How to lead a QIP Managing the team and changing the culture

Dr Adham Khalek - RCEM 13th April 2016

Overview• Why is leadership important

• Leadership vs. Management

• Do’s and Don’ts

• Organisational Culture

• Influencing Change

Why is leadership important?

Leadership and

management

Goals & Objectives Vision

PeopleOrganisation & Structure

Autocracy Democracy

EnablingRestraining

ChallengingConforming

Originating

Innovating

Imitating

Procedures Policy

Inspiring Trust

FlexibilityConsistency

Directing & Controlling

Administering

MANAGERFOCUS

LEADERFOCUS

MANAGERFOCUS

LEADERFOCUS

GOOD MANAGERS DO THE THINGS RIGHT

GOOD LEADERS DO THE RIGHT THING

EMERGENCYMEDICINECLINICIAN

What is your Style?

Coaching

Goleman Leadership Styles

Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results

Coercive

Authoritative

Affiliative

Democratic

Pacesetting

Coercive

Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results

The leader’s modus operandi Demands immediate compliance

The style in a phrase “Do what I tell you”

Underlying emotional intelligence competencies

Drive to achieve, initiative, self-control

When the style works best In a crisis, to kick start a turnaround, or with problem employees

Overall impact on climate Negative

Authoritative

Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results

The leader’s modus operandi Mobilises people towards a vision

The style in a phrase “Come with me”

Underlying emotional intelligence competencies

Self confidence, empathy, change catalyst

When the style works best When changes require a new vision, or when a clear direction is needed

Overall impact on climate Most strongly positive

Affiliative

Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results

The leader’s modus operandi

Creates harmony and builds emotional bonds

The style in a phrase “People come first”

Underlying emotional intelligence competencies

Empathy, building relationships, communication

When the style works best To heal rifts in a team or to motivate people during stressful circumstances

Overall impact on climate Positive

Democratic

Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results

The leader’s modus operandi Forges consensus through participation

The style in a phrase “What do you think?”

Underlying emotional intelligence competencies

Collaboration, team leadership, communication

When the style works best To build buy-in or consensus, or to get input from valuable employees

Overall impact on climate Positive

Pacesetting

Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results

The leader’s modus operandi Sets high standards for performance

The style in a phrase “Do as I do, now.”

Underlying emotional intelligence competencies

Conscientiousness, drive to achieve, initiative

When the style works best To get quick results from a highly motivated and competent team

Overall impact on climate Negative

Coaching

Goleman D. Leadership That Gets Results [Internet]. Harvard Business Review. 2000 [cited 2016 Apr 4]. Available from: https://hbr.org/2000/03/leadership-that-gets-results

The leader’s modus operandi Develop people for the future

The style in a phrase “Try this”

Underlying emotional intelligence competencies

Developing others, empathy, self-awareness

When the style works best To help an employee improve performance or develop long-term strategic strengths

Overall impact on climate Positive

Do you have just one Style?

Emotional Intelligence

• The ability to manage ourselves and our relationships effectively

• Unlike IQ can be learned

• Increases with age

Goleman D. What Makes a Leader? [Internet]. Harvard Business Review. 2004 [cited 2016 Apr 4]. Available from: https://hbr.org/2004/01/what-makes-a-leader

Emotional Intelligence• Five components

• Self-awareness

• Self-regulation

• Motivation

• Empathy

• Social SkillGoleman D. What Makes a Leader? [Internet]. Harvard Business Review. 2004 [cited 2016 Apr 4].

Available from: https://hbr.org/2004/01/what-makes-a-leader

High-Impact Leadership Behaviours

• Person-centeredness

• Front Line Engagement

• Relentless Focus

• Transparency

• BoundarilessnessSwensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve Health of populations, and reduce Costs. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013.

Leadership DO & DONT’s

DO:

• Define what success & failure will look like

• Have a strategy

• Identify & engage with key stakeholders

• Constantly review progress & feedback

DON’T:

• Expect change overnight

• Avoid dealing with conflict or problems

• Require 100% ‘Buy-in’

• Let failure stop you

Assessing the

culture

Assessing Culture

Staff unempowered and disengaged

All change resisted

Normalisation of deviance

Resting on old laurels

Blame externalised - No insight

Disconnected management

Invisible/Ineffective Clinical leadership

No departmental or Trust identity

Low morale

Assessing Culture

Staff listened to and actively involvedChange embraced

Open approach - Good Clinical Governance

Department / Trust constantly looking to improve

Appropriate analysis of issues - no cognitive dissonance

Engaged management aware of ‘coal face’ issuesClinical leadership fully engaged with the issues Staff proud to work for department / Trust

High morale

Influencing change

Force Field Analysis• Some Types of forces:

• Resources

• Vested interests

• Traditions

• Organisational Structures

• Regulations

• Institutional Policies/norms

NHS Improving Quality. Force Field Analysis [Internet]. 2014. Available from: www.nhsiq.nhs.uk

Sustainability Modelling

• Ten factors over three domains

• Process

• Staff

• Organisation

Doyle C, Howe C, Woodcock T, Myron R, Phekoo K, McNicholas C, et al. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement. Implement Sci. 2013;8:127.

Gregory Shea & Cassie Solomon Change Management Is Bigger Than Leadership. Harvard Business Review. 2013 [cited 2016

Apr 8]. Available from: https://hbr.org/2013/03/change-management-is-bigger-th

“….therein lies the key to successful, embedded and sustained change: alter the

environment, and people will adapt to it…..We behave based on the reality around us”

Summary• Why is leadership important

• Leadership vs. Management

• Do’s and Don’ts

• Organisational Culture

• Influencing Change