Maggie Woods Leadership Development Team, NHS South Central Programme Lead for Leadership, Oxford Deanery

What we will cover today Context Leadership Teamwork and leadership Leadership and change Two approaches to leadership So what?

The NHS sees I million patients every 36 hours, spending 2 billion a week. The number of managers is 3.6 % of the workforce Source Kings Fund 2011

% patients diagnosed with dementia whose care has been reviewed in the last 15 months, 2009-10

The number of people aged 85+ in this country will double in the next 20 years

4% efficiency saving for 4 years = 20 billion

Constants Clinical Engagement, GP commissioning Relationship with patients, shared decision making Outcome focused to drive delivery Independent sector, voluntary and private, QIPP challenge

Lets talk Leadership………

Leadership is the art of motivating a group of people to achieve a common goal Kings Fund May 2011

The function of leadership is to add value

The NHS Leadership Framework It includes 5 core dimensions, drawn from the MLCF/CLCF: Demonstrating Personal Qualities Working with Others Managing Services Improving Services Setting Direction There are two additional dimensions Creating the vision Delivering the strategy

Management Matters! Kings Fund May 2011

Interesting Reading Kings Fund report; May 2011 http://www.kingsfund.org.uk/publications/nhs_leadership.html The conclusions challenge some of the negative attitudes towards managers, and questions current plans for major reductions in management and administration costs. The commission believes that the NHS needs to move beyond the outdated model of heroic leadership to recognise the value of leadership that is shared, distributed and adaptive. In the new model, leaders must focus on systems of care and not just institutions and on engaging staff in delivering results.

Outcomes, Activities, Behaviours PEOPLE + RESOURCES Outcomes, Activities, Behaviours ACHIEVE VISION KNOWLEDGE SKILLS ABILITIES VARIABLES LEADERSHIP/ MANAGEMENT

Poor leadership has a cost, Francis – what he identified: Preventable deaths insufficient attention to professional standards a weak professional voice in management decisions acceptance of poor standards of conduct low staff morale - demoralised a lack of any systematic approach to coordinating care very poor communication

Team Working and Leadership

% Staff Working in Teams The link between the Management of People & Patient Mortality in Acute Hospitals West M et al. Int J HR Management 2002 13:8 1299-1310

“Don’t tell people how to do it, tell them what to do and wait for the results” General Patton

Employee Engagement (NHS Staff Survey Findings) Performance Appraisal Team Working Job Design Supervisors’ Support Work Pressure Having an interesting job Feeling valued by colleagues Overall Engagement Advocacy Intrinsic Engagement Involvement Employee Reactions Health and Well-being Stress Presenteeism Hospital Performance Quality of Services Financial Performance Absenteeism Patient Mortality Rate client Satisfaction

Benefits of Team Working Reduced hospitalisation and associated costs Improved service provision Improved levels of innovation in patient care Reduced error rates Lower patient mortality Enhanced patient satisfaction Increased staff motivation and mental well-being West, M.A. & Borrill, C.S. (2005). The Influence of Team Working. In Cox, J., King, J., Hutchinson, A. & McAvoy, P. (eds). Understanding Doctors’ Performance. Oxford: Radcliffe Publishing.

Team functioning and patient satisfaction 3.3 3.2 3.1 Clarity of objectives 3 Reflexivity Patient experiences Support for innovation 2.9 2.8 2.7 Low Moderate High Team functioning

Staff absenteeism 5% more staff working in real teams associated with 0.27% in overall absenteeism rate (p < .001) For an “average” acute hospital, this represents a potential estimated saving of over £1 million per year in direct salary alone

Does your team have clear goals/ objectives? Who is in your team? Questions for you? Does your team have clear goals/ objectives? Who is in your team? Do you have regular 121s and feedback mechanisms? M West research indicated that in a 1/3rd of GP surgeries at least 2 of the GPs don’t talk to ach other.

Leadership and Change Management

It takes 18 months for a change to become effective.

Change as a Human Process DENIAL Anger COMMITMENT Internalising Realisation Shock Self Esteem or Morale PAST FUTURE Search for meaning Depression Testing RESISTANCE Acceptance & letting go EXPLORATION Time Adapted from Adams, Hayes and Hopson : Transition, understanding and managing personal change; 1976

Future, Engage , Deliver, Steve Radcliffe Good To Great, Jim Collins

Help people see the future, create a future that is compelling, makes best use of their skills. Move from the present. Future Engage Deliver Engage with people: open & honest conversations. Feedback Maintain a healthy emotional bank account. Listen and hear. Be present. Autonomy. Cross sectors/ boundaries Mobilise the team’s drive for improvement, provide a sense of purpose, hold people to account, drive for results and celebrate success so people feel they have done something important . Make things happen Leaders may vary in the three areas, FED, try not to focus on the ones you like, Good leaders are up to something! Feedback, give and receive, lift spirits, empower, challenge, identify the possibilities, Ask the question, how am I doing as a leaders. Be present, notice things, Don ignore the most difficult, Engage , cascade, plan a campaign, who is the most difficult

Good to Great, Level 5 Leaders All good to great companies had level Five leaders Level 5 = personal humility and professional will Modest and safe effacing, motivated to produce sustainable results, plough horses Level 5 leaders; look out the window to attribute success, in the mirror when things go wrong Many people have the potential to be level five leaders Most level five leaders come from within their companies

Level five leaders, get the right people on the bus… and the wrong people off the bus, and then figured out where to drive it When in doubt…..don’t hire - keep looking When you need to make people change- act Put your best people on your biggest opportunities, not your problems

Create a climate.. Lead with questions…not answers Engage in dialog and debate not coercion Conduct investigations without blame Build red flag mechanisms to identify essential information that cannot be ignored

What actions do you need to take to become the leader that you aspire to be?

Thank you maggie.woods@southcentral.nhs.uk