2D - Navigating power and politics in health and service ......On behalf of Professor Justin Waring,...

2D - Navigating power and politics in health and service change

Leading Quality Improvement: The importance of political skill?

Will Warburton, Director of Improvement, The Health Foundation

On behalf of Professor Justin Waring, Health Services Management Centre, University of

Birmingham, with Cheryl Croker, AHSN Patient Safety Director

November 2019

Problems of implementing improvement

13.11.19 Leading Quality Improvement: The importance of political skill?

• Change processes are often protracted and can be wasteful of

time, human capability and scarce financial resources

• Delays in the implementation of change can sustain sub-optimal

care

• Change often leads to variable, dysfunctional and unintended

outcomes

Thinking about ‘Politics’• Health care is ‘politics’

• Big ‘P’ Politics • The government, politicians and civil

servants

• Statutory obligations and regulations

• The formal institutions of care

• Small ‘p’ politics• Competing interests and motives

• Influential groupings and power

blocs

• The negotiations, trades-offs and

games



Front Stage

• ‘Public performance’ of rationally considered, logically phased and

visibly participative change

• Recognises the need for plans, milestones, formal governance and

communication

• Legitimising change, gives license to operate

• Gives reassurance and security

Back Stage

• Recruitment and maintenance of support

• Identifying and dealing with resistance

• Politicking, wheeler-dealing, coalition building, trade-offs, often not

able to be openly discussed

• Gossip, ‘have you got a few minutes’, ‘a word in your ear’

Thinking about ‘Politics’

• Organisations and workplaces are

inherently ‘political’

• “By pretending that power and influence

don’t exist, or at least shouldn’t exist, we

contribute to…the almost trained and

produced incapacity of anyone except

the highest-level managers to take

action and get things done.” (p.10)


Organisational politics


• “the activities taken to acquire, develop and use power and other

resources to obtain one’s preferred outcomes” (Pfeffer, 1981: 7)

• Beyond ‘formal authority’ and ‘charismatic’ leadership:• Control of resources and evidence and expertise

• Formulate strategies and set the agenda

• Co-opt experts

• Foster goodwill and build alliance

• Craft political language to shape meanings

Political ‘savvy’

• Some organisations seem more ‘political’• Excessive competition

• Ambiguous goals

• Complex structures

• Constant change

• Powerful people refuse to change

• Punishment culture

• Limited resources

• Sound familiar?


Political ‘savvy’

• The structural challenge

• The political challenge

• The cultural challenge

• The educational challenge

• The emotional challenge

• The physical and technical challenge


Lessons learnt from seven in-depth case

studies of the quality improvement journeys

of care providers in the UK, US and Europe

The Political Challenge


‘Negotiating the politics of change associated with implanting and

sustaining the improvement process, including securing stakeholder

buy-in and engagement, dealing with conflict and resistance, building

change relationships, and agreeing and committing to a common

agenda for improvement’

Solutions to the Political Challenge


• Political credibility: senior leaders with authority and skill to broker and manage

the ‘politics of engagement’, e.g. selling the case

• Clinical engagement: strong clinician engagement and ownership

• Peer-to-peer relationships: communication and influence to allow innovations to

spread rapidly

• Clinical-managerial partnering: a compact binding managers and clinicians to a

common agenda

• Staff empowerment: affording staff real control over their local environment

• Patient empowerment: so they can influence and participate in improvement

work

• External partnering: strong and mutual collaborations

Political skill


• “The ability to effectively understand others at work, and use such

knowledge to influence others to act in ways that enhances one’s

personal and/or organizational objectives.” (Ferris et al. 2005)

1. ‘social astuteness’ or awareness of others

2. ‘interpersonal influence’ on others

3. ‘networking ability’ to build alliances and make deals

4. ‘apparent sincerity’ or being seen as authentic and genuine

Beyond the Machiavellian

• Political skill is often seen in negative terms

– the ‘dark art’ - cunning, duplicity,

manipulation

• Political skill has a constructive ‘bright side’

• Reconcile and mediate conflict, negotiate

peace, bring about change


Acquiring and using political skill

• Public managers and civil servants use

political astuteness to translate policies into

practice and realise everyday services

• Managers usually acquire political skill

through experience – 88% reported

developing skills by mistakes or handling

crisis

• Leadership programmes can be effective


Real life accounts…


• Cheryl Crocker – confronting the political reality of the NHS

Activity 1: part 1


• 10 minutes… in pairs or trios

• Talk about a significant (small p) political issues or controversy from your career that

hampered efforts at change or QI

1. What made the issue ‘political’ – what defined it as political for you

2. How was it manifest in the behaviours or strategies of key people

3. What impact did it have on the service

4. How did you (or someone else) manage the politics

• Capture thoughts on post-it notes

Activity 1: part 2


• 5 minutes…as a whole table….place your post-it notes on the flip

chart under these headings…

1. What made it ‘political’?

2. How did it manifest in behaviours of key people?

3. What impact did it have on the service?

4. How did you (or someone else) manage the politics?

Real life accounts…


• The experience of acquiring and honing political skill…

• What have been the pivotal turning points in your thinking about

organisational politics?

Activity 2


• 10 minutes…. in groups of 4-5, reflect your own experiences…

• And thinking about future leaders…record on the flip chart…

• What do you think could help people learn about and acquire

political skill?

Reflections and the future


• NIHR Healthcare Leadership with Political Astuteness (HeLPA)Justin Waring, Simon Bishop, Georgia Black, Jenell Clarke, Mark Exworthy, Naomi Fulop, Jean Hartley, Angus Ramsay, Bridget Roe

• Aims to investigate the acquisition, use and contribution of leadership with ‘political astuteness’ in the implementation of strategic health system change

• Anticipated learning and outputs:

The co-production of materials and resources for the recruitment, training and development of current and future service leaders

Reflections and the future


Work Package 1: Narrative Review (Complete)

Work Package 2: Narrative Interview Study (Completed)

Work Package 3: In-depth case studies (Please get in touch if

interested in participating)

Work Package 4: Co-production workshops (Please participate

in the workshops – contact sheet being circulated)

Thank you

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