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Leading with values
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What we will learn together today
1. Why values are important
2. Our influence as leaders
3. Managing attitude and behaviour
4. Cascading values to our teams
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“I’m afraid it’s curiosity”
Curiosity increases intelligence. When the brain experiences novelty,
it releases dopamine – which increases synaptic plasticity.
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Oxytocin. ‘The social hormone’.
If you let someone know you trust them – it will increase their oxytocin
levels, and they will consequently exhibit more trustworthy behaviours.
What comes first. Trusting someone, or trustworthy behaviours?
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Proposed shared values and behavioursMore than 3,500 patients and colleagues helped develop these values and behaviours. They describe how we expect
everyone who works here to behave with others - patients, whānau, colleagues, providers and other organisations.
They apply to all of us, whatever our role or level.
Our draft values What we want to see from each other, at our best… What we never want to see from each other…
Kind Manaakitanga
Our kindness fosters better care and better
teamwork
• Puts people at the centre of their care
• Is attentive, helpful, caring, supportive
• Treats people with respect
• Protects people’s dignity and privacy, and helps to reduce pain
• Is reassuringly professional
• Puts people at ease
• Thinks they know better for others
• Makes people feel like an inconvenience
• Shows no compassion for anxiety, stress or pain
• Is abrupt, rude, bullying or judgmental of others
Open Pono
We listen, hear and communicate openly
and honestly and with consideration for others
• Listens and hears, with understanding and empathy
• Involves people in choices; Communicates clearly and openly
• Keeps people informed, so they know what's happening
• Displays honesty and integrity
• Speaks up if they have a concern; accepts feedback; keeps people safe
• Talks over other people, makes assumptions, fobs people off
• Ignores or excludes other people, whānau or teams
• Leaves people in the dark, or feeling confused
• Walks by poor care or behaviour, rejects feedback
Positive Whaiwhakaaro
We bring a positive attitude and are always
looking to do things better
• Is positive, friendly, approachable,and smiles when appropriate
• Always looks to improve, and has a ‘can do’ attitude• Aims for excellence, high quality, and the best outcomes• Is appreciative and encouraging
• Negativity, blames other people, excessive grumpiness• Has a ‘can’t do’ attitude, and acts as a barrier to change• Is satisfied with under-performance or poor quality• Belittles or criticises others’ efforts
Community Whanaungatanga
Our success comes from nurturing and
building on the strengths in our community
• Is culturally sensitive, respects others• Connects people, teams, providers and communities• Trusts people and is trustworthy • Works in partnership, collaborates well• Values other people’s time, aims to be efficient and productive• Values people, builds relationships
• Shows little consideration of cultural needs
• Works in a silo, is inward-looking
• Dismissive of other people’s skills, experience, or ideas; micro-manages
• Dismisses the value of other people’s time, is late, makes people feel rushed or comes across as “too busy”
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Using values to stimulate conversation
1. Discuss: how can our values be helpful to us as a team?
2. Read through our values and behaviours
3. Each find a ‘green’ behaviour, which your team already role models and lives up to
3. Then each find one ‘red’ behaviour where your team could do better, or be more consistent
4. Discuss what you found in pairs or small groups. What did you learn from this?
Discussion: using values to inspire team improvement
If you’d like to give more feedback to our draft values and behaviours,
the survey will remain open to the end of the week, on Pulse.
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When we get it right for patients.
Source: In Your Shoes, n = 179; Māori forum – patients and whānau, n = 45
The 224 patients who took part in In Your Shoes/Māori forum sessions talked through their experiences in detail. These stories are captured in more than 400 pages of text, which are not shared in this report to protect confidentiality. This analysis draws out key words from positive aspects of those stories, showing what we are doing well, from our patients’ perspective. Word height is proportional to usage. These good experiences cluster into 7 key themes.
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When we don’t get it right for our patients
Source: In Your Shoes, n = 179; Māori forum – patients and whānau, n = 45
As patients told us about their experiences in In Your Shoes sessions, they were asked to identify which aspects were positive, and which were negative. This analysis draws out the key phrases patients used when talking about negative aspects of their experience. Word height is proportional to number of mentions. Clustered into 6 key themes – which cover behaviours, processes, environment, as well as the emotional impact of poor experience on patients and whānau.
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Why focus on improving patient experience?
“The available evidence
suggests that measures
of patient experience
are clear, distinctive
indicators of healthcare
quality.”Manary et al, New England Journal of Medicine, 2013
Our objective is to improve our patient experience, building on existing good practice, because a better patient experience drives improved patient care.
p3All tools and approaches © April Strategy LLP 2016
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A ‘good day’ at work for staff…
Enough time to do the job properly. A good staff: patient ratio, finishing on time.
Safe and supported. Supportive manager and colleagues.
Clear instructions and safe practice.
Teamwork.All on the same page.Everyone knows their roles, we gel ‘as
one’ team, we work towards clear goals.
Happy to help others. The charge nurse asks ‘can I
help?’ when we’re really busy.
Being around positive,
cheerful people.Greeted with a smile, hearing
laughter, seeing enthusiasm.
Communication. Honest conversations.
A shared understanding.
Community.Connected with patients in the
community, building trusted
relationships. Interacting
with staff. Sharing moments.
Contributing.Mutual respect. ‘Have a say’.
Feedback is listened to.
Prepared and in control.A well-oiled wheel. On time. Work flows well.
We make a plan and a back up plan.
Finding solutions.Learning as we go. Using our skills and
experience to achieve something tangible.
Focused
and ‘in
the zone’.Giving 100%.
Engrossed in
achieving a task.
Busy. Productive.Efficient and
making
progress.
Looking
forward.
Sparking
ideas,
making
changes.
Making a
difference.Doing something
that changes
someone’s life.My work matters. It
gives me a buzz.
Feel valued.A ‘thanks’ for
the little things.A senior clinician delivered baking to
everyone in the department. A client rang
to say ‘thank you’ after they’d been upset.
Positive
outcomes and
feedback.Proud to be
giving the care
I want to give.
Source: In Our Shoes, n = 415
In the In Our Shoes sessions, we asked attendees to recall their most important ‘good day’ at work, at the DHB, and identify what caused that good day. In the analysis below, the area of each box is proportional to the number of staff for whom this was their most important driver of a ‘good day’. The words are quotes from staff attendees that sum up that cluster well.
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A ‘bad day’ at work for staff…
Under resourced.
Understaffed.Growing patient numbers...
IT issues causing
delays and frustration.
Negativityflourishing in the team.
Mood vacuum cleaners.‘Victim mode’, negatives not solutions.
Communicationbreak downs.
Having to stalk managers for a
response. No discussions.
Not listened to, not believed, undermined.
Feeling fobbed off and being
unable to express myself.
Silos. Not
working together.No-one prepared to help.
People defend their patch
at the expense of others.
Resistance to change. A problem exists but
nothing is done. Barriers.
Frantically busy.More and more expected
all hours and all days.
When the workload tips the
balance, no-one enjoys it.
Interruptions.Constant demands.
Multiple requests and
high expectations.Under pressure, pulled
in too many directions.
Blame. Criticism.Feeling ashamed, feeling a failure.
Blamed even when it’s not your fault.
Rude colleagues.
Disrespected. Judged.Hostility. Phone calls received with silence.
Feeling a nuisance, embarrassed by others.
Bullied.Watching others
be bullied.Scared, intimidated.
It makes you feel
unworthy, incapable.
Isolated.
A lack of
support.Feeling like a
‘fish out of
water’, like
I’m drowning.
Set up
to fail.
Taken for granted.
Unappreciated. Efforts are not validated.
Abilities dismissed. Put down.
Undervalued.
Po
or
lea
ders
hip
,
hie
rarc
hy,
mic
ro-
ma
na
ge
me
nt.
Re
ac
tive
ch
an
ge.
De
cis
ion
sa
re
made e
lsew
here
,
with
ou
t m
y in
pu
t.
Tim
e d
ela
ys,
can
cellati
on
s. Inadequate.
Unable to give
basic care.Disappointment. Patient not getting better.
Source: In Our Shoes, n = 415
In the In Our Shoes sessions, we asked attendees to recall their most important ‘bad day’ at work, at the DHB, and identify what caused that bad day. In the analysis below, the area of each box is proportional to the number of staff for whom this was their most important driver of a ‘bad day’. The words are quotes from staff attendees that sum up that cluster well.
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Why focus on improving staff experience?
Our objective is to make Southern DHB an even better place to work, building on existing good practice, because higher staff engagement drives higher quality patient care.
“There is a clear
relationship between
the wellbeing of staff
and patient wellbeing.”Boorman 2009, Kingsfund 2013
p3All tools and approaches © April Strategy LLP 2016
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The importance of leaders in healthcare
70%70% of the variation in
levels of engagement
between staff is driven
by employees’ direct
line manager
Employees who strongly
agree that their manager focuses
on their strengths are more than
TWICE as likely to be engaged
(67%), as those whose manager
focuses on weaknesses (31%)
Organisations with fastest growth in productivity rates, source 80% of improvement ideas from the
front line.
Our objective is to develop the leadership skills in clinical and non-clinical leaders, that are essential in delivering the very highest level of quality for patients.
“Positive staff ratings of both top
leadership and supervisory
leadership were associated with
relatively high staff job
satisfaction… with clinical
governance review ratings and
lower levels of patient complaints.”
Leadership and Leadership Development in Health Care: The
Evidence Base. The Kings Fund. Professor Michael West et al. 2015
p3All tools and approaches © April Strategy LLP 2016
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The CHOICE cycle
The choice cycle.
“We get what we give”
I get
I do
They get
They do
For individualsFor leadersFor organisations
It’s down to themIt’s up to me
p10All tools and approaches © April Strategy LLP 2016
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Coaching self-awareness
What I get as a result
My actions and behaviours
What the other person does
What others get as result
I get
I do
You get
You doStart here
1 What did you do4 What result did you get
5 What result did you WANT?
6 What could you have
done differently?
2 What did the other person get /
understand, how did they feel?
7 What would they
have got instead?
3 What did they do
8 What might they have
done differently?
9 What might the result have been?
Choice
cycle
p11All tools and approaches © April Strategy LLP 2016
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What happens if we don’t give feedback?
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Practice giving feedback
A time when you weren’tliving up to our values
In pairs – tell you partner
• Your behaviour• The impact
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Constructive feedback
‘So what was happening
there?”
All tools and approaches © April Strategy LLP 2016p8
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Sign in pairs
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The power of positivity
YESYESYES
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Choosing a positive attitude
It’s upto me
It’s downto them
GETTING
UNSTUCK
DO SOMETHING
If there were just one
thing that you could
do… what would it be?
• Results
• Taking action
• Doing something
• Influencing where you can
• Stuck, excuses…
• But…
• They never…
• It’s the…
All tools and approaches © April Strategy LLP 2016p13
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A ‘good day’ at work for leaders…
Less pressure, no distractions. Time to be visible and
make human connections.
Fully staffed. Others have
a manageable workload.
Available resources.
Trusted and
empowered.Autonomy to decide. Freedom
to use flair. Showing initiative.
Enthusiasm and positivity.People willing
to ‘give it a go’. Each day is a chance for
fresh opportunities.
Engagement, high energy.
Supporting and enabling.Providing a clear understanding of roles,
recognising and rewarding, advocating.
Positive communicationbetween staff and patients. Openness.
Talking directly to people, one-to-one.
Seeing my team pull together.
A unified goal and approach.
Great team spiritkeeps the service safe.
Staff know each other’s strengths, work
with a shared purpose and know how
they can each contribute. It validates
my role and makes me feel excellent.
Feeling
proud.My team did
their utmost.
Thanked. Feeling accepted.Recognition. Valued as
part of the team.
Listened to.Seniors listen to my
ideas. Supported.
Pre-planning
and being
prepared.Knowing what
needs to be done.
Implementing
change.Talking through
barriers, moving
forward.
Working together
to improve care.
Good things come
out of a challenge.
Achieving milestones. ‘All ducks are in
a row’ and the
team working
with me make
an achievement.
Solving
problems.Ideas that result in
a solution. Staff
asking ‘how can we
make this better?’
Difficulties absorbed.
Confidence
in my staff
to deliver.Staff using
their areas
of expertise.
Hands on care
and positive
outcomes. Patient and family focus.
Source: In Leaders Shoes, n = 325
In the In Leaders’ Shoes sessions, we asked attendees to recall their most important ‘good day’ at work, as a leader, and to identify what caused that good day. In the analysis below, the area of each box is proportional to the number of leaders for whom this was their most important driver of a ‘good day’. The words are quotes from leaders attendees that sum up that cluster well.
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A ‘bad day’ at work for leaders…
Doing more with less.
Insufficient tools,
no beds, a lack
of staff, poor IT.
Obstructive people. Passive/aggressive behaviour,
bullying attitudes, criticism, defensiveness, distrust.
Downward spirals
of negativity.Collective negativity
drags you down. Staff frustration immobilizes you.
Conflict in the team. Or when our cultural protocols
conflict with business protocols.
Poor communication due to a lack of cohesiveness.
I become the fixer, putting out
fires. It creates more work.
Breakdown in
team functioning. Not doing their part, no responsibility.
Ignored.Staff refuse to listen.
Not heard by leadership.
Too much pressure.
Overwhelmed. No time to meet everyone’s expectations.
Lack of shared care resulting in
more work and time pressure.
Hurdles restraining innovation. Barriers. Unable to
use good ideas.
Slow process of change.Po
or
care
.D
ecis
ion
s n
ot in
th
e
pa
tie
nt’s b
est in
tere
st.
Dif
fic
ult
c
on
ve
rsa
tio
ns.
Managin
g u
npro
fessio
nal
behavio
urs
, ste
pp
ing
in
.
Bu
reau
cra
tic
pett
iness.
Tim
e w
astin
g. T
rivia
.Powerless.
Stuck in
the middle.Struggling to get
permission to do
your job. Futility.
Devalued.
A lack of
respect for
what we do.Being at the end of
the blame chain.
Feeling
lost. Lacking
support
and
direction.
Source: In Leaders Shoes, n = 325
In the In Leaders’ Shoes sessions, we asked attendees to recall their most important ‘bad day’ at work, as a leader, and identify what caused that bad day. In the analysis below, the area of each box is proportional to the number of leaders for whom this was their most important driver of a ‘bad day’. The words are quotes from leaders attendees that sum up that cluster well.
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Getting unstuck exercise
It’s upto me
It’s downto them
GETTING
UNSTUCK
DO SOMETHING
If there were one thing
that you could do…
what would it be?
• Results
• Taking action
• Doing something
• Influencing where you can
• Stuck, excuses…
• But…
• They never…
• It’s the…
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Think of something that makes a
bad day at work for you. Start to
get unstuck. If there were one thing
you could do, to start to tackle or
overcome this – what would it be?
Coach each other in pairs – to get
to a first step you could take…
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S
T
R
O
N
G
SuccessesWhat have you achieved. What are you proud of? What is your success story today / this week?
TalentsWe all have individual strengths. Which of your personal talents / skills helped you to achieve this?
ReasonsWhat is it about these strengths that helped you make this success happen?
OpportunitiesWhich aspect of your job could you be doing better right now? What objective are you not delivering on? Where is your specific opportunity to do better?
New useHow might you use the strengths you talked about, to help you improve / do better in that area?
GroupWhat strengths do other people in the group / team have, that add to yours – you could ask for their help
Strengths-based coaching
All tools and approaches © April Strategy LLP 2016p21
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2x
Antoine de Saint-Exupery
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Staff and Leader ambition
Our vision: let’s make Southern the most…
…healthcare service in all New Zealand
Source: In Our Shoes, n = 415; In Leaders Shoes, n = 325
In the staff and leadership sessions, we asked attendees to define a ‘vision’ for the DHB by asking ‘if we could make the DHB the most ‘something’ in New Zealand – what could that ambition be?’ These are their responses. The size of each word is proportional to the number of people who gave that word as their ambition for the DHB.
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Defining values-
based leadership
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Remember the best leader / manager you ever had. What did they do to help you be at your best?
Remember the worst leader manager you ever had. What were the things they did that ?
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How to improve engagement
Communication• Employees whose managers hold regular meetings
with them are 3x more likely to be engaged• Even higher if daily contact (face to face / phone)
Set goals / give feedback• Engaged employees - more likely to say their
manager helps them set work priorities and performance goals
• And that their manager holds them and others accountable
Focus on strengths• 67% of employees who say their manager focuses on
their strengths are engaged vs 31% of those who say their manager focused on their weaknesses
Source: Gallup. The state of the American Manager 2015p25
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Behaviours staff want from managers/leaders…
Source: In Our Shoes, n = 415
More of Less of
In the Leading with Values development workshops in May, we will ask leaders to set out their own ‘behavioural compact’ – co-creating the expectations they have of themselves. The next 3 charts begin to set out stimulus for that conversation. This analysis shows what DHB staff ask for ‘more of’ and ‘less of’ from their managers and leaders. Word height is proportional to the number of mentions.
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Behaviours leaders themselves can commit to…
Source: In Leaders Shoes, n = 325
This analysis shows the behaviours that DHB leaders can themselves commit to demonstrating ‘more of’ and ‘less of’. Word height is proportional to the number of mentions.
More of Less of
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Identity
Beliefs and values
Capabilities
Behaviour
Environment
Mission & Purpose
What are the characteristics of a great, values-based leader?
Robert Dilts – The Neurological levels of change
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THE BENEFIT OF APPRECIATION
Receiving gratitude
78% of people say they
would work harder if they were
recognized.
67% of employees are
motivated by praise. More than
by a cash bonus!
14% better employee
engagement in appreciative
organizations
80% of people who feel
appreciated are not actively
looking for another job
Source - Globoforce Mood Tracker
Practicing gratitude• Decreases stress hormones
like cortisol by up to 23%
• Decreases blood pressure and
heart rate variability
• Lowers risk of depression
• Improves our own self-esteem
• Improves our resilience and
ability to deal with trauma
And…
• 95% of people think more
grateful bosses will be more
successful
• Only 18% thinks it shows
weakness in a manager
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37All tools and approaches © April Strategy LLP 2016
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Thank you
@timmkeogh
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