Leadership for Improvement

1. Leadership for Improvement Dr Catherine Hannaway Senior Fellow, Durham University and NHS Institute for Innovation and Improvement

2. Leadership and Management • What Matters? • Talent Spotting • Leadership Qualities • 10 Steps to Leadership & Management

3. Leadership and Management -definitions • Leadership is showing the way-showing what to do next. Leadership is not dependent on role or seniority. • Management is the responsibility for the use of resources. Management is dependent on role and includes seniority.

4. The Context • Since 1974, the NHS has undergone 11 major reorganisations (1 every 3 years) • The average career expectancy of a Chief Executive is currently 22 months • Leadership instability is not conducive to change, because it creates a ‘trust’ deficit • Local management in the NHS is often perceived by clinicians as politically rather than patient driven, a view reinforced through a centralist approach to achieving national targets

5. A bit of theory........ • Some personality traits may lead people naturally into leadership roles. This is the Trait Theory. • A crisis or important event may cause a person to rise to the occasion, which brings out extraordinary leadership qualities in an ordinary person. This is the Great Events Theory. • People can choose to become leaders. People can learn leadership skills. This is the Transformational or Process Leadership Theory.

6. “New paradigm” approach • Less concerned with “Great man” models of leadership • More concerned with change/improvement • “Transformational”- visionary leadership • More “soft stuff” emphasis on working through others

7. “New paradigm” approach • Leaders with more faith in other people than they have in themselves (and they have a lot of faith in themselves!) • Leader as servant and partner (Greenleaf) • Ambition, optimism, openness and personal humility • Importance of connectedness & inclusiveness Professor Beverly Alimo-Metcalfe of www.realworld-group.com

8. What Matters? • What matters is the approach to leadership and management • What matters is how you do it • What matters is what you say, what you do and how you behave.

9. From the ‘Leadership for Health Improvement Programme’ in ‘Managing for Health’ Chapter 7. Hannaway, Hunter & Plsek 2007)

10. The definition of insanity is continuing to do the same thing over and over again and expecting a different result. Albert Einstein

11. “ People do not resist change per se. People resist loss.” (Heifetz and Linsky 2002)

12. D x V x FS > RRichard Beckhard's Change Formula • D = Dissatisfaction: The higher your dissatisfaction with the status quo gets, the more likely you are to initiate change. • V = Vision: The clearer and specific your vision is the more traction you can acquire in making change. • FS = First Steps: The clearer you on your First Steps the more capable you are at following through on change.

13. D x V x FS > R R = Resistance to Change: Resistance can be about fear, time or monetary costs, emotional concerns or any number of issues or reasons that hold you back. Basically, resistance is anything that stops you from making change. Richard Beckhard's Change Formula

14. A Leaders Role in Preparing for Change • Create a compelling narrative about the status quo and the consequences of failing to change that is tangible, logical, has intellectual rigour and touches individuals • Articulate a coherent vision about a future state that is both inspirational and desirable, and the role of the individual within it that makes them want to go there • Develop a strategy which has clear and ambitious goals aligned wholly with the vision (not National targets!) • Empower the staff, give them the permission and the skills, and help them develop their plans to deliver the strategy and achieve the vision • But there must be: • Consequences for not changing • Disincentives for resisting • Benefits from moving to the new state • Incentives for getting there quickly

15. North Tees MLCF MANAGER Evaluation:

16. The Talent Potential Model – NHS EOE • Engages and inspires others • Demonstrates political astuteness • Builds effective networks • Delivers collaboratively • Shows good self management • Demonstrates personal drive and motivation • Expresses desire to learn • Shows resilience Personal agility Influencing Potential Strategic understanding • Shapes the future of the organisation • Engages in broad scanning • Lives the NHS values • Develops capabilities • Demonstrates action orientation • Motivates and empowers others • Shows good analysis and problem solving Results orientation

17. Organisational Talent Mapping Overview Exceeds expectations Outstanding performance against objectives and behaviours required at level Meets Expectations Meets the expectations for performance against objectives and behaviours required at level Performance Partially Met Expectations Below “met expectations” against performance objectives and behaviours required at level Potential NOT LIKELY TO BE READY Shows limited potential to develop at current level within 3-5 years or shows no motivation / aspiration to want to progress EMERGING TALENT Shows potential & motivation to develop at current level in some respects. Shows future promise and expected to progress within 3-5 years DEVELOPING TALENT Demonstrates the potential & motivation to develop at current level& to progress within 1-3 years READY NOW Demonstrates the Potential, motivation & experience to perform at next level. In next <12 months, should focus on developing leadership behaviours at next level

18. Total No: No of Clinicians: No of Doctors: No of BME: No of Women: Insert Key Role (as defined by your organisation) This template can be used to provide numbers & demographics of ALL those applicable individuals within your organisation NL1 ET1 DT1 RN1 Total No: Total No: Total No: Total No: No of Clinicians: No of Clinicians: No of Clinicians: No of Clinicians: No of Doctors: No of Doctors: No of Doctors: No of Doctors: No of BME: No of BME: No of BME: No of BME: No of Women: No of Women: No of Women: No of Women: NL2 ET2 DT2 RN2 Total No: Total No: Total No: No of Clinicians: No of Clinicians: No of Clinicians: No of Doctors: No of Doctors: No of Doctors: No of BME: No of BME: No of BME: No of Women: No of Women: No of Women: NL3 ET3 DT3 New to level Total No: Total No: Total No: Total No: No of Clinicians: No of Clinicians: No of Clinicians: No of Clinicians: No of Doctors: No of Doctors: No of Doctors: No of Doctors: No of BME: No of BME: No of BME: No of BME: No of Women: No of Women: No of Women: No of Women: TOTAL AVAILABLE POOL x

19. Succession planning is typically defined as ‘a process by which one or more successors are identified for key posts (or groups of similar key posts) and career moves and/or development activities are planned for these successors. Succession planning sits inside a much wider set of resourcing and development processes that can be defined as succession or talent management’ (Hirsh. W. IES Report 372, October 2000).

20. Being Spoilt for Choice for key roles and levels • Encouraging everyone to spot Talent •  Encouraging more clinicians to become Leaders •  Being Reflective of our Communities •  Transparency around what is required to progress, and support to progress • Enabling all healthcare organisations to access the best Leaders •  Being as focused on Leadership as on finances and clinical outcomes

21. The Health White Paper • Patients and Carers (Health Watch) • Standards (CQC and NICE) • Managing the market (Monitor) • “Any Willing Provider” • The NHS Commissioning Board • GP Commissioning Consortia • Health and Wellbeing Boards • Public Health England and Local Public Health

22. Personal qualities - such as developing self awareness and acting with integrity. • Working with others - such as building and maintaining relationships and working within teams. • Managing services - such as planning and managing resources, people and performance. • Improving services - such as ensuring patient safety and encouraging improvement; and • Setting direction - such as making decisions and evaluating impact.

23. People/Personal Leadership 1. Inspirational leader of people across professional boundaries 2. Helps others perform their best 3. Continuously aims for self-development 4. Is an effective role-model for others

24. Quality Leadership 1. Demonstrates outstanding patient commitment 2. Demonstrates commitment to quality of care and outcomes 3. Effectively prioritises patient safety 4. Ensures a positive patient experience

25. Service Leadership 1. Understands drivers of financial performance 2. Identifies and prioritises opportunities to improve operational excellence 3. Delivers service specific strategies and objectives

26. Collaborative Leadership 1. Acts within the overall interests of the trust 2. Communicates and collaborates effectively with other leaders in the trust 3. Engages executive as appropriate 4. Effectively engages with other stakeholders (GPs, PCTs, social services, internal customers)

27. Some thoughts on leadership and management • Genuine concern for others • Ability to communicate and inspire • Decency • Humanity • Humility • Sensitivity • Respect for others Beverley Alimo-Metcalfe summarised the 7 qualities as the leader being a servant not a hero

28. 10 Steps to leadership and management 5 process steps: 1. Listen to other people 2. Think about what they have said 3. Exercise judgement- come to a decision 4. Explain your decision and persuade others 5. See it through with courage

29. 10 Steps to leadership and ManagementKen Jarrold 5 behaviour steps: 1. Demonstrate your commitment to the work of your organisation and your belief in service improvement. 2. Respect the people you work with and take delight in their development. 3. Exercise empathy - put yourself in other people’s shoes

30. 10 Steps to leadership and Management - Ken Jarrold 4. Build trust by acting with integrity and living your values 5. Act with humility and be willing to learn