© The Johns Hopkins University and The Johns Hopkins Health System Corporation, 2011 Leadership, Teamwork, and Engagement Michael A. Rosen, PhD Armstrong Institute for Patient Safety and Quality Johns Hopkins University School of Medicine

Agenda Why talk about leadership, teamwork, and engagement? What do effective leaders do? 1.Use power wisely. 2.Lead with vision and values. 3.Build trust. Armstrong Institute for Patient Safety and Quality 2

Why talk about leadership, teamwork, and engagement? It matters for managing patient care. It matters for safety and quality improvement teams. It matters at the organizational level. Armstrong Institute for Patient Safety and Quality 3

Trust in Leadership and Patient Safety Armstrong Institute for Patient Safety and Quality 4 Vogus, T.J., & Sutcliffe, K.M. Medical Care, Vol. 45, No. 10 (Oct., 2007), pp

Perceptions of leadership and mortality Armstrong Institute for Patient Safety and Quality 5 Huang et al., 2010 …the odds ratio for mortality was 1.24 for the hospital. For every 10% decrease in perceptions of management items…

Leadership matters at the organizational level Hospital scores on the PSOA Leadership Domain are meaningfully related to Core Measure Performance Weaver, Rosen, Goeschel, et al., in progress

What is leadership? “…the only thing of real importance that leaders do is to create and manage culture… the unique talent of leaders is their ability to understand and work with culture… it is an ultimate act of leadership to destroy culture when it is viewed as dysfunctional.” –Schein, E. H. (2006, p. 11). Organizational culture and leadership. Jossey-bass.

Five conditions leaders can put in place to facilitate teamwork 1.Ensure the team is a ‘real’ team 2.Compelling direction 3.Enabling structure 4.Supportive organizational context 5.Expert coaching Hackman, 2002

What do effective leaders do? 1.Use power wisely. 2.Lead with vision and values. 3.Build trust. Armstrong Institute for Patient Safety and Quality 9

1. Effective leaders use power wisely. What is power? How do leaders exercise power? Which strategies are effective under what conditions? Armstrong Institute for Patient Safety and Quality 10

We talk about empowerment, but what is power? Armstrong Institute for Patient Safety and Quality 11 Power LegitimateRewardCoerciveExpertReferent Control over information

How do leaders exercise power? Rational persuasion Apprising Inspirational appeals Consultation Exchange tactics Collaboration Personal appeals Ingratiation tactics Legitimating tactics Pressure tactics Coalition tactics Armstrong Institute for Patient Safety and Quality 12

What strategies work best? Attempting to influence someone to support and idea or to do something? Consultation and inspirational appeals work well. People don’t understand what you want to do? Rational persuasion works well (in a strong form; weak forms don’t work). People believe in the idea, but don’t think it’s feasible? Collaboration works well. Avoid pressure and legitimating tactics They rarely work. Have an idea with strong and salient personal benefit for people? Apprising tactics work well. Influencing a subordinate? Exchange and ingratiation are moderately effective. Ineffective for dealing with superiors. Pre-existing personal relationships with person you are influencing? Personal appeals are moderately effective. Armstrong Institute for Patient Safety and Quality 13 Yukl, 2009

2. Lead with vision and values Vision is a leader’s statement of a desired, long-term future state. –The quality of a vision statement has been shown to impact individual, group / team, and organizational outcomes (e.g., performance, attitudes, capacity to manage change). Armstrong Institute for Patient Safety and Quality 14

What does an effective vision statement look like? Brevity Clarity Abstractness and stability Challenge Future orientation Desirability or ability to inspire Armstrong Institute for Patient Safety and Quality 15 Kirkpatrick, 2009

Leading with vision and values State the desired values. Model the desired values. Integrate the values into the organizational systems. Armstrong Institute for Patient Safety and Quality 16

3. Build trust. Trust is the estimated probability that someone will do something: –That will affect our own actions, workload, emotions, or other outcomes –Without our being able to monitor and double check they’ve done it Do you feel comfortable putting something you value in the hands of someone else? Armstrong Institute for Patient Safety and Quality 17

Benevolent Intentions Integrity Ability Mayer & Davis (1999); Colquitt et al., (2007) Components of trust

Components of Trust Benevolent Intentions Integrity Ability My perception that another… Is capable of performing task at hand Is known to be successful at things they try Has necessary knowledge Is well qualified Has skills that increase our performance Mayer & Davis (1999); Colquitt et al., (2007)

Benevolent Intentions Integrity Ability My perception that another… Cares about my welfare Would not knowingly do anything to hurt me Looks out for me Will go out of their way to help me Mayer & Davis (1999); Colquitt et al., (2007) Components of Trust

Benevolent Intentions Integrity Ability My perception that another… Will stick to their word Tries to be fair in dealing with others Shows consistency between their words & actions Uses sound principles or values to guide their behavior Mayer & Davis (1999); Colquitt et al., (2007) Components of Trust

How can leaders build trust? Build a culture of trustworthiness. Increase leader ability. Build leader benevolence. Demonstrate leader integrity. Armstrong Institute for Patient Safety and Quality 22

Action items Self-assess (as a team)… –Who uses what type of power through which means in your projects? Are there better approaches? –Do you have a vision statement for your organization? For your CUSP team? Does it meet the criteria of effectiveness? How is it implemented? –Where are our opportunities to build trust? Increase ability? Build benevolence? Demonstrate integrity? Armstrong Institute for Patient Safety and Quality 23