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