Leadership for improvement

1. Leadership for improvement Kate Harmond Executive Masterclass Melbourne April 2004

2. An ambitious agenda • Consolidating policy • Challenging practice • Clinical politics • Celebration

3. Public opinion Service failures Staffing issues Access improvement Clinical governance Investment Policy context

4. Care based on visits Professionals control care Information is a record Care is based on a continuous healing relationship The patient is in control Knowledge is shared freely A new world?

5. Decisions based on training or experience “Do no harm” is up to the individual Secrecy is necessary Decision making is evidence based Safety relates to the system Transparency is necessary New rules?

6. The system reacts to needs Cost reduction is sought Professional roles shape the system Needs are anticipated Waste is constantly decreased Co-operation is an explicit priority New culture?

7. Effective interagency working • Sharing across cultures • Learning new languages • Focus on practice • Demonstrate improvement • Challenge pre-conceptions • Respect and value the differences

8. Spreading innovation • Innovators • Early/late majority • Laggards Reference Rogers E Diffusion of Innovations NY The Free Press 1995

9. …or... • Eagles • Sheep • Donkeys

10. Health warning! • We are all donkeys • Not a permanent trait • Not necessarily irrational • Donkeys have feelings too

11. Music hall song If I had a donkey Wot wouldn’t go D’you think I’d wallop him? No, no, no

12. Shakespeare Cudgel thy brains no more about it; Thy dull ass will not mend his pace with beating. Hamlet

13. Carrots for health! • Patient benefit • Prestige • Peer pressure • Publication • Praise • Purchasing power

14. Clinical leadership • Vision and inspiration • Practice goals (eg mobility, pain relief) • Role modelling • Audit health outcomes • Clinical governance • Research and development

15. Managerial leadership • Articulate the vision • Organisational goals (eg waiting times) • Role modelling • Measure systems improvements • Corporate governance • Process redesign and development

16. Lessons from top companies • Constant improvement • Culture for innovation • Team development • Community involvement • Client centred • Open and blame-free environment

17. Leaders’ roles • Build the will to improve • Set aims and measures • Create a plan to achieve the vision • Provide on-going review and support • Deal with the hygiene factors • Agree and monitor individuals’ goals

18. Leaders’ challenges • Change management • Crisis resolution • Quality improvement • Managing complexity • Managing ambiguity • Agitating

19. Leaders’ qualities • Integrity • Openness • Sense of humour • Respect for others • Listening and learning • Moral courage

20. Celebration • Show-case successes • Use the media • Keep the personal touch • Thank people in public as well as private, even consultants! • Fun is not a crime!

21. With monstrous head and sickening cry And ears like errant wings The devil’s walking parody On all four-footed things Fools! For I too had my hour; One far fierce hour and sweet: There was a shout about my ears, And palms before my feet. G K Chesterton 1874-1936 The donkey

22. References Institute of Medicine Crossing the quality chasm, Corrigan JM, Washington National Academy Press, 2001 Fraser S Accelerating the spread of good practice, Kingsham Press, 2002 Berwick D Big issues in the next ten years of improvement Paper presented at IHInational forum, Orlando, December 2001

23. Thank you!