Motivated to Lead

Simon Edgar

Director of Medical Education

NHS Lothian

simonedgar@nhs.net

@simongasman

With thanks to Steve Swensen @Mayo

Workshop Faculty

• Sue Sloan• OD Consultant• Lead Practitioner Clinical Leadership• sue.sloan@nhs.net

• Hannah Monaghan• Histopathologist• Deputy Director of Medical

Education

And other friends

Two-thirds of young hospital doctors under serious stress, survey revealsSaturday 11 February 2017

“I am totally fed up with this current system, no on-call rooms. No time or place to have food. Have to come early to see my patients and leaving late, ensuring they are safe. I really love my job but it keeps taking more and more from me while giving less and less back.”

“We are exhausted, frustrated and burned out. I see lapses in safety daily and, even if somebody cared, there is no money or staff to do anything about it,”

“I have reached a point where my physical and mental health have been seriously adversely affected, and I wonder whether I’m suffering from burnout.”

Joy in WorkIntellectual, behavioral and emotional1 commitment to meaningful and satisfying work

1The feeling of success and fulfilment that results from meaningful work

….withoutjoyandmeaninginwork,theworkforcecannotperformatitspotential.

“At Gaylord Hotels, we are dedicated to providing our STARS

with the support and resources necessary to provide flawless

service in an environment that fosters fun, encourages open

communication and development, and upholds our values”

WeemploySTARS

Discuss with your neighbour for 30 secs…

“How things are done around here….especially when no-one is looking”

A simple definition of Culture?

3.0

2.0

1.0

Maslow, A.H. (1943). "A theory of human motivation". Psychological Review. 50 (4): 370–96.

Basic

Psychological

Self-Fulfillment

EngagementHowconnectedanemployeeistotheculture,missionandvaluesofanorganisation…. andthedegreetowhichtheyareenabledandinspiredtoparticipateinfurtheringthem.

PersonalResilience

MayoClinicPhysicianLeaders“Thedimensionsofeffectivephysicianleadershipasevaluatedbythecompositeleaderscoreinourstudycouldbesummarizedasfollows”:

• Inform

• Engage

• Inspire

• Develop

• Recognize

ImpactofOrganizationalLeadershiponPhysicianBurnoutandSatisfactionShanafelt,MD;Gorringe,MS;Menaker,EdD;Storz,MA;DavidReeves,PhD;Buskirk,MD;Sloan,PhD;andSwensen,MDMayoClin Proc.2015;90(4):432-440

Joy in Work

Intellectual,behavioralandemotionalcommitmenttomeaningfulandsatisfyingwork.

RecipeforSuccessPurposeandVision:co-create&articulate aclearvisionforHealthandcarepractice;share thatwithclinicalstaff; support individualstocraftasenseofpurpose[rolesandgoals]forthemselves

Mastery:buildalearningsystemthatsupportsandpromotesskills[knowledge,technical,team,system]neededbyindividualstorealiseandachievetheirpotential&promoteteam-working

Autonomyandcontrol:createandpromoteasystemofteambasedcarethatsupportsandendorsesprofessionalautonomyandindividualcontrol

Care&Compassion:engageinmeaningfulconversationstopromotethesecomponentsforstaff

Appreciating,inquiringandsharing

Appreciating,inquiringandsharingAttables:ØQuickintroductionsroundthetableØ10minutestodiscuss3questions (comingonnextslide)andshareyourreflectionsonSimon’spresentationandyourownexperiences(briefandsuccinct!)

• Howdoesthisallsound?• Whatresonateswithyou?• Whatdoyoualreadydowellinyour

workplacetopromotestaffengagementandjoyinwork?

3Leadership‘interventions’toallowDoctorsintrainingto‘playtotheir

strengths’

1.TheSensesFramework2.HavingMeaningfulconversations3.TransactionalAnalysis

1.SensesFramework

• Security• Belonging• Purpose• Significance• Achievement• Continuity

Reference:NolanM.,BrownJ.,DaviesS.,NolanJ.,KeadyJ.2006TheSensesFramework:ImprovingCareforOlderPeopleThroughaRelationshipCentredApproach.GettingResearchintoPractice(GRIP)ReportNo2

2.Havingmeaningfulconversationsatwork

3keyingredients:• Honesty• Benevolence• Courage

WITSToolWhenyousay/do(ordon�tsayordo)......

I feel........

Theeffectorimpactis...........

SonexttimeI’dlikeyouto.......

Toptips• Beclearaboutwhatyouaretryingtoachieve(begin

withtheendinmindandprepare,askyourself‘whatismyintent?’)

• Listen empathically(seekfirsttounderstand,thenbeunderstood)

• Showup(Iwanttotalktoyoubecause…I’veseen/heard/felt...Ithinkitsimportantforusbothbecause...Myconcern/worryis...Theriskofnotaddressingthisis...Ihavecontributedtothisby...IamsorryIhaven’tsaidanythingbeforenow...)

• Lookforthepositives(Ithinkwecanresolvethis...Ireallywanttofindawayforward)

• Listenmore(Howaboutwetalkaboutthis?I’dliketohearyourtakeonthis...howdoyouseethings?)

3.TransactionalAnalysis

• Ego-states• DramaTriangle• WinnersCircle• Drivers

WhatareyourBarrierstoMeaningfulConversation?

Whatgetsintheway?

LothianInterventionsPurpose Mastery Autonomy Compassion

MedicalLeadershipAcademy

MBTI

PeerMentoring

PairedLearning

iMatter

Signpostingtootherhelpfultools• FranklinCovey‘7HabitsofHighlyEffectivePeople’

• MyersBriggsTypeIndicator

• EmotionalTouchPoints

• AppreciativeInquiry• PairedLearningReferences:CoveyS.R(1989)The7HabitsofHighlyEffectivePeople,SimonandShuster,USA.

BriggsK.C(1976)MyersBriggsTypeIndicator.PaloAlto,CA.ConsultingPsychologistsPress.

DewarBetal(2010)UseofEmotionalTouchPointsasamethodoftappingintotheexperienceofreceiving

compassionatecareinahospitalsetting.JournalofResearchinNursing,15(1),pp29-41.

Cooperrider,D.&Whitney,D.D.2005,Appreciativeinquiry:Apositiverevolutioninchange,Berrett-KoehlerPublishers.

Workshop Faculty

Sue Sloan

• OD Consultant

• Lead Practitioner Clinical Leadership

• sue.sloan@nhs.net

• @susansloan08

Hannah Monaghan

• Histopathologist

• Deputy Director of Medical Education

• hannah.monaghan@nhslothian.scot.nhs.uk>

Simon Edgar

• Director of Medical Education

• simonedgar@nhs.net

• @simongasman

Dave Caesar

• ED Physician

• Senior Clinical Advisor SG

• dave.caesar@nhslothian.scot.nhs.uk

Andy Stevenson

• ED Physician

Please be in touch

Motivatedtolead?Thewhy,thehowandthewhat…

3Leadership‘interventions’toallowDoctorsintrainingto‘playtotheir

strengths’

1.TheSensesFramework2.HavingMeaningfulconversations3.TransactionalAnalysis

SensesFramework

• Security• Belonging• Purpose• Significance• Achievement• Continuity

Reference:NolanM.,BrownJ.,DaviesS.,NolanJ.,KeadyJ.2006TheSensesFramework:ImprovingCareforOlderPeopleThroughaRelationshipCentredApproach.GettingResearchintoPractice(GRIP)ReportNo2

Havingmeaningfulconversationsatwork

3keyingredients:• Honesty• Benevolence• Courage

WITSToolWhenyousay/do(ordon�tsayordo)......

I feel........

Theeffectorimpactis...........

SonexttimeI’dlikeyouto.......

Toptips• Beclearaboutwhatyouaretryingtoachieve(begin

withtheendinmindandprepare,askyourself‘whatismyintent?’)

• Listen empathically(seekfirsttounderstand,thenbeunderstood)

• Showup(Iwanttotalktoyoubecause…I’veseen/heard/felt...Ithinkitsimportantforusbothbecause...Myconcern/worryis...Theriskofnotaddressingthisis...Ihavecontributedtothisby...IamsorryIhaven’tsaidanythingbeforenow...)

• Lookforthepositives(Ithinkwecanresolvethis...Ireallywanttofindawayforward)

• Listenmore(Howaboutwetalkaboutthis?I’dliketohearyourtakeonthis...howdoyouseethings?)

TransactionalAnalysis

• Ego-states• DramaTriangle• WinnersCircle• Drivers

CP NP

A

AC FC

FunctionalEgoStates(positive)

ControllingParentSetsboundaries

DirectiveCommands

NurturingParentPraisesencouragessupports

AdultConceptualises

SolvesproblemsAssertive

Grounded&rational

AdaptedchildConforms,

doingthingsforothers

FreeChildNatural,funloving

rebellious,uninhibited

CP NP

A

AC FC

FunctionalEgoStates(negative)

ControllingParentPutspeopledown

JudgmentalAuthoritarian

NurturingParentGivesunsolicitedadviceTakesoverfromothers

AdultConceptualises

SolvesproblemsAssertive

Grounded&rational

AdaptedchildPassive,apologeticdifficultysayingno

FreeChildRisktakingbehavioursEmotionaloutbursts

Inappropriatebehaviour

TheDramaTrianglePersecutorCharacteristics:Discountcapacityofotherstothinkandactforthemselves

Partoftheirgoalistopunish

Putpeopledown

Belittleothers

RescuerCharacteristics:

Discountcapacityofotherstothinkandactforthemselves

Helpotherswithoutaskingiftheywanttobehelped

Domorethantheirfairshare

Dothingstheydon’twanttoVictimCharacteristics:Putthemselvesdown

Discountcapacityofotherstothinkandactforthemselves

DonotuseAdultforthinkingandproblem-solving

Believe�Icannotcopeonmyown�

Karpman (1968)

TheWinner�sCircle

Adult

AssertiveCharacteristics:Askforwhattheywant

Say�No� towhattheydon’twantMakechangesinordertogettheirneedsmet

Donotpunish

Arewillingtonegotiate

CaringCharacteristics:

Donotdothethinkingforothers

Donottakeoverunlessasked

Donotdomorethantheirshare

Say�No� towhattheydon’twantKnowhowtolistentoothers

Areself-aware

VulnerableCharacteristics:

UsetheirAdult-EgoStateforthinking

andproblemsolving.Areawareoftheirfeelings

&usethemasdataforproblemsolving.

Arewillingtoaskforhelpwhentheyneedit

andrefusewhentheydon’t

Behavioural‘Drivers’

• PleaseOthers (I’moksolongasIpleaseyouandotherpeople)

• BePerfect (I’moksolongasIamperfectanddoeverythingperfectly)

• Bestrong (I’moksolongasIamstronganddon’taskforhelp)

• TryHard (I’moksolongasItryhard)• HurryUp (I’moksolongasIhurryup)

Signpostingtootherhelpfultools• FranklinCovey‘7HabitsofHighlyEffectivePeople’

• MyersBriggsTypeIndicator

• EmotionalTouchPoints

• AppreciativeInquiry• PairedLearningReferences:CoveyS.R(1989)The7HabitsofHighlyEffectivePeople,SimonandShuster,USA.

BriggsK.C(1976)MyersBriggsTypeIndicator.PaloAlto,CA.ConsultingPsychologistsPress.

DewarBetal(2010)UseofEmotionalTouchPointsasamethodoftappingintotheexperienceofreceiving

compassionatecareinahospitalsetting.JournalofResearchinNursing,15(1),pp29-41.

Cooperrider,D.&Whitney,D.D.2005,Appreciativeinquiry:Apositiverevolutioninchange,Berrett-KoehlerPublishers.