MEDEV Subject Centre New forms of leadership for medical and health professions’ education?

1. MEDEV Subject CentreNew forms of leadership for medical and health professions’ education? Professor Judy McKimm Professor Bernard Moss 30 June 2010

2. Aims of the workshop • To develop your leadership knowledge, understanding and skills • To explore how spirituality and value-led leadership may be embedded in medical and healthcare curricula • To relate an understanding of these forms of leadership to your own professional practice

3. Your learning needs ....

4. Leadership theories and concepts • Leadership is a socially constructed phenomenon • There is no single right or wrong way • And no ‘one’ definition ...... Although there is some consensus

5. ‘Great Man’ or Trait theory

6. Context and contingency theories • Fielder (1964) • contingency theory • no ‘one best way’ • certain behaviours work best in certain situations • Hersey and Blanchard (1969,77,88) • situational leadership • “different strokes for different folks”

7. Covey (1994) Managers • work within an existing paradigm • solve problems • manage existing resources Leaders • create new paradigms • challenge systems • seek new opportunities

8. Transactional vs transformational The transactional leader • Recognizes what it is that we want to get from work and tries to ensure that we get it if our performance merits it •  Exchanges rewards and promises for our effort •  Is responsive to our immediate self interests if they can be met by getting the work done The transformational leader • Raises our level of awareness and consciousness about the significance and value of outcomes, and ways of reaching them • Gets us to transcend our own self-interest for the sake of the team, organization or society • Alters our need level (after Maslow) and expands our range of wants and needs

9. Transforming leadership ‘…occurs when one or more persons engage with others in such a way that leaders and followers raise one another to higher levels of motivation and morality’ (James Burns, 1978)

10. Transformational leadership Leaders transform followers (as opposed to engaging in transactions) by: • Increasing followers’ awareness of of task importance and value • Focussing followers on the goals of the team and the organization • Activating the higher order needs of followers (Bernard Bass, 1985)

11. Transformational leadership The 4 ‘Is’ • Idealized influence • Inspirational motivation • Intellectual stimulation • Individualized consideration (Bass, 1985)

12. Transformational leadership is promoted in many public sector frameworks (Bolden et al, 2003)

13. Problems with transformational leadership • Venerates the individual to the exclusion of the team and the organisation • Aggregated list of ‘qualities’ becomes over-powering • Little evidence of effectiveness • Potentially dangerous…

14. Charismatic leadership Combines transformational with trait theories

15. Charismatic leadership • Dominant personality with desire and self confidence to influence others • Strong role model • Articulation of ideological goals with moral overtones • High expectation of others

16. Distributed leadership Leadership as a process Importance of social capital Emergent, Open boundaries, Expertise dispersed

17. The servant-leader is servant first. It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead (Greenleaf, 1970) Listening Awareness and sensitivity Stewardship Building a community Foresight Persuasion not coercion Conceptualisation Commitment to the growth of people Healing Facilitation Empathy

18. Collaborative leadership Leadership shown by a group that is acting collaboratively to solve agreed upon issues Uses supportive and inclusive methods to ensure that all people affected by a decision are part of the change process Requires a new notion of power... the more power we share, the more power we have to use www.collaborativeleadership.org

19. Why collaborate? Collaborative practice leads to improved health outcomes: • Improved patient care • Improved access to and co-ordination of health outcomes • More appropriate use of resources • Improved patient safety, reduced clinical errors • Decrease in complications, hospital stays, cost of care • Funding often geared to collaboration for innovation WHO, 2007 & 2009

20. The nature of collaboration Collaboration is a state of mind and not just a theoretical approach Assumption that teams are the cornerstone of an integrated health and social care workforce Effective teamworking improves health outcomes and the patient experience Collaborative leadership is effective for complex situations

21. Collaboration and partnership working “Partnership is a formalised agreement between individuals or organizations to work together within the bounds of the agreement Collaboration is a philosophical and cultural commitment to the principles and practice of partnership working in the shared interest of better outcomes for the end-user and the whole community” McKimm, Millard and Held, 2008

22. You cannot not influence ....

23. Emotional intelligence • Self-awareness • Self-regulation • Motivation • Empathy • Social skills Back to trait theory?

24. Emotional Intelligence

25. Emotional Intelligence

26. Emotional Intelligence

27. A framework of emotional competenciesfrom The emotionally intelligent workplace, Cherniss and Goleman, 2001

28. Activity Using the framework of emotional competencies, talk with your partner about areas of strength or improvement for yourself, people you manage or your team.

29. Spiritual intelligence and spirituality in leadership

30. Afternoon session

31. You cannot not influence ....

32. Working across boundaries Activity Mapping your world .....

33. Our Iceberg Is Melting John Kotter and Holger Rathgeber, 2005 Source: orclville.blogspot.com/2007/11/our-iceberg-is...

34. Fullan (2001) • Moral purpose • Understanding change • Coherence making • Building relationships • Knowledge creation and sharing

35. Michael Fullan, 2001 Fullan, M. (2001) "Leading in a culture of change" San Francisco: Jossey-Bass

36. Activity: Challenges and opportunities Think about - • Levels of working • Ways of working • Underpinning assumptions • Leadership styles etc ....

37. Challenges Collaboration often occurs within very complex systems Much of the work occurs in the gaps and ‘spaces between’ organisations, professions, departments New forms of working are required – boundary spanners, co-ordinating, networking, meshworking, communities of practice How do we develop shared values between organisations, professions, subject disciplines? Structural and societal obstacles to collaboration Are these skills always recognised and rewarded? Are these new forms of leadership accepted?

38. Ethics and values ....

39. Leadership that works…. Modelling the way – leading by example, consistent with leader’s stated values; celebrating ‘small wins’ that signify achievements; dismantling barriers to achievement of values Inspiring a shared vision – developing a compelling vision of the future, enlisting the commitment of others Challenging the process – being on the look-out for opportunities to improve the organisation and being prepared to experiment Enabling others to act – promoting collaborative working; empowering others; building trust Encouraging the heart – recognising individuals’ contributions; celebrating accomplishments Bryman, 2007, based on Kouzes and Posner (2003)

40. Putting theory into practice ...

41. Leadership models ... Collaborative Transformational Situational Dispersed/Distributed Servant leadership Value led leadership Leaders as connectors…..

42. Leadership that gets resultsGoleman (2000) flexibility to innovate sense of responsibility level of standards aptness of rewards clarity of mission and values commitment to common purpose      

43. Partnership and collaboration: leadership qualities “Collaborative leaders are personally mature. They have a solid enough sense of self that they do not fear loss of control” (Turning Point Program, 2003) A leader must have “integrity and humility. It is about removing barriers between individuals, teams, functions and other organisations to work towards the achievement of a joint vision” (Beverly Alimo-Metcalf, 2003)

44. Participatory or collaborative leader www.anecdote.com.au

45. Leadership and followership No-one leads all the time Followers are very rarely passive, especially professionals. Kelley (1992) suggests four roles: • Passive followership • Active followership • ‘Little l’ leadership (leading in small ways, at all levels) • ‘Big L’ leadership

46. Polylogue – multiple conversations • Develop organisations and people through multiple, tempered ‘fierce conversations’ • Engenders a philosophy of shared responsibility and commitment • Benefits of polylogue include future leader development and staff retention through a co-operative working environment

47. A new workforce? • ‘Tempered radicals’ - willing to act on different external agendas and take risks, yet work successfully within organisations (Meyerson, 2004) • Broker, mediator and negotiator - increasingly being recognised, recruited and trained for these specific cross-boundary roles (Hartle et al, 2008; Tennyson and Wilde, 2000) • Boundary spanners - believe in collaboration, demonstrate an ability to obtain and distribute information strategically, see problems in new ways, craft solutions and develop and support the skills of others (Bradshaw, 1999)