Why is leadership important and what are the benefits to ... Wearne presentation 260612.pdfWhy is...
Transcript of Why is leadership important and what are the benefits to ... Wearne presentation 260612.pdfWhy is...
Why is leadership important and what are the benefits to patients?
Mandy Wearne
NHS North Western Deanery
Kings House Conference Centre
26 July 2012
Overview
1.‘Watching from the side lines’ – what are the lessons?
• National and international drivers in healthcare
• What drives you and me to lead?
2. What does good leadership look like for patients?
• What are the benefits for patients?
3. Leadership lessons from research
• How do I develop my leadership style?
Watching from the side lines…
Consensus management, supply driven, clinical autonomy
1980’s Thatcherism Raising demand, low investment
Tight expenditure controls, market testing
– First cost improvement programme 1983
– Griffiths report introduced general management (Sainsbury’s)
‘Working for Patients’(1989)
Introduced the internal market
Separation of purchasing and providing,
GP fund holding created
Self governing NHS trust (from 1991)
‘The new NHS: Modern and Dependable’ Blair (1997)
Abolished internal market and GP Fund Holding
Advocated a third way – ‘free from centralised control’
Introduced national standards and developed governance
481 PCGs to commission services and embedded budgetary influence
Commissioned Wanless review – NHS principles reasserted – commitment to increase in investment
NHS Plan 2000
Increase health spending In line with EU average Specific commitments Hospitals, beds, clinicians, pay & conditions Promises Cleanliness, hospital food, matrons! Greater choice for patients, advocacy services Reduced waiting times, improve PC access
A new internal market 2003/4
Payment by results
Patient choice
Plurality of provision – Independent Sector Treatment Centres (ISTCs)
Established self governing- ‘Foundation Trusts’
2006-2008
Introduced World Class Commissioning
Cancelled third wave ISTC’s
100 Foundation Hospitals approved
NHS constitution revisited
‘High Quality Care for All’ 2008 Lord Darzi: Quality Care: ‘clinically effective, personal and safe’
Themes: -
Patient experience core dimension of quality
Clinical engagement
Outcome measures
CQUIN incentives
Standardised pathways
Openness and transparency through publication
Increasing regulation
White paper: July 2010 Equity and Excellence: Liberating the NHS
• Put patients at the heart of everything the NHS does
• Focus on continually improving those things that really
matter to patients – the outcome of their healthcare
• Empower and liberate clinicians to innovate, with the
freedom to focus on improving healthcare services
The Health and Social Care Bill: April 2013
• Improve quality and choice of care for patients, and increase transparency for taxpayers
• Give GPs and other clinicians the primary responsibility for commissioning health care
• Create a coherent system of regulation for providers, to drive quality and efficiency
• Limit Ministers’ ability to micromanage, while ensuring they remain ultimately accountable
Nat
ion
al
Loca
l Ministers and the Department of Health including Public Health England
Patients and the public
NHS Commissioning
Board Monitor
NHS Trust Development
Authority
Local authorities
Health and WellBeing Boards [Part of local authorities]
Local Healthwatch [Formerly LINks]
Public health providers
NHS providers, including: •NHS foundation trusts and NHS trusts •Primary care providers •Independent and third sector providers
Social care providers
Local authorities Clinical
commissioning groups
National Institute for Health and Care Excellence
Health and Social Care Information Centre
Care Quality Commission
including Healthwatch
England
Public Health NHS Adult Social Care
London Anne Rainsberry
(location unknown)
NCB David Nicholson Leeds / London
South Andrea Young
(location unknown)
North Richard Barker
(location unknown)
NCB 27 Local Area Teams (location unknown)
Midlands & East Paul Watson
(location unknown)
3 CSSs 6 CSSs 6 CSSs 8 CSSs
32 CCGs Pop: 8.85M
50 CCGs Pop: 14.1M
62 CCGs Pop: 16.6M
68 CCGs Pop: 15.7M
Health and Wellbeing Boards HealthWatch PPI 3rd Sector Local Authorities
General Public
Citizens Panel
Tim Kelsey Bill McCarthy
Colin Douglas
Paul Streets
Function
Service Reconfiguration and System Oversight Commissioning / Public Health Services Specialist Commissioning / Pharmacy
Primary Care Commissioning Dentist
Veterans / Offenders Optometry
CCG development / assurance Emergency planning / resilience / response
Overall Framework
Policy Strategy
Oversight(?)
Communications
Engagement Patient Experience / Patient Voice
Public Engagement / Involvement / Partnership
Commissioning Support Freedom of Information Continuing Health Care Equality and Diversity Business Intelligence
Etc.
Commissioning Primary Acute
Community Integrated
Continuing Health Care Etc, etc
Health Watch England Public Health England Local Medical Council
Higher Education England National Provider Development Trust
Clinical Senates Clinical Networks Provider Trusts
CQC Monitor
Other Players
National & international drivers
1. Efficiency, productivity, cost control
2. Biotechnology & pharmaceuticals
3. Consumerism and patient choice
4. The chronic diseases of longevity, lifestyle and the environment
Micawber’s Law
“Income £20 expenditure £19.19 shillings = happiness
Income £20 – expenditure £20.1 shilling = misery!”
What drives you and me to lead?....
Impact of culture
Culture forms a complex framework of local, national, organisational and professional attitudes and values within which groups and individuals function.
The reality and strength of culture become salient when we work within a new group and interact with people who have well-established / diverse norms and values.
What is leadership and how does it differ from management?
Overall Definitions
Leadership and Management are two distinctive and complementary systems of action, each having its own function and characteristic activities
Organisations need both to survive and develop in an increasingly complex and volatile environment
Kotter J P, “What Leaders Really Do”
Leadership and Management (or Leading and Managing) Each system of action involves:
1. deciding what needs to be done
2. creating networks of people and relationships to accomplish the agenda
3. trying to ensure that those people actually do the job
but each function accomplishes these 3 tasks in different ways Kotter J P, “What Leaders Really Do”
Leaders
(Leading)
Managers
(Managing) Deciding what needs to be done
Set a direction: develop a vision of the future and strategies for producing the necessary changes
Plan and budget: set targets for the future, detailed steps and allocate resources
Creating networks of people and relationships
Aligning people: communicate the new direction and gain commitment
Organise and staff: create a structure and set of jobs and organise people
Ensuring people do the job
Motivate and inspire: change needs high energy to overcome barriers and leaders need to stir a sense a belonging, idealism and self esteem
Control and problem solve: monitor results v plan and resolve difficulties
BUT…..
Are leaders and managers different people?
Can you be both?
Answer?
Smart organisations understand that the real challenge is to combine strong leadership and strong management
To succeed, they need to develop “leader-managers” i.e. people who can do both functions.
Leadership is about coping with change.
Management is about coping with complexity.
Kotter J P, “What Leaders Really Do”
What does good leadership look like for patients ?....
Starts with understanding there is a deal..
Between patients, taxpayers, citizens and the NHS
• Expectations and service experience
• Would we recommend our own service to family and friends?.....
Context Quality = safety, effectiveness and experience
NHS Outcome Framework – Domain 4 – ‘improving the experience of care’
Mid Staff Inquiry – appalling ‘experience of care’
(CQC – 50% hospitals poor care and 25% possibly criminally negligent care of the elderly)
Raising expectations, demographic changes and technology revolution continues
Challenging economic climate
Two important dimension
• What happens to me
• How I feel about the experience
• Access, waiting times,
availability
• Consultation time
• Out of hours care
• Confidentiality
• Outcome of consultation
• Expertise
• Accessibility
• Interpersonal aspects of
care
• Multi-disciplinary
working
• Patient Involvement in
decision making
• Information provision
treatment medicines
• Understanding of
patient needs
• Use of alternative means
communication
SERVICE DELIVERY STAFF COMMUNICATION
RESPECT UNDERSTANDING EFFECTIVENESS SAFE
COMFORT HONESTY REASSURANCE SELF CONFIDENCE
The evidence suggest patients want to feel better!
• This is as much about HOW they feel about the service they received (the emotional experience) as the clinical outcome they were seeking
Male
Born 1948
White British
Second marriage
Affluent
From a well-known family
Prince of Wales
Prince of Darkness
The approach Based on this information, do you know who this well-known person is?
The average human has one breast and one testicle. ~Des McHale
Leadership challenge -‘the cost to serve’
• We need to gain insight into the true cost of service by asking ‘what matters’ to patients
• Our insight needs to be thorough and detailed
• It starts by developing a new relationship with the people who use the service and those who serve….
• ...and aligning our systems and processes to be held to account for delivering patient centred care
Business case
Lower staff turnover and absenteeism
Enhanced patient recovery
Improved productivity and efficiency
Informing choice and decision making
Leadership lessons from research
How to be an Effective Leader
Leading and Developing Others
Personal Qualities Leading the Organisation
Showing genuine concern Being honest & consistent
Networking & achieving
Enabling Acting with integrity Focusing effort
Being accessible Being decisive Building shared vision
Encouraging questioning Inspiring others Supporting a developmental culture
Shared decision making Resolving complex problems
Facilitating change sensitively
Alimo-Metcalfe B and Alban-Metcalfe: Leadership Research and Development Limited 2005
11 Reasons Why CEOs Fail 1. Arrogance: you’re right and everyone else is wrong 2. Melodrama: always grab the centre of attention 3. Volatility: your mood shifts are sudden and
unpredictable 4. Excessive caution: the next decision you make may
be your first 5. Habitual distrust: you focus on the negatives 6. Aloofness: you disengage and disconnect
7. Mischievousness: rules are only suggestions
8. Eccentricity: it’s fun to be different just for the sake of it
9. Passive resistance: your silence is misinterpreted as agreement
10. Perfectionism: you get the little things right while the big things go wrong
11. Eagerness to please: you want to win any popularity contest
Dotlich DL, Cairo PC. 2003. Why CEOs Fail. San Francisco: Jossey-Bass
Emotional Intelligence
Emotional intelligence is the practice of using thinking about feelings to guide behaviour. The cornerstone of emotional intelligence is self-awareness.
Emotional Intelligence Conceptual Model
Personal Competence Social Competence
Self awareness Social awareness
Self management Relationship management
Each EI domain is composed of specific sets of competencies
EMOTIONAL INTELLIGENCE The competency framework
PERSONAL COMPETENCE
Self awareness
-Emotional self awareness
-Accurate self assessment
-Self confidence
SOCIAL COMPETENCE
Social awareness
-Empathy
-Organisational awareness
-Service
Self management
-Emotional self control
-Transparency
-Adaptability
-Achievement oriented
-Initiative
-Optimism
Relationship Management
-Inspirational Leadership
-Influence
-Developing others
-Communication
-Change catalyst
-Building bonds
-Teamwork and collaboration
How do I develop my leadership style (s)?
Emotional Intelligence and Leadership Style
Which leadership behaviours yield positive results?
Research on a random sample of nearly 4000 executives worldwide found 6 distinct leadership styles.
The research also indicated that leaders with the best results use most of the 6 styles in a given week, depending upon the business situation.
The Six Styles
1. Visionary
2. Coaching
3. Affiliative
4. Democratic
5. Pacesetting
6. Commanding
The Leadership Styles in a Nutshell
VISIONARY COACHING AFFILIATIVE
How it builds resonance
Moves people toward shared dreams
Connects what a person wants with the organization’s goals
Creates harmony by connecting people to each other
Impact on climate Most strongly positive
Highly positive Positive
When appropriate When changes require a new vision, or when a clear direction is needed
To help an employee improve performance by building long-term capabilities
To heal rifts in a team, motivate during stressful times, or strengthen connections
Goleman, D., Boyatzis, R., and McKee, A. (2002), Primal Leadership.
Six Leadership Styles
DEMOCRATIC PACESETTING COMMANDING
How it builds resonance
Values people’s input and gets commitment through participation
Meets challenging and exciting goals
Soothes fears by giving clear direction in an emergency
Impact on climate
Positive Because too frequently poorly executed, often highly negative
Because so often misused, highly negative
When appropriate
To build buy-in or consensus, or to get valuable input from employees
To get high-quality results from a motivated and competent team
In a crisis, to kick-start a turnaround, or with problem employees
Goleman, D., Boyatzis, R., and McKee, A. (2002), Primal Leadership.
The Leader-Manager Needs Many Styles
• Studies show the more styles a leader exhibits, the better!
• The most effective leaders switch flexibly among the leadership styles as needed
• How? – By being very sensitive to the impact they are having on others and seamlessly adjusting their style to get the best results
• Unlike IQ, the skills of emotional intelligence can be learned at any age!
Organisations and emotions
Feelings shape and lubricate social transactions. They contribute to and reflect the culture and structure of organisations. Order and control, the very essence of the ‘organisation’ of work, concerns what people ‘do’ with their feelings.
‘Emotion in organisations’
Edited by Stephen Fineman, 1993
Summary 1. NHS constantly changing and complex • Drivers the same throughout the world
• Needs leadership and management
• Our own drivers come from the culture and values embedded in our organisations, professional groups and who we are
2. For patients, good leadership delivers what matters to them • What happens to them and how they feel about their care
• Experience is an important outcome of their care
3. Research says the best leaders adapt their styles readily • Self awareness builds Emotional Intelligence
• Emotional Intelligence is the practice of using thinking about feelings to guide behaviour