Leading with values - Southern DHB · Leading with values. 2 What we will learn together today 1. Why values are important 2. Our influence as leaders 3. Managing attitude and behaviour

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Leading with values

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What we will learn together today

1. Why values are important

2. Our influence as leaders

3. Managing attitude and behaviour

4. Cascading values to our teams

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“I’m afraid it’s curiosity”

Curiosity increases intelligence. When the brain experiences novelty,

it releases dopamine – which increases synaptic plasticity.

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Oxytocin. ‘The social hormone’.

If you let someone know you trust them – it will increase their oxytocin

levels, and they will consequently exhibit more trustworthy behaviours.

What comes first. Trusting someone, or trustworthy behaviours?

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Proposed shared values and behavioursMore than 3,500 patients and colleagues helped develop these values and behaviours. They describe how we expect

everyone who works here to behave with others - patients, whānau, colleagues, providers and other organisations.

They apply to all of us, whatever our role or level.

Our draft values What we want to see from each other, at our best… What we never want to see from each other…

Kind Manaakitanga

Our kindness fosters better care and better

teamwork

• Puts people at the centre of their care

• Is attentive, helpful, caring, supportive

• Treats people with respect

• Protects people’s dignity and privacy, and helps to reduce pain

• Is reassuringly professional

• Puts people at ease

• Thinks they know better for others

• Makes people feel like an inconvenience

• Shows no compassion for anxiety, stress or pain

• Is abrupt, rude, bullying or judgmental of others

Open Pono

We listen, hear and communicate openly

and honestly and with consideration for others

• Listens and hears, with understanding and empathy

• Involves people in choices; Communicates clearly and openly

• Keeps people informed, so they know what's happening

• Displays honesty and integrity

• Speaks up if they have a concern; accepts feedback; keeps people safe

• Talks over other people, makes assumptions, fobs people off

• Ignores or excludes other people, whānau or teams

• Leaves people in the dark, or feeling confused

• Walks by poor care or behaviour, rejects feedback

Positive Whaiwhakaaro

We bring a positive attitude and are always

looking to do things better

• Is positive, friendly, approachable,and smiles when appropriate

• Always looks to improve, and has a ‘can do’ attitude• Aims for excellence, high quality, and the best outcomes• Is appreciative and encouraging

• Negativity, blames other people, excessive grumpiness• Has a ‘can’t do’ attitude, and acts as a barrier to change• Is satisfied with under-performance or poor quality• Belittles or criticises others’ efforts

Community Whanaungatanga

Our success comes from nurturing and

building on the strengths in our community

• Is culturally sensitive, respects others• Connects people, teams, providers and communities• Trusts people and is trustworthy • Works in partnership, collaborates well• Values other people’s time, aims to be efficient and productive• Values people, builds relationships

• Shows little consideration of cultural needs

• Works in a silo, is inward-looking

• Dismissive of other people’s skills, experience, or ideas; micro-manages

• Dismisses the value of other people’s time, is late, makes people feel rushed or comes across as “too busy”

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Using values to stimulate conversation

1. Discuss: how can our values be helpful to us as a team?

2. Read through our values and behaviours

3. Each find a ‘green’ behaviour, which your team already role models and lives up to

3. Then each find one ‘red’ behaviour where your team could do better, or be more consistent

4. Discuss what you found in pairs or small groups. What did you learn from this?

Discussion: using values to inspire team improvement

If you’d like to give more feedback to our draft values and behaviours,

the survey will remain open to the end of the week, on Pulse.

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When we get it right for patients.

Source: In Your Shoes, n = 179; Māori forum – patients and whānau, n = 45

The 224 patients who took part in In Your Shoes/Māori forum sessions talked through their experiences in detail. These stories are captured in more than 400 pages of text, which are not shared in this report to protect confidentiality. This analysis draws out key words from positive aspects of those stories, showing what we are doing well, from our patients’ perspective. Word height is proportional to usage. These good experiences cluster into 7 key themes.

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When we don’t get it right for our patients

Source: In Your Shoes, n = 179; Māori forum – patients and whānau, n = 45

As patients told us about their experiences in In Your Shoes sessions, they were asked to identify which aspects were positive, and which were negative. This analysis draws out the key phrases patients used when talking about negative aspects of their experience. Word height is proportional to number of mentions. Clustered into 6 key themes – which cover behaviours, processes, environment, as well as the emotional impact of poor experience on patients and whānau.

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Why focus on improving patient experience?

“The available evidence

suggests that measures

of patient experience

are clear, distinctive

indicators of healthcare

quality.”Manary et al, New England Journal of Medicine, 2013

Our objective is to improve our patient experience, building on existing good practice, because a better patient experience drives improved patient care.

p3All tools and approaches © April Strategy LLP 2016

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A ‘good day’ at work for staff…

Enough time to do the job properly. A good staff: patient ratio, finishing on time.

Safe and supported. Supportive manager and colleagues.

Clear instructions and safe practice.

Teamwork.All on the same page.Everyone knows their roles, we gel ‘as

one’ team, we work towards clear goals.

Happy to help others. The charge nurse asks ‘can I

help?’ when we’re really busy.

Being around positive,

cheerful people.Greeted with a smile, hearing

laughter, seeing enthusiasm.

Communication. Honest conversations.

A shared understanding.

Community.Connected with patients in the

community, building trusted

relationships. Interacting

with staff. Sharing moments.

Contributing.Mutual respect. ‘Have a say’.

Feedback is listened to.

Prepared and in control.A well-oiled wheel. On time. Work flows well.

We make a plan and a back up plan.

Finding solutions.Learning as we go. Using our skills and

experience to achieve something tangible.

Focused

and ‘in

the zone’.Giving 100%.

Engrossed in

achieving a task.

Busy. Productive.Efficient and

making

progress.

Looking

forward.

Sparking

ideas,

making

changes.

Making a

difference.Doing something

that changes

someone’s life.My work matters. It

gives me a buzz.

Feel valued.A ‘thanks’ for

the little things.A senior clinician delivered baking to

everyone in the department. A client rang

to say ‘thank you’ after they’d been upset.

Positive

outcomes and

feedback.Proud to be

giving the care

I want to give.

Source: In Our Shoes, n = 415

In the In Our Shoes sessions, we asked attendees to recall their most important ‘good day’ at work, at the DHB, and identify what caused that good day. In the analysis below, the area of each box is proportional to the number of staff for whom this was their most important driver of a ‘good day’. The words are quotes from staff attendees that sum up that cluster well.

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A ‘bad day’ at work for staff…

Under resourced.

Understaffed.Growing patient numbers...

IT issues causing

delays and frustration.

Negativityflourishing in the team.

Mood vacuum cleaners.‘Victim mode’, negatives not solutions.

Communicationbreak downs.

Having to stalk managers for a

response. No discussions.

Not listened to, not believed, undermined.

Feeling fobbed off and being

unable to express myself.

Silos. Not

working together.No-one prepared to help.

People defend their patch

at the expense of others.

Resistance to change. A problem exists but

nothing is done. Barriers.

Frantically busy.More and more expected

all hours and all days.

When the workload tips the

balance, no-one enjoys it.

Interruptions.Constant demands.

Multiple requests and

high expectations.Under pressure, pulled

in too many directions.

Blame. Criticism.Feeling ashamed, feeling a failure.

Blamed even when it’s not your fault.

Rude colleagues.

Disrespected. Judged.Hostility. Phone calls received with silence.

Feeling a nuisance, embarrassed by others.

Bullied.Watching others

be bullied.Scared, intimidated.

It makes you feel

unworthy, incapable.

Isolated.

A lack of

support.Feeling like a

‘fish out of

water’, like

I’m drowning.

Set up

to fail.

Taken for granted.

Unappreciated. Efforts are not validated.

Abilities dismissed. Put down.

Undervalued.

Po

or

lea

ders

hip

,

hie

rarc

hy,

mic

ro-

ma

na

ge

me

nt.

Re

ac

tive

ch

an

ge.

De

cis

ion

sa

re

made e

lsew

here

,

with

ou

t m

y in

pu

t.

Tim

e d

ela

ys,

can

cellati

on

s. Inadequate.

Unable to give

basic care.Disappointment. Patient not getting better.


In the In Our Shoes sessions, we asked attendees to recall their most important ‘bad day’ at work, at the DHB, and identify what caused that bad day. In the analysis below, the area of each box is proportional to the number of staff for whom this was their most important driver of a ‘bad day’. The words are quotes from staff attendees that sum up that cluster well.

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Why focus on improving staff experience?

Our objective is to make Southern DHB an even better place to work, building on existing good practice, because higher staff engagement drives higher quality patient care.

“There is a clear

relationship between

the wellbeing of staff

and patient wellbeing.”Boorman 2009, Kingsfund 2013


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The importance of leaders in healthcare

70%70% of the variation in

levels of engagement

between staff is driven

by employees’ direct

line manager

Employees who strongly

agree that their manager focuses

on their strengths are more than

TWICE as likely to be engaged

(67%), as those whose manager

focuses on weaknesses (31%)

Organisations with fastest growth in productivity rates, source 80% of improvement ideas from the

front line.

Our objective is to develop the leadership skills in clinical and non-clinical leaders, that are essential in delivering the very highest level of quality for patients.

“Positive staff ratings of both top

leadership and supervisory

leadership were associated with

relatively high staff job

satisfaction… with clinical

governance review ratings and

lower levels of patient complaints.”

Leadership and Leadership Development in Health Care: The

Evidence Base. The Kings Fund. Professor Michael West et al. 2015


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The CHOICE cycle

The choice cycle.

“We get what we give”

I get

I do

They get

They do

For individualsFor leadersFor organisations

It’s down to themIt’s up to me


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Coaching self-awareness

What I get as a result

My actions and behaviours

What the other person does

What others get as result

I get

I do

You get

You doStart here

1 What did you do4 What result did you get

5 What result did you WANT?

6 What could you have

done differently?

2 What did the other person get /

understand, how did they feel?

7 What would they

have got instead?

3 What did they do

8 What might they have

done differently?

9 What might the result have been?

Choice

cycle


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What happens if we don’t give feedback?

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Practice giving feedback

A time when you weren’tliving up to our values

In pairs – tell you partner

• Your behaviour• The impact

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Constructive feedback

‘So what was happening

there?”

All tools and approaches © April Strategy LLP 2016p8

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Sign in pairs

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The power of positivity

YESYESYES

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Choosing a positive attitude

It’s upto me

It’s downto them

GETTING

UNSTUCK

DO SOMETHING

If there were just one

thing that you could

do… what would it be?

• Results

• Taking action

• Doing something

• Influencing where you can

• Stuck, excuses…

• But…

• They never…

• It’s the…


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A ‘good day’ at work for leaders…

Less pressure, no distractions. Time to be visible and

make human connections.

Fully staffed. Others have

a manageable workload.

Available resources.

Trusted and

empowered.Autonomy to decide. Freedom

to use flair. Showing initiative.

Enthusiasm and positivity.People willing

to ‘give it a go’. Each day is a chance for

fresh opportunities.

Engagement, high energy.

Supporting and enabling.Providing a clear understanding of roles,

recognising and rewarding, advocating.

Positive communicationbetween staff and patients. Openness.

Talking directly to people, one-to-one.

Seeing my team pull together.

A unified goal and approach.

Great team spiritkeeps the service safe.

Staff know each other’s strengths, work

with a shared purpose and know how

they can each contribute. It validates

my role and makes me feel excellent.

Feeling

proud.My team did

their utmost.

Thanked. Feeling accepted.Recognition. Valued as

part of the team.

Listened to.Seniors listen to my

ideas. Supported.

Pre-planning

and being

prepared.Knowing what

needs to be done.

Implementing

change.Talking through

barriers, moving

forward.

Working together

to improve care.

Good things come

out of a challenge.

Achieving milestones. ‘All ducks are in

a row’ and the

team working

with me make

an achievement.

Solving

problems.Ideas that result in

a solution. Staff

asking ‘how can we

make this better?’

Difficulties absorbed.

Confidence

in my staff

to deliver.Staff using

their areas

of expertise.

Hands on care

and positive

outcomes. Patient and family focus.

Source: In Leaders Shoes, n = 325

In the In Leaders’ Shoes sessions, we asked attendees to recall their most important ‘good day’ at work, as a leader, and to identify what caused that good day. In the analysis below, the area of each box is proportional to the number of leaders for whom this was their most important driver of a ‘good day’. The words are quotes from leaders attendees that sum up that cluster well.

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A ‘bad day’ at work for leaders…

Doing more with less.

Insufficient tools,

no beds, a lack

of staff, poor IT.

Obstructive people. Passive/aggressive behaviour,

bullying attitudes, criticism, defensiveness, distrust.

Downward spirals

of negativity.Collective negativity

drags you down. Staff frustration immobilizes you.

Conflict in the team. Or when our cultural protocols

conflict with business protocols.

Poor communication due to a lack of cohesiveness.

I become the fixer, putting out

fires. It creates more work.

Breakdown in

team functioning. Not doing their part, no responsibility.

Ignored.Staff refuse to listen.

Not heard by leadership.

Too much pressure.

Overwhelmed. No time to meet everyone’s expectations.

Lack of shared care resulting in

more work and time pressure.

Hurdles restraining innovation. Barriers. Unable to

use good ideas.

Slow process of change.Po

or

care

.D

ecis

ion

s n

ot in

th

e

pa

tie

nt’s b

est in

tere

st.

Dif

fic

ult

c

on

ve

rsa

tio

ns.

Managin

g u

npro

fessio

nal

behavio

urs

, ste

pp

ing

in

.

Bu

reau

cra

tic

pett

iness.

Tim

e w

astin

g. T

rivia

.Powerless.

Stuck in

the middle.Struggling to get

permission to do

your job. Futility.

Devalued.

A lack of

respect for

what we do.Being at the end of

the blame chain.

Feeling

lost. Lacking

support

and

direction.


In the In Leaders’ Shoes sessions, we asked attendees to recall their most important ‘bad day’ at work, as a leader, and identify what caused that bad day. In the analysis below, the area of each box is proportional to the number of leaders for whom this was their most important driver of a ‘bad day’. The words are quotes from leaders attendees that sum up that cluster well.

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Getting unstuck exercise

It’s upto me

It’s downto them

GETTING

UNSTUCK

DO SOMETHING

If there were one thing

that you could do…

what would it be?

• Results

• Taking action

• Doing something

• Influencing where you can

• Stuck, excuses…

• But…

• They never…

• It’s the…

p13

Think of something that makes a

bad day at work for you. Start to

get unstuck. If there were one thing

you could do, to start to tackle or

overcome this – what would it be?

Coach each other in pairs – to get

to a first step you could take…

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S

T

R

O

N

G

SuccessesWhat have you achieved. What are you proud of? What is your success story today / this week?

TalentsWe all have individual strengths. Which of your personal talents / skills helped you to achieve this?

ReasonsWhat is it about these strengths that helped you make this success happen?

OpportunitiesWhich aspect of your job could you be doing better right now? What objective are you not delivering on? Where is your specific opportunity to do better?

New useHow might you use the strengths you talked about, to help you improve / do better in that area?

GroupWhat strengths do other people in the group / team have, that add to yours – you could ask for their help

Strengths-based coaching


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2x

Antoine de Saint-Exupery

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Staff and Leader ambition

Our vision: let’s make Southern the most…

…healthcare service in all New Zealand

Source: In Our Shoes, n = 415; In Leaders Shoes, n = 325

In the staff and leadership sessions, we asked attendees to define a ‘vision’ for the DHB by asking ‘if we could make the DHB the most ‘something’ in New Zealand – what could that ambition be?’ These are their responses. The size of each word is proportional to the number of people who gave that word as their ambition for the DHB.

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Defining values-

based leadership

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Remember the best leader / manager you ever had. What did they do to help you be at your best?

Remember the worst leader manager you ever had. What were the things they did that ?

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How to improve engagement

Communication• Employees whose managers hold regular meetings

with them are 3x more likely to be engaged• Even higher if daily contact (face to face / phone)

Set goals / give feedback• Engaged employees - more likely to say their

manager helps them set work priorities and performance goals

• And that their manager holds them and others accountable

Focus on strengths• 67% of employees who say their manager focuses on

their strengths are engaged vs 31% of those who say their manager focused on their weaknesses

Source: Gallup. The state of the American Manager 2015p25

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Behaviours staff want from managers/leaders…


More of Less of

In the Leading with Values development workshops in May, we will ask leaders to set out their own ‘behavioural compact’ – co-creating the expectations they have of themselves. The next 3 charts begin to set out stimulus for that conversation. This analysis shows what DHB staff ask for ‘more of’ and ‘less of’ from their managers and leaders. Word height is proportional to the number of mentions.

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Behaviours leaders themselves can commit to…


This analysis shows the behaviours that DHB leaders can themselves commit to demonstrating ‘more of’ and ‘less of’. Word height is proportional to the number of mentions.

More of Less of

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Identity

Beliefs and values

Capabilities

Behaviour

Environment

Mission & Purpose

What are the characteristics of a great, values-based leader?

Robert Dilts – The Neurological levels of change

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THE BENEFIT OF APPRECIATION

Receiving gratitude

78% of people say they

would work harder if they were

recognized.

67% of employees are

motivated by praise. More than

by a cash bonus!

14% better employee

engagement in appreciative

organizations

80% of people who feel

appreciated are not actively

looking for another job

Source - Globoforce Mood Tracker

Practicing gratitude• Decreases stress hormones

like cortisol by up to 23%

• Decreases blood pressure and

heart rate variability

• Lowers risk of depression

• Improves our own self-esteem

• Improves our resilience and

ability to deal with trauma

And…

• 95% of people think more

grateful bosses will be more

successful

• Only 18% thinks it shows

weakness in a manager

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37All tools and approaches © April Strategy LLP 2016

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Thank you

@timmkeogh

Search “Tim Keogh April”

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Leading with values - Southern DHB · Leading with values. 2 What we will learn together today 1. Why values are important 2. Our influence as leaders 3. Managing attitude and behaviour