Annual Medical Leadership & Management Conference‘Values-based Leadership’

Beverly Alimo-Metcalfe CPsychol. FBPsSEmeritus Professor of Leadership Studies, University of LeedsProfessor of Leadership, University of Bradford School of ManagementFounding Director, Real World Group

Manchester, July 7th 2015

© Real World Group 2015www.realworld-group.com

Leadership: it’s time for a new direction

Increaseeffectiveness

Sustainmotivation

Maintainwellbeing

Create a culture of high RfC

Encourage learning & innovation

Key leadership challenges in the NHS

Strengthen collaboration

Staff wellbeing is critically important…

• “..trust performance overall is linked to higher levels of staff health and well-being... 

• Staff ill-health is ..a serious barrier to the provision of consistently high quality patient care

• “over 80% of the 11,000 NHS staff who took part in the review’s staff perception survey [said] that their state of health affects the quality of the patient care they deliver”.

Source: Boorman, S. (2009).

Lest we forget…

Francis report 1 year on: Nuffield Trust findings

Source: The Francis Report: One Year On, The Nuffield Trust, Feb. 2014

The role of leadership in embedding a culture of delivering sustained high quality care

VISION

PerformanceOutputs

Resources

+ Our Vision of high

quality care

Board Leadership

People’sKSA

Exp. & Pot.

Organisational Leadership

Leadership

Organisational culture

?

Opening the ‘Black box’:5 Primary drivers of human effort

Meaning

Autonomy

Mastery

Appreciation

Social support

Engagement

Leadership: New vs. ‘traditional’ models

1 From leadership as position, to leadership as practice

2 Leadership as a social process - a dynamic, collective activity

3 Leadership as learning: outcome

From individual to collective

Emerges in and through relationships & networks of influence Interactions are collaborative; influence is 2-way

The kind of social interactions that are called ‘leadership’ result in learning and growth for the individuals involved, and for the organisation

The Model of Engaging Leadership

TLQ™ Dimensions

© Real World Group 2011

ENGAGING INDIVIDUALS

PERSONAL QUALITIES &

VALUES

Being Honest & Consistent

Acting with Integrity

Showing Genuine Concern

Being Accessible

Enabling

Encouraging Questioning

ENGAGING THE ORGANISATION

Supporting a Developmental Culture

Inspiring Others

Focusing Team Effort

Being Decisive

MOVING FORWARD TOGETHER

Building Shared Vision

Networking

Resolving Complex Problems

Facilitating Change Sensitively

‘Engaging’ leadership principles

Leader as servant and partner

Leadership is a social process and is distributed

Leadership is about connecting people and ideas - through a shared vision - co-ownership - co- design, and - empowering partners in implementation

The 2 dimensions of leadership

Degree of Competence

WHAT

Degree to which Engaging

HOW

A

B C

How to achieve challenging goals (and change) through engagement

C.I.A.Accept

Influence & Ideas

Change

Embedding a culture of engagement & wellbeing, high readiness for change, high performance, and high quality care

Leadership & culture

‘2 sides of the same coin’

Creating the appropriate culture is the single most important

responsibility of a leader…

Schein, E.H. (2010). Organisational Culture & Leadership. London, Wiley

Leadership & team working – the new relationship

“..a shared process of enhancing the collective and individual capacity of people to accomplish their work roles effectively... the leadership actions of any individual leader are much less important than the collective leadership provided by members of the organisation”

(Yukl, 1999, p.293).

Does a culture of EL embedded in teams, predict high quality care?

Examined the validity of the model

3-year SDO-funded longitudinal investigation RWG & Kings College 2004 – 2007 (Alimo-Metcalfe et al., 2007, 2008)

Leadership Culture & Change Inventory (LCCi) (80 teams; n = 743)

Outcome measures (external performance measures + engagement & wellbeing)

Controlled for a range of contextual variables

Source: Alimo-Metcalfe, B., Alban-Metcalfe, J., Samele, C. Bradley, M. & Mariathasan, J. (2007) ‘The impact of leadership factors in implementing change in complex health and social care environments: NHS Plan clinical priority for mental health crisis resolution teams (CRTs)` . Department of Health NHS SDO, Project 22/2002

Research findings: Impact of leadership on successful change in the NHS

1. Competencies did not predict performance

2. A culture of engaging leadership significantly predicts:

Team effectiveness/Productivity

Engagement

Reduced stress & emotional exhaustion

Source: Alimo-Metcalfe, B., Alban-Metcalfe, J., Bradley, M., Mariathasan, J. & Samele, C. (2008). ‘The impact of engaging leadership on performance, attitudes to work and well-being at work: a longitudinal study’. The Journal of Health Organization & Management, 22, 6, 586-598.

Clinical leadership: A study of surgical teams

Sample: 669 heart operations in 16 hospitals implementing new micro-surgical technology

Aim: to identify what differentiated the ‘successful’ from the ‘unsuccessful’ implementers

Unexpected findings re what didn’t matter:

- Educational background and experience of the team

- Status of the surgeon

Source: Edmundson, Bohner, & Pisano (2001). ‘Speeding up team learning’, HBR, 125-132

Clinical leadership: A study of surgical teams (2)

Leader created culture of ‘psychological safety’, and engagement

Neutralised fear of embarrassment by encouraging suggestions, pointing out potential problems, admitting mistakes,

Reduced barriers created by a hierarchical culture by emphasising that everyone must feel free to point out suggestions or concerns

“Surgeons gave up their dictatorial authority so that they could function as partners in the operating teams”

Source: Edmundson, Bohner, & Pisano (2001). ‘Speeding up team learning’, HBR, 125-132

2nd 3-year study: The association between leadership and a culture of high quality care, innovation, and improvement – and of staff engagement & wellbeing

Alimo-Metcalfe, B., Bradley, M., Alban-Metcalfe, J. & Locker, A. (2013). Leading to Quality: An investigation of the impact of leadership & team working on staff morale & wellbeing, & team performance, among mental health teams within Yorkshire & the Humber Strategic Health Authority. (Funded by Yorkshire & The Humber SHA. Conducted by University of Bradford School of Management).

Characteristics of high-performing, engaged teams that successfully handle change, & create a culture of quality, innovation, & improvement

Culture of Quality

Innovation & Improvement

Engagement & Wellbeing

Sustained High Quality Services

Encourage Collective

Experience & Learning

Create Culture of Psychological

Safety & Strong Social Support

Engage all in determining how

to achieve the vision

Strengthen a Sense of Team

Potency; Celebrate

Enable a Culture of

Development & Review

Build a Shared Vision

Prioritise regular F2F

communication

Source: Alimo-Metcalfe et al., , 2007, 2008, 2013, 2014

Ensure Clear Goals, Roles, & Responsibilities

Remember the ‘Losada ratio’

3:1Losada, M. (1999). ‘The complex dynamics of high performance teams’. Mathematical and Computer Modelling, 30, (9–10), 179–1

Effect of positive emotions – on team effectiveness Higher Performing teams exhibited a wider range of behaviour, &

their discussions were more fluid & flexible

While having a higher incidence of positive comments, there were also strong challenges. But members “bounced back” quickly after a criticism

Pointing out problems & challenges appeared to ignite performance & inspire the members to think with greater clarity & effectiveness

Where the ratio was lower than 3:1 there was lower resilience & narrower range of behaviours

In particular, after negative comments, people seemed to lose creativity & authenticity

Losada, M. (1999). ‘The complex dynamics of high performance teams’. Mathematical and Computer Modelling, 30, (9–10), 179–192.

Some leadership challenges for you…

How can I strengthen the culture of my team/area to enable colleagues to have a strong sense of meaning in their jobs, and feel excited by, and confident in what they do, and of the future?

What can I do to encourage a healthier ‘positivity ratio’ in my team?

How can I strengthen a culture of engaging leadership in relation to how my colleagues/team relates to patients/other parts of the organisation and with partners & others?

What can I do to encourage a culture of sharing learning , innovation, and of ‘potency’, pride & celebration?

What impact could doing the above have on our patients, colleagues, our partners, our service? How can we measure this?

Who will do this if I don’t? When will I start?

But never forget that…

Culture is me!