1. Launch Event for NW R&D Programme
Leadership and Team Working for High Quality Care
 Professor Michael West
Lancaster University Management School
And
The Work Foundation
Launch Event for NW R&D Programme
Releasing Potential
Midland Hotel, Manchester
27th June 2012

2. Leadership for high quality patient care
Patient focus
Clear aligned goals and objectives at every level
Good people management
Employee engagement
Positive emotional environments and relationships
Real team working

3. Patient Satisfaction  
Patient satisfaction highest in trusts that have clear goals at every level - communication between patients and staff is good; patients feel involved in decisions about their care.
Staff views of their leaders strongly related to patients’ perceptions of the quality of care.
Staff satisfaction and commitment predict patient satisfaction.
Supportiveness of immediate managers and extent of staff positive feeling predicts patient satisfaction.
Discrimination against BME staff background predicts low patient satisfaction.

4. Patient Satisfaction  
Bullying, harassment or abuse from patients/ relatives/ friends links to patients not having respect and dignity.
Physical violence from patients etc. predicts low patient satisfaction.
High work pressure - patients report too few nurses. Errors, near misses etc., patients report insufficient support, information, privacy and respect.
Poor staff health and well-being, high levels of presenteeism, work-related stress, injury rates, turnover- patients less satisfied, poorer quality of care, perform badly financially and have higher levels of absenteeism.

5. Patient Satisfaction  
Staff receiving job-relevant training, helpful appraisal meetings, and good support from line managers have both low and decreasing levels of patient mortality at the same time as providing better quality care for patients generally.
Staff having health and safety training is related to patients’ perceptions of quality of care.
A well structured appraisal leads to high staff engagement, better health and well-being and less ‘presenteeism’. Poorly structured appraisals have no effect on engagement.
Trusts with higher levels of staff engagement deliver services of higher quality and perform better financially; higher patient satisfaction scores, lower staff absenteeism and lower patient mortality

6. Patient Mortality
The best predictor of patient mortality is percentage of staff working in well structured teams
Those working in teams have better overall health and well being and lower levels of stress and presenteeism.
Good training and development opportunities for staff and support from managers linked to lower patient mortality
Lower mortality in trusts whose staff have opportunities to influence and contribute to improvements at work.
The percentage of staff receiving well structured appraisals is also related to patient mortality.
A positive organisational climate is associated with low and declining levels of patient mortality.

7. Turnover
Staff plan to leave when they experience harassment, bullying or abuse from their colleagues or managers
When they witness errors that could harm patients or staff when they do not see effective action by managers towards violence or harassment from patients etc.
They are less likely to leave if they have flexible working options
Those working in effective and supportive teams are much less likely to leave the service.

8. Absenteeism
Key factors are whether staff feel dissatisfied with the quality of work and patient care they are able to deliver
Not having an appraisal in the last 12 months
Suffering work-related stress, physical violence from staff, patients or members of the public in the last 12 months
Not having equality and diversity training in the last 12 months
Trusts with more engaged employees have much lower absenteeism.

9. Boorman Report - Absenteeism
10.3 million working days per year
45,000 whole time equvalents (WTEs)
4.5% of workforce; £1.75 billion
BT and Royal Mail achieved 30-40% reductions saving £555 million

10. NHS stress, health and well-being
‘Presenteeism’ Pressure to attend when unwell – 22%
NHS as exemplar e.g., smoking, drinking, diet
Bullying and harassment (14% report bullying by managers and colleagues in 2010)
A move from average to good staff health well being would save 840,000 staff days per year (£13.7 million)
Use of agency staff to cover absence costs £1.45 billion; recruitment costs to cover turnover £4.5k; ill health retirement £150 million

11. Infection Rates
In trusts where a large percentage of staff feel they can contribute towards improvements at work, infection rates are decreasing
Infection rates are also falling in trusts that invest in staff training.
Where staff report errors, near misses and incidents, the quality of services improves
A culture of learning rather than blame leads to service improvement for patients
An increased focus on and support for incident reporting leads to improvements in the quality of patient care

12. Employee Engagement Performance Appraisal Employee Reactions
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
Patient Satisfaction

13. Positivity builds resilience
Barbara Fredrickson
Positivity ratio > 3:1; Maximum 11>1
Fredrickson & Losada, American Psychologist (2005) 60,
(... and negativity is necessary)

15. Positive affect
Job satisfaction is associated with better performance – individual and organizational levels
CEO positive affect, climate and company performance
Disruptive behaviour, conflict and feedback

16. A culture and all leaders focused on patient needs
A culture of trust - in leaders, managers and system
What leaders pay attention to, monitor, model and resource
The criteria for recruitment, selection, promotion and disciplinary action
Flat hierarchies, rituals and rites; celebrations of accomplishment and innovation
The focus of the organisation’s systems and procedures is on meeting patients’ needs

17. Key Issues Positivity Building trust
Relationships and managing poor relationships
Giving feedback and appreciation
Encouraging innovation

18. Team working in organizations promotes productivity, innovation and staff well being

19. Benefits of Team Based Working
Reduced hospitalisation and costs
Increased effectiveness and innovation
Increased well-being of team members
Multi-disciplinary teams deliver high quality patient care and implement more innovations
Lower patient mortality
Reduced error rates
Reduced turnover
Lower and sickness absence
Increased organisational commitment and engagement

20. Health care team effectiveness1
1.5 2
2.5 3
3.5
<3.2
>3.8
External ratings of effectiveness
Team Functioning

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

22. Team working and mental health%

23. Leadership and health care team effectiveness
% of team members reporting clear leadership

24. Employee Involvement Programme*
The extent of team working in hospitals predicts:
job satisfaction
organisational commitment
adherence to organisational
rules and procedures
individual and organisational
innovation
cooperation with co-workers
patient mortality
West et al., Working together: Staff involvement and Organizational
Performance in the NHS. Final Report

25. Working in Teams in the NHS
‘Do you work in a team?’
If yes …
Does your team have clear objectives?
Do you have to work closely together to achieve these objectives?
Do you meet regularly to review your team effectiveness and how it could be improved?

26. Team working in Primary Care
300 PCTs
50,000 respondents
% working in real teams
% working in pseudo teams
Organizational health and safety overall
.41
-.43
% staff suffering injury at work in previous year
-.30
.36
% staff witnessing potentially harmful errors/near misses in previous month
-.32
.30
% staff experiencing physical violence in previous year
-.36
.34
% staff experiencing bullying, harassment or abuse in previous year
-.29
50, trusts

27. Working in Team and Errors, Stress and Injury (170 acute trusts, 120,000 respondents)

28. Working in Teams, Harassment and Violence
All odds ratios for pseudo teams are higher than 1. However, only odds ratio of ‘harcol’ for real teams is significantly lower than 1 and others are not significant.
Odds=p/(1-p); Odds Ratio=[p1/(1-p1)] / [p2/(1-p2)]
At trust level, control variables include size, area, speciality, teaching, explaining 16%, 17%, 10% and 13% variance of the prevalence of ‘harcol’, ‘violcol’, ‘harpat’, and ‘violpat’, respectively.
At individual level, the control variables include gender, age, tenure, disability, ethnic, managerial role, and occupation groups. The odds ratios are as following:
harcol violcol harpat violpat
Gender (Femal)
Age (Elder)
Managerial Role (No)
Tenure (Long)
Disability (No)
Admin
AHP
Ambulance
Medical/Dental
Infrastructure
Nurses
Social Care
Manager
White
Mixed
Asian/Asian British
Black
Chinese

29. Patient mortality
5% more staff working in real teams associated with 3.3% drop in mortality rate (p = .006)
For an “average” acute hospital, this represents around 40 deaths per year

30. Key Factors for Team Effectiveness
Clear team leadership and Team Identity – inspiring vision
Clear Objectives – shared understanding and Role Clarity
Involvement in Decision Making and Constructive Debate
Effective Communication and Team members working interdependently

31. Key Factors for Team Effectiveness
Accurate and timely feedback on team performance
Positive, supportive relationships and Positive attitudes towards diversity
Inter-team cooperation and effectiveness and Organisational loyalty

33. Knowledge, skills and attitudes (KSAs) for teamwork
communication
goal setting and performance management
planning and co-ordination
collaborative problem-solving
conflict resolution

34. KSAs for teamwork … communication
understand and use communication networks - sufficient contact
communicate openly and supportively
listen actively and non-evaluatively
consistency between verbal and non-verbal
value of ritual greetings and small talk

35. KSAs for teamwork … goal setting and performance management
help establish clear and challenging team goals
monitor, evaluate, support and give feedback on team and individual performance

36. KSAs for teamwork … planning and co-ordination
to co-ordinate activities, information and task interdependence between members
to clarify tasks and roles of team members and ensure balance of workloads

37. KSAs for teamwork … collaborative problem-solving
identify problems requiring participation and use appropriate participation strategies
recognise and deal with obstacles to collaborative group problem-solving
support and explore proposals for innovation

38. KSAs for teamwork … conflict resolution
discourage undesirable conflict
employ win-win rather than win-lose negotiation strategies
recognise types and sources of conflict and implement appropriate conflict resolution and reduction strategies

39. Reflexivity
Teams are more effective and innovative to the extent that they routinely reflect upon their objectives, strategies, processes and environments and make changes accordingly.
Relationship between team based working,
reflexivity and CGR evaluations

40. Where does team working fit in?
Patient focus
Clear aligned goals and objectives at every level
Good people management
Positive emotional environments and relationships
Employee engagement
Real team working

41. Team Performance Inventory
Inputs Processes Outputs
Team task design
Effort and skills
Organisational support
Resources
Team Processes
Objectives
Reflexivity
Participation
Task focus
Team conflict
Creativity and innovation
Individual satisfaction
Attachment
Team effectiveness
Inter-team
relationships
Team innovation
Leadership
Leading
Managing
Coaching

42. 3. Teamworking
Books

43. 2. Additional web sites Web site with our DOH reports http://www. dh
2. Additional web sites   Web site with our DOH reports Engagement - Positivity   Teamworking – Our company developing teamworking in NHS  

44. LEADERSHIP VALUES - How can you promote these values and virtues in the organization?

45. Thank you
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