1. Interprofessional Learning Network 2020 Workforce Vision Workshop The Importance of Leadership
Hazel Mackenzie
Head of the National Leadership Unit
NHS Education for Scotland
29th August 2013
General briefing
The background information to this event is in your file. In summary, this programme is run by IHM supported by Pfizer UK Ltd. The event will be held at the Campanile Hotel in Glasgow
The programme is aimed at middle managers from diverse (NHS) backgrounds and structured around 3 master classes. This is the first one
Each master class will include a CEO or policy person and a leading thinker / academic
Martin Hill will provide an introduction and then you will have an hour with the group.
I am unsure of exact numbers but the documentation indicated 2 or 3 from each Board
Having discussed it with Madeleine and Martin, I have designed the presentation to be a mix of policy context, shifting leadership paradigms and an opportunity for you to include your own personal examples of what is changing in your world and what is required now as a CEO. My sense is that you will do that last bit very well and it would be really valued. I also wanted to give a good lead in to Keith Grint without presenting what he will be saying.
As this is the first module of the programme I have also included some slides to rally the participants and engage them

2. Outline The context of change The leadership challenges
What does this mean for how we think about leadership?
What does it mean for you in your role?
This sets out what you are going to cover. Perhaps just add that you will draw from your own personal experiences to illustrate and that you will encourage them to input
You might also want to say something about why your are focussing so much on leadership in terms of adapting to change….many writers see the terms leadership and change as synonymous.
You may also want to say something right at the start on thinking about leadership as all of us and not ‘them’ . You have a slide o this later but it is sometimes useful right at the start

3. Our 2020 Vision
Our vision is that by 2020 everyone is able to live longer and healthier lives at home, or in a homely setting.
We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.
Scottish Government, 2012
2020 Vision:
Integrated primary and social care, and more effective working with the voluntary sector
A focus on prevention, anticipation and supported self- management in order that everyone can live longer healthier lives at home, or in the community as long as possible.
When hospital treatment is required, and cannot be provided in a community setting, day case treatment should be the norm and it should be provided in the place which can guarantee highest quality, safety and a good experience.
A focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.
Perhaps just add the obvious …that getting from where we are to the vision will require transformational change

4. Healthcare Quality Strategy: Reflects what people expect
Caring and compassionate staff
Clear communication
Effective collaboration
A clean and safe care environment
Continuity of care
Clinical excellence
This is what patients and their carers have told us that they want and expect from their healthcare experiences.
On paper, it looks simple to do and is what all of us have joined to service to deliver, however there are many things that can get in the way. This will lead in to what you say later about culture .
You may want to refer to Mid Staffordshire

5. Nurturing Quality Person-centred values and behaviours
Safe care and effective interventions delivered reliably across whole system pathways
Enabling infrastructure - the right conditions, resources and governance

6. Sustainable Quality
Emphasis of the Quality Strategy is on sustainable quality
It is a balance and we need to ensure that what we are doing is in the triangle that both improves quality AND reduces cost

7. Getting to the third curve
Co-production
& assets
Performance
Improvement
Performance
The three curves provides a good lead into what you will later say about adaptive leadership.
The main point is that the quality strategy invites us to move beyond performance management (though that is still important) toward improvement and finally the third curve about co production
The three curves invites us to think about leadership I a very different way. In particular it is about ‘holding solutions lightly’ and about shifting the power balance, and seeing it as power with rather than power over. Again I think this will chime with Keith's idea of the difference between the role of the commander (performance management end) towards ‘wicked issues’ i.e. intractable issues with no clear answer.
Time

8. Being person-centred makes sense…
“The findings make it clear that cultures of engagement, positivity, caring, compassion and respect for all – staff, patients and the public –provide the ideal environment within which to care for the health of the nation. When we care for staff, they can fulfil their calling of providing outstanding professional care for patients”
Michael West et al, 2012, p15.
I have put this slide in as a balance with the previous one and to make the link between person centred health and care relating not only to how we work with patients, but also how we work with each other
As you know Michael West had a good evidence base for his statements

9. Person-centered practice
You may or may not want this one. It was really just to point out that adapting to change requires us to think about not just what we do but how we do it….values, behaviours, culture

10. The main leadership challenge….
“One of the main challenges for the UK public sector is to deliver improved services through a motivated workforce in an age of austerity”
Deloitte (2010)
Hopefully a useful slide to move you on to the next section The double bind of less money, needing more form our staff, needing to resolve wicked issues etc

11. Our 2020 Workforce Vision
We will respond to the needs of the people we care for, adapt to new, improved ways of working, and work seamlessly with colleagues and partner organisations. We will continue to modernise the way we work and embrace technology. We will do this in a way that lives up to our core values
Together, we will create a great place to work and deliver a high quality healthcare service which is among the best in the world

12. Our values
The values that are shared across Scotland's Health Service are:
Care and compassion
Dignity and respect
Openness, honesty and responsibility
Quality and teamwork

13. Making sure it happens
Putting the Staff Governance standard into practice in all that we do
Ensuring that everyone is clear about the values and behaviours expected of them
Empowering teams and individuals to innovate
Nurturing and developing team working and professionalism
Employing people who demonstrate out core values
Recognising achievement and effort of individuals and teams
Valuing and developing management skills and competencies and having managers who lead by example
Developing leadership skills and competencies at all levels
Recognising and valuing the role of carers in the delivery of health care
Creating a culture of organisational learning
Valuing on the job learning

14. A challenging context…
Complexity
Cultural change
High levels of public expectation and interest
Changing demographics
Achieving public value
Collaborative working across traditional boundaries
Co production
Diversity and equality
Global recession
This slide summarises your first sections on the context of change and the leadership challenges
It is hopefully self explanatory. You may want to pause here and give an example of something that you are working on that reflects some /all of the elements

15. So, what might it feel like?
Exhilarating
Stimulating
Busy
Anxiety-provoking
Scary
Frustrating & disappointing
Distressing
Lack of focus
Loss of meaning
Lack of alignment ………
This is an important slide and you might here want to introduce some of the research on engagement (McLeod and Clark) wellbeing at work (Derek Mowbray) and team wellbeing (Michael West)
Although this might seem a bit of a ‘light slide’ I have found participants always relate to it as it really reflects their ‘lived reality’
The point to make is that all of this is co existing in organisations, teams and within the same person at different times.
This will also link well when Keith talks about ‘cooking the conflict’…..i.e. in dealing with ‘wicked issues’ the role of the leader is not to quell the conflict but recognise it as sometimes necessary to draw issues out. Keith will likely talk about the role of the leader in ‘controlling the temperature’ when cooking the conflict ( theses are adaptive leadership theory terms ..i haven't made it up honest!) So there is an opportunity to ask them to reflect on this

16. New world leadership …
This section move on to consider what does all this mean for how we think about leaders and leadership….about the new world that we are in.

17. We are moving … From “Old World” … Lower complexity, slower change
Learning has a long shelf- life
“The senior ones know most”
Somewhere ‘someone’ knows
Doing more of the same is the rule
…To “New World”
High complexity, fast change
Learning has a short shelf-life
Knowledge is scattered
No individual can pretend to ‘know’
Innovation is the ‘rule’
I have found that generally this resonates for participants
The important point is that it is never truly either / or, but more of a both/ and.
This will chime well with Keith's ideas around critical, tame and wicked issues. I have used this slide and the next so that it aligns but is not exactly the same as what Keith will say.
If you choose to use it then you might want to verbally use his terminology as a lead in for his session. In the same way as you talk about the three curves
Obeng and Gillet, 2008, p3

18. Meaning shifting roles…
From “I manage”…
My team reports to me
I have a hierarchical role
I understand what is happening
I have fixed objectives
I manage by fixing things myself
I manage from knowledge and experience
To “I lead…”
We are part of a virtual network
Influencing is the way forward
I manage projects
I cope with ambiguity
I lead teams to fix things
I lead without knowledge and experience
So this second slide talks about that shift in the role of the leader and will build well into what you say next
An example here from your own experience would be great …how you see your role and how that has shifted over time form say your first management experience. What you now think the capabilities of a great CEO are….what has changed?
Obeng and Gillet, 2008

19. To what extent does this reflect your personal experience?
Pause to reflect
To what extent does this reflect your personal experience?
How far has your team made this shift towards a new world?
this is just to give them time to assimilate what you have said and how it relates to their own context

20. Leadership defined “Leadership is a performing art – a
collection of practices
and behaviours rather
than a position “
Kouzes and Posner (2005)
So this section moves on to think a bit more about what it means for them in adapting to change and working with others
Restates your previous points about leadership more as a process than about a position

21. Engaging leadership Concern for the needs of staff
Empowering staff by trusting them to take decisions
Listening to others ideas and being willing to accommodate them
Finding time to discuss issues despite being very busy
Supporting others by coaching and mentoring
Inspiring all staff to fully contribute to the work of them team
Actively promoting the achievements of the team to the outside world
The next slides are a quick scamper through the literature
You may feel that you have said enough already on engagement but if you do have time I will build into the adaptive leadership slide
Alimo-Metcalfe, 2008

22. Distributed leadership
Keeps the person at the centre
Includes positional leaders AND leadership as a social process
Role of the positional leader is to encourage others to exercise leadership
Leadership as practices and organisational interventions not just leader attributes
Relationship based – conversations as core business process
Developing skills to engage, collaborate, across systems and sectors
So the notion of distributed leadership is inter related to adaptive leadership…they are not separate

23. “Leadership must be exercised across shifts, 24/7, and reach every individual; good practice can be destroyed by one person who fails to see themselves as able to exercise leadership, as required to promote organisational change or who leaves something undone or unsaid because someone else is supposed to be in charge.
The NHS needs people to think of themselves as leaders not because they are personally exceptional, senior or inspirational to others, but because they can see what needs doing and can work with others to do it.”
My favourite quote….can be linked to mid staffs again
The point of the slide is to bring it back to them as middle managers …there role is to create the conditions for this
Turnbull James, The King’s Fund, 2011, p.18

24. Adaptive leadership?
Where we are facing ‘adaptive’ challenges, i.e., “systemic problems with no ready answers”, the solutions exist not in the single leader but rather…
“in the collective intelligence of employees at all levels, who need to use one another as resources, often across boundaries, and learn their way to those solutions”.
Here is your link between what you have said about distributed leadership and adaptive leadership
Heifetz & Laurie, 1997 (p )

25. Leadership across networks?
“There is a transition occurring from the old paradigm in which leadership resided in a person or a role, to a new one in which leadership is a collective process that is spread throughout networks of people”.
Nick Petrie (Center for Creative Leadership), 2011, p.6
You may want this one or not

26. Adaptive leadership
“Rather than fulfilling the expectations that they will provide answers, leaders have to ask tough questions. Rather than protecting people from outside threats, leaders allow them to feel the pinch of reality in order to stimulate them to adapt. Instead of orientating people to their current roles, leaders must disorientate them so that new relationships can develop. Instead of quelling conflict, leaders have to draw the issues out. Instead of maintaining norms, leaders have to challenge ‘the way we do business’ and help others distinguish immutable values from historical practices that must go”
Heifetz and Laurie, 1997
This is a long quote and you may not want to use it all
I think the key messages in it is about how hard this is! Also about balance. The ability of leaders to know when they are facing a ‘wicked’ issue You may again want to mention the idea of regulating the temperature…the importance of knowing when to turn the temperature up and when to turn it down
I also think the last point about immutable values is really important to make

27. Know yourself, be authentic Seek to understand others
Being a leader
Know yourself, be authentic
Seek to understand others
Be aware of your impact on others
Reflective practice
Emotional resilience
Building effective relationships
So this is what is needed of them
You cant lead effectively if you are not able to lead yourself and understand your impact. In fact it is rally critical in leading adaptively…being attuned to where people are at and avoiding a bull in a china shop approach
Keith article that I sent you on ‘ Wicked problems and clumsy solutions’ has a whole section on the role of the leader which will help bring this slide alive

28. And it is all about relationships…..
Relationship with self
Relationship with others
Relationship with organisation and beyond
Again the notion that adapting to change requires all of us to keep ‘in relationship’ with ourselves, others and our organisational and beyond

29. Who supports those who support others?
Learning networks
‘communities of practice’
Development in situ
Action learning
Coaching
Mentoring
As CEO of NES just a slide here about ongoing development. If you have time you may want to say something about your personal approach to this and how you prioritise it

30. It’s about you ….
Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek.
Barack Obama
Back to them in their role…..adapting to change is not about ‘others’ neither is culture

31. Commitment to reflection and action
What has this raised for you?
How does it relate to your current context?
What one thing might you do to strengthen your leadership?
I have put this slide in as one of the aims of the programme is for them to keep a reflective journal so this will help prompt that