Trust] that has been asked to research and recommend an innovative, community-based idea for delivering [insert service e.g. mental health care or diabetes care) that is fit for the future.

You’ve thought hard about creating dispersed, responsive service options that reduce travel and put people in control of their health. You have come up with an investible proposition and will recommend it is put forward for commissioning. Your objective is to present this idea totheboardandwina‘yes’vote:

1. Prepare a compelling, three-minute presentation that pushes the board’s buttons.



Context

Successful working across health economies requires fresh thinking, as well as new and stronger partnerships.Andtheshiftto preventative care will involve new relationships with communities and healthcare users.

Looking to 2030, the backdrop for these changing relationships is likely to be a boom in virtual communications and the rise of personal carbon budgets. While low carbon services aren’t a hot topic in the local press today, Trusts will come under increasing pressure to cap their own emissions and help patients’ cut theirs too.

There’s also a risk that health inequalities in some populations will widen. Asthehealthservicegears itself for prevention so it will have increasing difficultly treating people who persist with unhealthy diets and life-styles because theyreject‘healthyliving’.






(RefertooneofthestoryboardsinFitfortheFuturetohelpwiththisexercise)


Resources

Roleplayscenario3-RadioInterviews

This is a fantasy exercise that allows boards to suspend their scepticism and meaningfully explore the case for sustainability leadership. It’s also an opportunity to practice bringing sustainability into the business case. Boards often have fun with this exercise. It’s important to close it by explicitly stepping out of the scenario - to distil the serious implications. To add an extra incentive you could come up with a credible-sounding prize fund or source of match-funding that’s up for grabs for the project or action that gains the most votes. Tallying the votes - while allowing the board to have a bit of fun with the exercise - is a useful reference point to come back in the reflection.

[Name of the Trust involved in the board session] has just put forward a number of proposals for projects that will demonstrate your leadership credentials for sustainability.

Your local radio station has got wind of this and has invited you on air to ask what they mean for patients and communities.

You’re going to split into groups of 3-5 to examine each of the projects, then go live on the show. Your interviewer will represent the concerns of local people so you will need to word your arguments carefully. Lots of rehearsal of possible questions and answers will help.

In this exercise we’ll:

1. Enact a radio interview for each of the proposals

2. Reflect on how convincing the arguments for leadership are for communities, patients, visitors and other stakeholders



Resources

RolePlay3a

Task

You’ve had mixed reactions from the local press: you’ve successfully stimulated debate.

The local radio station has invited you on air to explore your idea, what it means for patients and what it means for quality of care.

Your interviewer will represent the concerns of local people so you will need to word your arguments carefully:

1. review the storyboard that accompanies this role play. It shows one possibility of manyfordelivering‘fitforthe future’ diabetes care in the community.

2. prepare for your radio interview either by choosing to talk about this service proposition, or by developing one of your own. Get to know your service.

3. nominate up to two people to go live on the show and rehearse possible questions and answers.

Context

[Insert relevant Trust] has come up with an innovative new service proposition for diabetes care. Its main purpose is to open positive debate with communities about their shifting experience of healthcare - to help move the health economy towards prevention. By offering communities and patients a compelling, future alternative to what they have now, you hope to re-position the changing healthcare agenda as an opportunity agenda.

The service proposition is designed for a 2030 UK in which personal carbon budgets are the norm. This means the NHS has a leadership role not only in reducing its own emissions, but providing low carbon services for all.


• Whatarethepositivebenefits of this set-up for patients and communities?

• Whatarethepotentialdownsides and how will they be managed?


• Howcoulditpromoteimmediate health - for example, obesity, physical activity, road trauma, mental health, air pollution?


RefertooneofthestoryboardsinFitfortheFuture


Resources

RolePlay3b

Task

The local radio station has got wind of this and has invited you on air to ask what this means for patients. Asagroup,preparefortheinterview by discussing and developing arguments to defend and make the case for your decision. Nominate up to two people to go live on the show. Your interviewer will represent the concerns of local people so you will need to help the interviewee(s) to word their arguments carefully. Lots of rehearsal of possible questions and answers will help. Feel free to go beyond this brief if it will help you justify your decision.

Prompts

• Reducerisksofcolorectalcancer and cardiovascular disease by reducing the consumption of red and processed meats

• Cutobesityandpromotenutrition by encouraging reduced and healthier food intake. Hospitals can redefine their specifications for ingredients to ensure that, where relevant, food is sourced with lower levels of salt, sugar and unsaturated fat, and with higher levels of fibre and wholegrain.

Context

[Insert name of Trust] intends to source locally grown produce and install an onsite kitchen to serve freshly prepared food to hospital patients. In order to build the kitchen, a substantial area of the car park must be lost, which has sparked opposition amongst some staff and communities who say this will make hospital services harder to access.

• Reducetraffic-relatedaccidents, congestion and air pollution by buying locally grown, seasonal produce.

• Cutoutchemicalsthatundermine eco-system services by going organic and preparing food on site .

• Contributetothrivinglocaleconomies and sustainable livelihoods - both in the UK and in producer countries by sourcing local suppliers and fair-trade produce.

Example:NottinghamUniversityHospitalsTrust

• Isencouragingfourlocal farmers to trade as a Federation of small businesses to supply local and organic meat to the hospital, and is supporting Nottingham farmers in creating a cooperative.

• By2010,theTrustwillbe supporting the local economy with an annual spend of £6 million, of which £2 million will be spent on local produce.

28 NHS Sustainable Development Unit - What Future Now? Facilitator’s Guide - Sustainable Health Service Workshop for NHS Trust Boards

Resources

Presentationandslidedeck

There is an accompanying slide deck that supports the workshop agenda that can also be downloaded from the SDU (www.sdu.nhs.uk)

Each slide is annotated with notes to help you use them.

Before you start, get to know your audience and clarify your messages for the particular board you will be talking to. Once you’ve done this, you may find you want to edit or alter the slides to make the presentation your own.

Adviceonusingtheseslides

Asitstands,youcanusethispresentationtoconvey six messages:

1. We’re facing an environmental and social ‘crunch’becauseoureconomy-andweasindividuals within it - are using too much resource, too quickly.

2. Asaconsequence,theUKisrespondingtoaseries of emerging trends that include food and energy insecurity, water shortages, carbon constraint & rising inequality.

3. This is placing multiple pressures on the NHS,

which must deal with an increasingly complex set of issues that influence business continuity and health.

4. Sustainable development is a useful and structured way of navigating risk and seizing opportunities in this changing operating context.

5. The business case is less developed in the NHS

than in business, but this is changing as more Trusts apply sustainable development thinking in practice.

6. Like the private sector, Trusts can unlock business opportunity by using sustainable development as a unifying, corporate agenda.

http://www.sdu.nhs.uk

NHSSustainableDevelopmentUnit

VictoriaHouse,CapitalParkFulbourn,CambridgeCB215XB

Tel: 01223 597 792 Fax: 01223 597 712 Web: www.sdu.nhs.uk

The NHS Sustainable Development Unit develops organisations, people, tools, policy, and research

to help the NHS in England fulfil its potential as a leading sustainable and low carbon organisation.

PublishedMay2010

©NHSSustainableDevelopmentUnit,2010.Allrightsreserved.

The Sustainable Development Unit (SDU) is part of the NHS. It is primarily focused on helping the NHS become a leading sustainable and low-carbon organisation. It achieves this by advising, creating and leading on policy which is designed to steer the NHS along a low-carbon pathway and be an exemplar public sector body. Formed inApril2008itsfirstobjectivewastocreateaCarbonReductionStrategyfortheNHSinEngland.“SavingCarbon,ImprovingHealth”waslaunched in January 2009 and sets out the NHS’s commitment to meet major reductions in carbon emissions in line with UK and international targets. The SDU is helping the NHS reach those goals by shaping policy and raising awareness across every level of the organisation.

FitfortheFuturecomplimentstheCarbonReduction Strategy by highlighting the need for the NHS to be a good corporate citizen by reducing its carbon footprint. The NHS is responsible for over 21 million tonnes of carbon dioxide per annum, one of the largest public sectoremittersofCO2intheworld.Ithaseconomic and ethical obligations to reduce its impact on the environment not only for public health but for its own health and long term survival.

Forum for the Future - the sustainable development organisation - works in partnership with more than 120 leading businesses and public sector bodies, helping them devise more sustainable strategies and deliver these in the form of new products and services.

Our vision is of business and communities thriving in a future that is environmentally sustainable and socially just. We believe that a sustainable future can be achieved, that it is the only way business and communities will prosper, but that we need bold action now to make it happen. We play our part by inspiring and challenging organisations with positive visions of a sustainable future; finding innovative, practical ways to help realise those visions; enabling leaders to bring about change; and sharing success through our communications

Documents

What Future Now?s... · worksheets and slide deck NHS boards are - by their nature - a challenging and intellectually rigorous audience. ... but are only now being picked up in practice