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“What makes clinical leaders tick?”

“What makes clinical leaders tick?”. “ The real voyage of discovery is to not to visit distant lands but to see with new eyes” Proust.

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“What makes clinical leaders tick?”

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  1. “What makes clinical leaders tick?” “The real voyage of discovery is to not to visit distant lands but to see with new eyes” Proust Shani and Pasmore (1985) have a tighter definition stating that action research is an ‘emergent inquiry process applying integrated behavioural sciences and organisational knowledge to solving organisational problems, in the spirit of collaboration and co-enquiry’. 1st cycle : Group setting 2nd cycle: Group setting 3rd cycle: World Cafe Purification techniques (Alasuutari 1995) and unriddling (Petkova 2006)

  2. My values and assumptions • Expect high standards • Intellectual commitment • Emotional attachment • Gender and diversity • Strong professional identity • Intuitive thinking • Highly value my role in the team • The blame lies with clinicians • Good multi-disciplinary working between MW and obstetricians • SHA and DH level joint thinking and communication • Unitary purpose

  3. 1st Cycle • What makes you want to improve clinical care provided to pregnant women? • What are the barriers you have experienced? Findings: • Taking pride in your work, high goals, the women • Positive patient experience • Fianancial resources • ‘Beavering away’ • ‘Jumping over hurdles’ • Lack of appropriate and timely information • Political agenda Rajasingam 2009

  4. So What? • Positive factors were internal loci of control • External factors are negative and punitive • Clinical versus management tension • Catch them early – Just do it! • Sea of apathy and helplessness • Who values what? Clinical or management roles Rajasingam 2009

  5. 2nd Cycle • What have you learnt from the ‘teams’ presentation? • How could you apply this to the issues you face? Findings: • Core values within teams relatively new concept • Positive emotion in leading • Safety, teams and pseudo-teams • ‘my team’ • Obstetricians work across different areas but does not apply to midwives? • Different priorities of obstetricians • Elephant in the room Rajasingam 2009

  6. So What? • De-stabilisation effect of changing team members • Lack of core values and vision • Maintain the equilibrium – resistance to change • Traditionally enforced patterns of behaviour • need ‘catch up time’ for inter-disciplinary working • Discomfort surfacing professional bureaucracy issues • Work identity taken over personal identity Rajasingam 2009

  7. 3rd Cycle • Are you a leader or a follower? • What are the barriers to multi-disciplinary team working in maternity services? • How could inter-professional relationships between midwives and obstetricians be improved? Findings: • Of course we lead ….don’t we??? • Follow NICE, RCM, RCOG etc • Follow the woman – want more patient surveys • Tripartite leadership – but who is responsible? • Professional identity, differing philosophies and agendas • Time pressure and fire-fighting • Seek refuge in monitoring systems for behaviour • Respect and equity Rajasingam 2009

  8. So what? • Followers of external pressures and factor • Root of the lack of leadership comes from the top level • Familiar with transactional and masculine leadership style • Does this come from the top level? • Tend towards stability • Managers not seen to have a role within team – them and us • Elephant in the room Rajasingam 2009

  9. VORTEXmodel Edge of chaos Edge of chaos Politics Turbulence DH • Values and variety • Organisational culture • Respect • Turbulent tsunami effect • Political environment • X-Factor SHA Organisation Professional Bureaucracies Culture Mental Models YOU Heart and Soul of the NHS Being in control Rajasingam 2009

  10. Leadership from the top? Politics Turbulence DH Pluralistic settings and aims SHA Divergent objectives Organisation Diffuse powers What vision? Which vision? Whose vision? Professional Bureaucracies Culture Mental Models Personal and collective vision Rajasingam 2009

  11. Top-Down Leadership Edge of chaos Edge of chaos Politics Tsunami public sector reforms – constantly changing landscape DH SHA Organisation Institutional leadership Complex adaptive systems Professional Bureaucracies Service leadership Frontline leadership Mental Models Allowself-organisation Rajasingam 2009

  12. Power with not Power over -Mary Parker-Follett Politics Turbulence Complex outer forces DH SHA Organisation Professional Bureaucracies X - Factor Empowerment Mental Models Internal stability Complex inner forces Rajasingam 2009

  13. Service Delivery Chain- chinks in the armour Politics Complex outer forces DH SHA Organisation Professional Bureaucracies X - Factor Empowerment Mental Models Internal stability Complex inner forces Rajasingam 2009

  14. Politics Complex outer forces DH Patient Value Maximisation (PVM) SHA Organisation Professional Bureaucracies X - Factor Empowerment Mental Models Internal stability Complex inner forces Rajasingam 2009

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