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How to lead a QIP Managing the team and changing the culture
Dr Adham Khalek - RCEM 13th April 2016
Overview• Why is leadership important
• Leadership vs. Management
• Do’s and Don’ts
• Organisational Culture
• Influencing Change
Why is leadership important?
Leadership and
management
Goals & Objectives Vision
PeopleOrganisation & Structure
Autocracy Democracy
EnablingRestraining
ChallengingConforming
Originating
Innovating
Imitating
Procedures Policy
Inspiring Trust
FlexibilityConsistency
Directing & Controlling
Administering
MANAGERFOCUS
LEADERFOCUS
MANAGERFOCUS
LEADERFOCUS
GOOD MANAGERS DO THE THINGS RIGHT
GOOD LEADERS DO THE RIGHT THING
EMERGENCYMEDICINECLINICIAN
What is your Style?
Coaching
Goleman Leadership Styles
Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results
Coercive
Authoritative
Affiliative
Democratic
Pacesetting
Coercive
Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results
The leader’s modus operandi Demands immediate compliance
The style in a phrase “Do what I tell you”
Underlying emotional intelligence competencies
Drive to achieve, initiative, self-control
When the style works best In a crisis, to kick start a turnaround, or with problem employees
Overall impact on climate Negative
Authoritative
Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results
The leader’s modus operandi Mobilises people towards a vision
The style in a phrase “Come with me”
Underlying emotional intelligence competencies
Self confidence, empathy, change catalyst
When the style works best When changes require a new vision, or when a clear direction is needed
Overall impact on climate Most strongly positive
Affiliative
Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results
The leader’s modus operandi
Creates harmony and builds emotional bonds
The style in a phrase “People come first”
Underlying emotional intelligence competencies
Empathy, building relationships, communication
When the style works best To heal rifts in a team or to motivate people during stressful circumstances
Overall impact on climate Positive
Democratic
Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results
The leader’s modus operandi Forges consensus through participation
The style in a phrase “What do you think?”
Underlying emotional intelligence competencies
Collaboration, team leadership, communication
When the style works best To build buy-in or consensus, or to get input from valuable employees
Overall impact on climate Positive
Pacesetting
Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results
The leader’s modus operandi Sets high standards for performance
The style in a phrase “Do as I do, now.”
Underlying emotional intelligence competencies
Conscientiousness, drive to achieve, initiative
When the style works best To get quick results from a highly motivated and competent team
Overall impact on climate Negative
Coaching
Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results
The leader’s modus operandi Develop people for the future
The style in a phrase “Try this”
Underlying emotional intelligence competencies
Developing others, empathy, self-awareness
When the style works best To help an employee improve performance or develop long-term strategic strengths
Overall impact on climate Positive
Do you have just one Style?
Emotional Intelligence
• The ability to manage ourselves and our relationships effectively
• Unlike IQ can be learned
• Increases with age
Goleman D. What Makes a Leader? [Internet]. Harvard Business Review. 2004 [cited 2016 Apr 4]. Available from: https://hbr.org/2004/01/what-makes-a-leader
Emotional Intelligence• Five components
• Self-awareness
• Self-regulation
• Motivation
• Empathy
• Social SkillGoleman D. What Makes a Leader? [Internet]. Harvard Business Review. 2004 [cited 2016 Apr 4].
Available from: https://hbr.org/2004/01/what-makes-a-leader
High-Impact Leadership Behaviours
• Person-centeredness
• Front Line Engagement
• Relentless Focus
• Transparency
• BoundarilessnessSwensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve Health of populations, and reduce Costs. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013.
Leadership DO & DONT’s
DO:
• Define what success & failure will look like
• Have a strategy
• Identify & engage with key stakeholders
• Constantly review progress & feedback
DON’T:
• Expect change overnight
• Avoid dealing with conflict or problems
• Require 100% ‘Buy-in’
• Let failure stop you
Assessing the
culture
Assessing Culture
Staff unempowered and disengaged
All change resisted
Normalisation of deviance
Resting on old laurels
Blame externalised - No insight
Disconnected management
Invisible/Ineffective Clinical leadership
No departmental or Trust identity
Low morale
Assessing Culture
Staff listened to and actively involvedChange embraced
Open approach - Good Clinical Governance
Department / Trust constantly looking to improve
Appropriate analysis of issues - no cognitive dissonance
Engaged management aware of ‘coal face’ issuesClinical leadership fully engaged with the issues Staff proud to work for department / Trust
High morale
Influencing change
Force Field Analysis• Some Types of forces:
• Resources
• Vested interests
• Traditions
• Organisational Structures
• Regulations
• Institutional Policies/norms
NHS Improving Quality. Force Field Analysis [Internet]. 2014. Available from: www.nhsiq.nhs.uk
Sustainability Modelling
• Ten factors over three domains
• Process
• Staff
• Organisation
Doyle C, Howe C, Woodcock T, Myron R, Phekoo K, McNicholas C, et al. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement. Implement Sci. 2013;8:127.
Gregory Shea & Cassie Solomon Change Management Is Bigger Than Leadership. Harvard Business Review. 2013 [cited 2016
Apr 8]. Available from: https://hbr.org/2013/03/change-management-is-bigger-th
“….therein lies the key to successful, embedded and sustained change: alter the
environment, and people will adapt to it…..We behave based on the reality around us”
Summary• Why is leadership important
• Leadership vs. Management
• Do’s and Don’ts
• Organisational Culture
• Influencing Change