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Annual Medical Leadership & Management Conference‘Values-based Leadership’
Beverly Alimo-Metcalfe CPsychol. FBPsSEmeritus Professor of Leadership Studies, University of LeedsProfessor of Leadership, University of Bradford School of ManagementFounding Director, Real World Group
Manchester, July 7th 2015
© Real World Group 2015www.realworld-group.com
Leadership: it’s time for a new direction
Increaseeffectiveness
Sustainmotivation
Maintainwellbeing
Create a culture of high RfC
Encourage learning & innovation
Key leadership challenges in the NHS
Strengthen collaboration
Staff wellbeing is critically important…
• “..trust performance overall is linked to higher levels of staff health and well-being...
• Staff ill-health is ..a serious barrier to the provision of consistently high quality patient care
• “over 80% of the 11,000 NHS staff who took part in the review’s staff perception survey [said] that their state of health affects the quality of the patient care they deliver”.
Source: Boorman, S. (2009).
Lest we forget…
Francis report 1 year on: Nuffield Trust findings
Source: The Francis Report: One Year On, The Nuffield Trust, Feb. 2014
The role of leadership in embedding a culture of delivering sustained high quality care
VISION
PerformanceOutputs
Resources
+ Our Vision of high
quality care
Board Leadership
People’sKSA
Exp. & Pot.
Organisational Leadership
Leadership
Organisational culture
?
Opening the ‘Black box’:5 Primary drivers of human effort
Meaning
Autonomy
Mastery
Appreciation
Social support
Engagement
Leadership: New vs. ‘traditional’ models
1 From leadership as position, to leadership as practice
2 Leadership as a social process - a dynamic, collective activity
3 Leadership as learning: outcome
From individual to collective
Emerges in and through relationships & networks of influence Interactions are collaborative; influence is 2-way
The kind of social interactions that are called ‘leadership’ result in learning and growth for the individuals involved, and for the organisation
The Model of Engaging Leadership
TLQ™ Dimensions
© Real World Group 2011
ENGAGING INDIVIDUALS
PERSONAL QUALITIES &
VALUES
Being Honest & Consistent
Acting with Integrity
Showing Genuine Concern
Being Accessible
Enabling
Encouraging Questioning
ENGAGING THE ORGANISATION
Supporting a Developmental Culture
Inspiring Others
Focusing Team Effort
Being Decisive
MOVING FORWARD TOGETHER
Building Shared Vision
Networking
Resolving Complex Problems
Facilitating Change Sensitively
‘Engaging’ leadership principles
Leader as servant and partner
Leadership is a social process and is distributed
Leadership is about connecting people and ideas - through a shared vision - co-ownership - co- design, and - empowering partners in implementation
The 2 dimensions of leadership
Degree of Competence
WHAT
Degree to which Engaging
HOW
A
B C
How to achieve challenging goals (and change) through engagement
C.I.A.Accept
Influence & Ideas
Change
Embedding a culture of engagement & wellbeing, high readiness for change, high performance, and high quality care
Leadership & culture
‘2 sides of the same coin’
Creating the appropriate culture is the single most important
responsibility of a leader…
Schein, E.H. (2010). Organisational Culture & Leadership. London, Wiley
Leadership & team working – the new relationship
“..a shared process of enhancing the collective and individual capacity of people to accomplish their work roles effectively... the leadership actions of any individual leader are much less important than the collective leadership provided by members of the organisation”
(Yukl, 1999, p.293).
Does a culture of EL embedded in teams, predict high quality care?
Examined the validity of the model
3-year SDO-funded longitudinal investigation RWG & Kings College 2004 – 2007 (Alimo-Metcalfe et al., 2007, 2008)
Leadership Culture & Change Inventory (LCCi) (80 teams; n = 743)
Outcome measures (external performance measures + engagement & wellbeing)
Controlled for a range of contextual variables
Source: Alimo-Metcalfe, B., Alban-Metcalfe, J., Samele, C. Bradley, M. & Mariathasan, J. (2007) ‘The impact of leadership factors in implementing change in complex health and social care environments: NHS Plan clinical priority for mental health crisis resolution teams (CRTs)` . Department of Health NHS SDO, Project 22/2002
Research findings: Impact of leadership on successful change in the NHS
1. Competencies did not predict performance
2. A culture of engaging leadership significantly predicts:
Team effectiveness/Productivity
Engagement
Reduced stress & emotional exhaustion
Source: Alimo-Metcalfe, B., Alban-Metcalfe, J., Bradley, M., Mariathasan, J. & Samele, C. (2008). ‘The impact of engaging leadership on performance, attitudes to work and well-being at work: a longitudinal study’. The Journal of Health Organization & Management, 22, 6, 586-598.
Clinical leadership: A study of surgical teams
Sample: 669 heart operations in 16 hospitals implementing new micro-surgical technology
Aim: to identify what differentiated the ‘successful’ from the ‘unsuccessful’ implementers
Unexpected findings re what didn’t matter:
- Educational background and experience of the team
- Status of the surgeon
Source: Edmundson, Bohner, & Pisano (2001). ‘Speeding up team learning’, HBR, 125-132
Clinical leadership: A study of surgical teams (2)
Leader created culture of ‘psychological safety’, and engagement
Neutralised fear of embarrassment by encouraging suggestions, pointing out potential problems, admitting mistakes,
Reduced barriers created by a hierarchical culture by emphasising that everyone must feel free to point out suggestions or concerns
“Surgeons gave up their dictatorial authority so that they could function as partners in the operating teams”
Source: Edmundson, Bohner, & Pisano (2001). ‘Speeding up team learning’, HBR, 125-132
2nd 3-year study: The association between leadership and a culture of high quality care, innovation, and improvement – and of staff engagement & wellbeing
Alimo-Metcalfe, B., Bradley, M., Alban-Metcalfe, J. & Locker, A. (2013). Leading to Quality: An investigation of the impact of leadership & team working on staff morale & wellbeing, & team performance, among mental health teams within Yorkshire & the Humber Strategic Health Authority. (Funded by Yorkshire & The Humber SHA. Conducted by University of Bradford School of Management).
Characteristics of high-performing, engaged teams that successfully handle change, & create a culture of quality, innovation, & improvement
Culture of Quality
Innovation & Improvement
Engagement & Wellbeing
Sustained High Quality Services
Encourage Collective
Experience & Learning
Create Culture of Psychological
Safety & Strong Social Support
Engage all in determining how
to achieve the vision
Strengthen a Sense of Team
Potency; Celebrate
Enable a Culture of
Development & Review
Build a Shared Vision
Prioritise regular F2F
communication
Source: Alimo-Metcalfe et al., , 2007, 2008, 2013, 2014
Ensure Clear Goals, Roles, & Responsibilities
Remember the ‘Losada ratio’
3:1Losada, M. (1999). ‘The complex dynamics of high performance teams’. Mathematical and Computer Modelling, 30, (9–10), 179–1
Effect of positive emotions – on team effectiveness Higher Performing teams exhibited a wider range of behaviour, &
their discussions were more fluid & flexible
While having a higher incidence of positive comments, there were also strong challenges. But members “bounced back” quickly after a criticism
Pointing out problems & challenges appeared to ignite performance & inspire the members to think with greater clarity & effectiveness
Where the ratio was lower than 3:1 there was lower resilience & narrower range of behaviours
In particular, after negative comments, people seemed to lose creativity & authenticity
Losada, M. (1999). ‘The complex dynamics of high performance teams’. Mathematical and Computer Modelling, 30, (9–10), 179–192.
Some leadership challenges for you…
How can I strengthen the culture of my team/area to enable colleagues to have a strong sense of meaning in their jobs, and feel excited by, and confident in what they do, and of the future?
What can I do to encourage a healthier ‘positivity ratio’ in my team?
How can I strengthen a culture of engaging leadership in relation to how my colleagues/team relates to patients/other parts of the organisation and with partners & others?
What can I do to encourage a culture of sharing learning , innovation, and of ‘potency’, pride & celebration?
What impact could doing the above have on our patients, colleagues, our partners, our service? How can we measure this?
Who will do this if I don’t? When will I start?
But never forget that…
Culture is me!