01

Values in Health Organizations Today

Òscar Dalmau i Valentí Martínez,
Member of the Steering Committee and
Academic Director of the Chair of Values-Based Leadership at UVic-UCC, respectively

A Joint Perspective between the Chair of Leadership in Values and Unió Consorci Formació on the Values of Health Organizations

In a time of significant transformation and change in the health sector, both in Catalonia and globally, the Chair of Leadership in Values at UManresa and Unió Consorci Formació (Catalan Union of Hospitals and Health and Social Consortium of Catalonia) have sought to take a joint perspective to identify the values that health organizations are incorporating as key elements in their leadership and strategic plans.

In fact, with the periodic updates of the organizations’ strategic lines and plans, including the revision of their vision and mission, it is also natural to review the values that should guide them in facing and overcoming the challenges ahead. These redefinition processes are generally collaborative and participatory with the entire organization and serve to jointly chart the course, as well as the whys and hows to get there.

When, for example, in the late ’90s an organization said, “we are a friendly and professional hospital organization,” and today says, “we are an organization committed to improving the health and well-being of individuals and the community,” it is not simply an aesthetic change or the incorporation of words that might sound better, but the expression of the will and direction in which it is currently working. Therefore, values do not have a static meaning. They depend on personal and collective experiences, and like these experiences, their meanings also evolve (the previous example reflects the evolution from talking about ourselves to focusing on others, the true reason for being).

Values in Health Organizations of Catalonia

Having analyzed the values currently published by more than 100 hospitals and health organizations in Catalonia, following the 4 levels of the conceptual framework of the Chair of Leadership in Values, we identify:

At the personal level: references to ethics, integrity, honesty, adaptability, responsibility, etc. This dimension is directly linked to the personal, ethical, and moral values of each individual, understanding them as a personal foundation connected to professionalism and commitment to vocation, profession, and the code of ethics, which inspires and guides conduct and practice.

At the team and people level: respect, dignity, empathy, assertiveness, humanity, recognition, teamwork, trust, human treatment, proximity, multidisciplinary work, etc. This is a set of ethical, social, relational values that start from oneself (initiative, flexibility, perseverance…) and connect, integrate, and make us part of a shared team project.

At the organizational level: the focus is on values of competence, corporate culture, collective intelligence. Thus, innovation, agility, adaptability, efficiency and sustainability, service and people orientation, efficiency, vocation towards excellence, quality and continuous improvement, collaboration and cooperation, person-centered care, etc. Therefore, a focus that connects collective wills and capacities towards new ways of doing things.

At the environment level, linked to purpose: promoting new ways of doing things (more creative, leveraging all digital and innovation potential but also alliances and cooperation with others), to enhance person-centered care, personalized support, empowerment of patients and families,… in an inclusive, respectful, generous, humble manner, with equality, transparency, and equity. Values that connect organizational competence with its sense of positive contribution to society. They have a more ethical nature linked to the community and social responsibility.

Quadruple Aim of the Institute for Healthcare Improvement

The values in health system organizations are therefore aligned with the conceptual framework of the Chair of Leadership in Values at UManresa. At the same time, they also correspond with the Quadruple Aim of the Institute for Healthcare Improvement, which establishes a global framework to achieve quality care and value-based health through four interrelated objectives and strategies: (1) improving population health with equity; efficiency, sustainability, and cost reduction of organizations and the system; enhancing patient experience and empowering them in their active role; increasing professional satisfaction and caring for their well-being.

Values are, therefore, the guide that should accompany the behaviors and actions of all health professionals to make this possible. That is why it is necessary to highlight them and give them a voice. To make us more aware of them, to connect them more with our daily practice, and to naturally guide new ways of doing things that are safer, more efficient, and of greater value to society.

And in this, we are all involved. Because our work is a model and a reflection of our way of doing things towards others. Therefore, do not stay on the sidelines. It depends on you.

(1). https://www.ihi.org/communities/blogs/the-triple-aim-or-the-quadruple-aim-four-points-to-help-set-your-strategy

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02

Schools of values and leadership

Jordi Lorente Servitja
Primary School Teacher and Pedagogue
President of CAE, Formació i Serveis Socioculturals
Professor of the Higher Vocational Training Cycle in “Sociocultural and Tourist Animation”

“Hace falta valor, ven a la escuela de calor” Radio Futura (1984)

We will not dwell much on opening debates about whether leaders are born or made. So far, the decoding of the human genome has not identified the “leadership chromosome,” and therefore, it must be the environment, it must be the surroundings, that foster these effects. Or… can anyone who thinks of a certain Royal House conclude otherwise? Either way, it is certain that lived experiences and frequented environments play an important role in this role we call “leader.”

To further emphasize this point, we refer to the authors of the study on “The Sources of Social Leadership” (CANTÓ, N; CASTIÑEIRA, A; FONT, A) published in 2009 under the auspices of the Bofill Foundation. In this study, based on 25 interviews with people perceived as social leaders within the Catalan sphere, it is concluded that the most relevant aspect to begin assuming social consciousness is “lived values, that is, the immersion of people in actions or vital examples that will shape their way of positioning themselves in the world.” (“The Sources of Social Leadership,” p. 121)

Before continuing to discuss where and how leadership can be fostered, let us comment that from our perspective, we cannot mention the “Leadership-values” binomial without first specifying the types of values we define. It is evident that all leadership has associated values. Consequently, we need to define a framework that allows us to see our position regarding what we value. It is a good exercise to point out that the consideration of “ethical” leadership has been promoted by documents such as the “Universal Declaration of Human Rights” or, to cite a more recent one, the so-called “SDGs,” the Sustainable Development Goals, within the so-called “2030 Agenda” of the UN itself. With this basis, we can begin to talk about where leadership with these values, values associated with something “social and community,” can emerge.

Well, once these two premises are established, let’s delve into the question and main objective of this article: are there schools of “ethical” leadership and values?

Are there schools of ethical leadership and values?

Forgive us for the “hype” touch we will add, but the answer can only be affirmative, having already pointed out the importance of lived values and experiences. Our immediate environment is full of organizations that facilitate “ethical leadership in and with social values.” Both formal and non-formal institutions can facilitate this background. For example, consider something basic within “Leadership” such as “learning to participate.” Can one learn to participate? As stated by the Working Group of CASC_CAT (Coordinator for Sociocultural Animation of Catalonia), “knowing how to participate can only be learned by participating: from the first educational institutions and childhood to other social circles. The experiential learning of participation is carried out more significantly in high participation models, such as associations.” (“Socioeducational Intervention in Youth,” 2017). And here we fully enter the specificity of a framework like Leisure Education institutions to identify them as schools of participation and ethical leadership in and with social values.

Moreover, thanks to the enormous effort of social researchers like Txus Morata, who with reliable data allow us to affirm that Leisure Education institutions transform communities and individuals by increasing levels of citizen participation, promoting horizontal leadership, and building social support networks. All this results in a higher degree of cohesion and social commitment in the territories where these institutions are present (“Educational Leisure, and Sociocultural Action, Promoters of Participation and Social Cohesion,” Morata, T.; ALONSO, I; PALASÍ, E; BERASATEGUI, N_2023).

Social Cohesion, the Great Forgotten

So, if we have educational leisure institutions that delve into and serve such an important value as “Social Cohesion,” why is it one of the great forgotten when making political decisions? As Dr. Anna Jolonch, PhD in Educational Sciences, points out in an interview (Diari de l’Educació, 26/05/2023), extracurricular activities are one of the main factors of inequality: “Not everyone can do music, dance, cultural or leisure activities… Many people do not have access to this education, and yet we know it is a huge success factor and an educational factor. There is a lack of more equal access because we have greatly improved equal access to compulsory schooling, but not leisure. And leisure, moreover, is a key factor in educating with values, with citizenship. Education should not only be about finding a job, it should be about educating people with certain values so they can work for the common good.”

Education 360

We have tried to start from an obvious question, such as whether we can learn to be leaders, to end up noting the lack of support that institutions with this function have: proposing platforms for learning social values.

Educational leisure institutions must be and feel supported within the broader framework of educational policies with a social background. And that is why we want to end the article by highlighting the importance of programs like “Educació 360,” which focuses on promoting policies and actions that facilitate access to activities outside compulsory educational institutions. A more global sense of education and a special focus on educational leisure institutions will allow us to have leaderships much more aligned with Sustainable Development Goals, ethical leaderships.

In all circles of human activity (politics, sports, religion, family, education,…) conditions for “ethical” leadership can arise, but we have sufficient evidence to think that Educational Leisure, due to its proximity to certain ethical values, provides an “extra” when it comes to ensuring commitment and social cohesion.

And now, to conclude, if you allow me the license to exchange some words from the wonderful song by “Radio Futura,” we might be closer to what we wanted to argue: it takes warmth, come to the school of values. (Although it is better not to misinterpret it and for climate change deniers to take it as a banner).

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03

Talk between Pep Guardiola, Manel Estiarte, Albert Estiarte and Valentí Martínez

Discussion on leadership and values that address various topics which are subjects of reflection by the Chair.

At the end of 2021, UManresa began discussions with Pep Guardiola and Manel Estiarte to create a Chair of Leadership in Values, an initiative that finally came to fruition during the first half of 2023. This path was undertaken with the awareness of facing a significant challenge, as leadership and values are very complex subjects to define and set boundaries for.

The inspiring capacity of Guardiola and Estiarte’s professional and sporting careers, both in terms of leadership and values, and especially the combination of both elements, was key in asking them to lead the Chair, an offer they gladly accepted. Albert Estiarte, the project’s promoter, has also closely linked himself to it by assuming the role of deputy director.

For its part, UManresa contributes to the Chair its experience in leadership training, especially in the business field, as well as the work it has done in recent years in identifying values, both in its pedagogical model and its corporate culture. This knowledge is concentrated in the two academic directors of the Chair, Valentí Martínez and Carlota Riera.

Beyond outward-facing work, such as training, research, or dissemination, chairs are also spaces for debate. We share fragments of a conversation between Pep Guardiola, Manel Estiarte, Albert Estiarte, and Valentí Martínez that, reflecting on leadership and values, point to different topics that should become subjects of reflection within the Chair.

About leadership and success

Albert Estiarte: Everyone says he is a leader, but there aren’t many leaders with values. Pep and Manel are among the few I know. Their leadership of the Chair of Leadership in Values should allow us to show examples of how to lead in a clean and noble way, as we were taught when we were children. There are many values, but for me, the ones that count and the ones I use in my daily life are those that were instilled in me as a child. What I am as an adult is what I was taught in my childhood. The example of Pep and Manel, as the good people they are, is a great asset for the Chair, and the challenge is to know how to transmit it to people who want to lead companies, institutions, schools, or teams.

Manel Estiarte: Talking about leadership makes me a bit uncomfortable. It can become toxic because it dictates how people should be and act. From my experience, from everything I’ve lived, from all the mistakes I’ve made, from everything I’ve learned, I take away one lesson about leadership that Pep shared with me some time ago: make those around you feel comfortable; make those who work with you, who admire you, who follow you, able to do their job well because you help them. A good leader is not the one who speaks the best, who does the best… Better, better, that word makes me tremble a bit.

Pep Guardiola: Leadership is often associated with success, but there are people who lead very well and do not achieve success (at least as it is commonly understood). It is important to understand that sometimes you simply win by chance. It seems that, even if you have done the job well, if you win, you are successful, but if you lose, you are a failure. We should redirect this tendency to go to extremes for the sake of younger generations.

We should not only mirror those who win to copy them. There are so many circumstances tied to winning, many of which do not depend on you! Everyone is as they are, and you cannot copy the winner thinking that you will also win. There are many elements at play behind a victory. No one can say that good leadership is this.

I believe a lot in the day-to-day. I arrive in the morning, open the door, and ask myself: what is there, what problems do we have, how do we approach today’s training session, how do we see ourselves… and from there, move forward.

Make things easy for those around you

Albert Estiarte: Everyone says he is a leader, but there aren’t many leaders with values. Pep and Manel are among the few I know. Their leadership of the Chair of Leadership in Values should allow us to show examples of how to lead in a clean and noble way, as we were taught when we were children. There are many values, but for me, the ones that count and the ones I use in my daily life are those that were instilled in me as a child. What I am as an adult is what I was taught in my childhood. The example of Pep and Manel, as the good people they are, is a great asset for the Chair, and the challenge is to know how to transmit it to people who want to lead companies, institutions, schools, or teams.

Manel Estiarte: Talking about leadership makes me a bit uncomfortable. It can become toxic because it dictates how people should be and act. From my experience, from everything I’ve lived, from all the mistakes I’ve made, from everything I’ve learned, I take away one lesson about leadership that Pep shared with me some time ago: make those around you feel comfortable; make those who work with you, who admire you, who follow you, able to do their job well because you help them. A good leader is not the one who speaks the best, who does the best… Better, better, that word makes me tremble a bit.

Pep Guardiola: Leadership is often associated with success, but there are people who lead very well and do not achieve success (at least as it is commonly understood). It is important to understand that sometimes you simply win by chance. It seems that, even if you have done the job well, if you win, you are successful, but if you lose, you are a failure. We should redirect this tendency to go to extremes for the sake of younger generations.

We should not only mirror those who win to copy them. There are so many circumstances tied to winning, many of which do not depend on you! Everyone is as they are, and you cannot copy the winner thinking that you will also win. There are many elements at play behind a victory. No one can say that good leadership is this.

I believe a lot in the day-to-day. I arrive in the morning, open the door, and ask myself: what is there, what problems do we have, how do we approach today’s training session, how do we see ourselves… and from there, move forward.

The relationship with people is the most important

Pep Guardiola: What I am clear about in this life is that you need to have fun. I seek to surround myself with good people who make me laugh; who, when we are having a hard time, come and tell me, you’ll see, in the end, everything will be fine. It seems that the one in charge has to make others happy, but I also deserve to be happy. And to be happy, I need to surround myself with people who make me have a good time. I need great professionals, obviously, but also those who make me have a good time. In the end, there comes a time when you want to live and work with people you like, basically people you have a good time with, with whom, when we are down, the pain becomes smaller, and with whom we can hug to celebrate the good moments.

Does being a leader with values guarantee that you will win? No. It doesn’t work the other way around either. You can be a bad person, provoke conflicts, and win everything. When you win and win a lot, an Olympics, a title, you realize that it’s okay, yes. In fact, you have worked hard to achieve success, but beyond that moment, if you haven’t had a good time, if it hasn’t been a shared victory, what’s the point?

Manel Estiarte: The relationship with people is the most important thing. Sometimes, I ask myself, if I could go back, speaking sportingly, what would you relive? The answer is never to score the important goal or to get back on the podium but to meet my teammates in the locker room and recover the relationship we had.

At eighteen, I was the top scorer at the Olympic Games, and when I returned home, the newspapers said I was the “leader of the Spanish team.” And I swallowed it. I thought everyone played for me. It’s not that I was unhappy, but I didn’t enjoy a good relationship with my teammates. They didn’t love me. Over time, I grew and learned. I was no longer the top scorer, but my relationship with my teammates improved, and I won much more. I’m not talking from a sporting point of view but emotionally, as an athlete and as a person.

Albert Estiarte: In the end, this learning process that Manel went through helped the Spanish water polo team win many titles, not him, who had already won many before, but the whole team.

A team is very healthy, very good, when it has good substitutes

Valentí Martínez: In our society, in general, we suffer from “result-focused obsession”, an obsession over results. We value people for their results and forget their dedication, commitment, and the responsibility they assume. The Chair should serve to break this pattern.

Pep Guardiola: Those who don’t win shouldn’t feel like failures. How can you tell a child who has tried hard but hasn’t gotten a good grade that they are a failure? I feel that when I was a child, this wasn’t so exaggerated. What is success? Winning? Lifting the trophy? The next day you wake up and realize it’s not. You’re happy because we’ve achieved it, because we’ve had a good time, but they’re already asking you to do it again.

Today, if you’re second, you’re already a failure. This can’t go on. That’s why it’s very important to surround yourself with people you enjoy, who, when things don’t go well, help you turn the page and try again.

Valentí Martínez: How do you manage people who may be very strong from a sporting point of view but are not good people? How do you deal with it?

Pep Guardiola: If the environment is healthy, either they incorporate themselves into the group’s dynamics or they move away on their own. If the environment is toxic, things get complicated. They are usually people with a great lack of empathy, who are not able to put themselves in others’ shoes. I believe a team is very healthy, very good, when it has good substitutes. They may be hurt because they want to play but understand that someone else can do just as well as them, accept that the coach decides that today someone else plays instead of them, recognize when they’ve had a bad performance and when someone else has been better.

The world of football is very exposed to the media. How many leaderships go unnoticed in other fields? How many painters, writers would like to have the attention we have for their works? Does having more attention make us better leaders? Better people? No. There are many circumstances that have brought us to where we are that don’t depend on us and for which we can’t take any credit.

In the end, we all seek kindness: to be loved and to love

Valentí Martínez: Which person influenced you the most in your childhood in shaping your value system?

Pep Guardiola: My first two coaches at Gimnàstic de Manresa. They would pick me up, then take me home, go to Súria to pick up another kid, and then another to Puig-reig…

Manel Estiarte: I had it easier. I slept in the bed next to him. It was my brother Albert. I didn’t like water and didn’t want to be a swimmer or a water polo player, but I did want to be like him.

Albert Estiarte: My mother. Whether I did well or not so well, she was always there to say: “Very good, my son, you did everything you could. You fought hard. You did very well.”

Pep Guardiola: This gives you much more in the long run. In the end, we all seek kindness, to be loved and to love.

Valentí Martínez: In fact, these kinds of messages are not so frequent today. There is a lot of concern in youth football about the unexemplary role of parents at the fields, whether arguing among themselves or disputing the coach’s decisions…

Manel Estiarte: Parents want their children to be like the players who constantly fill the screens…

Pep Guardiola: …instead of letting them be what they want to be.

 

This conversation took place in Manchester on July 18, 2023, with Albert Estiarte present via videoconference from Japan.

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04

Antoni Llobet recommends...

Antoni Llobet Mercadé
General Director
at Fundació Universitària del Bages

Talking with people from different fields, Xavier López builds, in “Lideratges Valents,” a broad reflection on what it means to lead. He shares with the reader this perspective which, although external to the educational world, provides very useful lessons and conclusions for everyone involved in education.

The book is highly engaging and makes it clear, through the example of the interviewed individuals, how personal decisions influence the environment, just as the decisions (and actions and attitudes) of teachers have a great impact on children and young people, an impact that can have significant consequences in their lives.

 

Antoni Llobet Mercadé
General Director of the Fundació Universitària del Bages

 

LÓPEZ, Xavier: Lideratges Valents
(prologue by Jordi Cuixart)

Editorial: COLUMNA EDICIONS, 2023
ISBN: 978-84-664-3085-2

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05

The forbidden island

Recommended by:
CAE, formació i serveis socioculturals

Author(s): Matt Leacock (game creator) C. B. Canga (illustrations) Devir (publisher)

Brief presentation: Cooperative game where a daring group of adventurers has the mission to find and take four treasures from a sinking island. The game is won if the four treasures are recovered and all players can escape from the island before it sinks.

Recommended ages: From 10 years old

Participants: 2-4 players

Game duration: 45 minutes

Components

  • 28 treasure cards (5 cards of each treasure and 8 special cards)
  • 6 adventurer cards and 6 pawns 24 double-sided terrain pieces (each with a unique name and image)
  • 24 flood cards (one for each of the 24 terrain pieces)
  • 4 treasure figures 1 water level indicator

 

Gameplay

Setup

  • The island is created with the 24 terrain pieces, with the colored side up, indicating solid ground. During the game, the terrain pieces will first flood (white and blue side up) and then sink (removed from the game, leaving a hole in their place). The game suggests making an island in the shape of a cross, but there are other variants that add more difficulty to the game. The treasures are placed next to the island.
  • Each player randomly receives an adventurer card that gives them special abilities. They take the pawn of the corresponding color and place it on the corresponding terrain piece.
  • The flood cards are shuffled and 6 are drawn. The 6 corresponding terrain pieces are flooded (the same image appears in white and blue).
  • 2 treasure cards are dealt to each player.
  • The water level is set according to the players’ expertise.

Game sequence

In turns, players perform three actions:

  1. Up to three actions to choose from: move the pawn to an adjacent piece, secure (flip) the terrain piece where the pawn is or an adjacent one if they are flooded, give a treasure card to another player located on the same terrain piece, or recover a treasure.
  2. Draw two cards from the treasure pile. A player can only have 5 cards at most. If they have more, they must discard the ones they want.
  3. Draw flood cards (as many as the water level indicates) and flood (flip) or sink (remove from the island, if already flooded) the corresponding terrain pieces. Holes will appear, making movements more complex. When a terrain piece with a pawn on it sinks, the pawn can be relocated to an adjacent solid or flooded terrain piece.

To obtain a treasure, a player with four treasure cards must be on one of the two specific terrain pieces that allow it to be recovered.

In the treasure pile, there are cards that generate special actions:

  • Waters Rise (3 cards). These raise the water level by one point. The higher the level, the more flood cards must be drawn each turn. When one of these cards appears, all flood cards played up to that point are shuffled and placed on top of the flood card pile. This way, the first flood cards to reappear will be those of the terrain pieces that are already flooded.
  • Sandbags (2 cards). These allow a flooded terrain piece to be flipped without using an action.
  • Helicopter (3 cards). These allow movement to any place on the island. Note: one helicopter card must be saved for the end of the game, allowing all players to escape the island with the 4 recovered treasures in one trip. If this is achieved, the game is won.

Conversely, the game is lost when:

  • The two terrain pieces that allowed the recovery of the same treasure have sunk.
  • The terrain piece corresponding to the landing pad sinks.
  • A player on a sinking terrain piece has no adjacent piece to relocate to.
  • The water level reaches the skull.

 

Beyond the game

Forbidden Island is a commercial game that allows team play and a good time with a high dose of tension derived from achieving the objective. It is a fully cooperative game where players can see each other’s cards and can even agree and plan different moves or sequences of moves together for maximum efficiency. Additionally, the difficulty level can be adjusted to the group’s expertise in the game by increasing the initial water level.

However, being cooperative does not mean everything is smooth sailing, nor that the game situations are free from tensions or contradictions. Here lies an educational opportunity around the game. Therefore, we propose, after a good game, to analyze and reflect on how the game went and what situations were experienced. What group dynamics were there? What leaderships emerged? Were they positive? Were everyone’s contributions listened to, respected, and considered? Was agreement and consensus sought, or did numerical majorities or impositions prevail? Was the victory objective prioritized over the process? In the end, did we thank each other for the game? Or the victory? Did the game allow us to grow as a team?

Some games test us and confront us with ourselves, our ways of doing things, our habits, our character, our values. The existence of a very clear common objective and increasing difficulties make Forbidden Island a fantastic game to bring out all these elements. Let’s take advantage of it.

More information

www.devir.cat / online game stores / physical game stores

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06

Manel Fontdevila's point of view

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