Leadership and Management CMT 201011

8/3/2019 Leadership and Management CMT 201011

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Leadership and ManagementThe Present & The FutureCMT 20th October 2011

Dr Robert Ghosh

CD, CUCChair, CE


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Segment 1. General Principles


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Why Now?

Everyone is talking about it

Modern phenomenon?

Old values

Not only are we living in more enlightened,egalitarian times where simple assumption ofauthority and power by way of status does

not wash, but those of us with status arealso driven by external forces such astargets.


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Definitions

Social influence (Marx)

Roman Catholic Diocese of Rochester: "the process of influencingthe behaviourof other people toward group goals in away that fully respects their freedom."

Everyone can lead


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Management

Latin: manu agere to lead by the hand Old French: mnagement the art of conducting,

directing The act, manner, or practice of managing; handling,

supervision, or control (Online dictionary) the skilful or resourceful use of materials, time, etc.(Online dictionary)

FACILITATION TAKING ON A BURDEN (not dependent on ability)

Specific knowledge: awareness of networks andlandscape

INFLUENCE LEADERSHIP!


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Doctors as managers

Con: history

Pro: medical knowledge; engagement ofother doctors


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Drivers for Management andLeadership

Management Course: this is usually anappraisal prerequisite in the penultimate year inARCP and RITA

High profile programmes within medicaleducation curricula, strategic health authoritiesand various other bodies

Leadership development considered a good

thing for the reasons identified in segment 1(definition and rationale)

Seen increasingly as career progression


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Standards and targets

Most would agree that any individual can tell people to do thingsand point them towards standards.

Leaders engage, enthuse and enlighten with regard to goals.

To maximise engagement, ensure complete awareness of: Reasons for conception of the target or standard by responsible body

(e.g. DoH, SHA) and their methodology for consultation andimplementation How the responsible body ensures compliance from the Trust and the

nature of any additional monitoring bodies The Trust response: complete rejection, partial acceptance, complete

acceptance and reasons for this Commissioning views

Trust Governor views The role of committees and divisions/directorates The role of the Department and the role of the individual; risks of

rejection of the goal/task/standard/target; ways of innovating toimplement


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Motivation

Targets will not be reached if theworkforce are unhappy, unmotivated andnot engaged

Leaders need to praise their staff (even ifon occasions this does not seem justified)and advertise their value to the Trust


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Transaction

Motivated, happy individuals will needdirection for goals and standards

Transactional approaches includeincentivisation and punishment


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Segment 2: Landscape


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History

The Griffiths Report the introduction of general management, 1983 Working for patients, 1989 (the internal market)

National Service Frameworks: 1998 NHS Direct: 1998 European Working Time Directive (EWTD): 1998 Measuring standards: 1999 (also 2004 and 2008) CHI 1999; HCC 2004, CQC 2008 NICE: 1999 The NHS Plan: A plan for investment, a plan for reform, 2000 Adverse healthcare events: An Organisation with a Memory, 2000 Kennedy report: 2001 Payment by results, and some other particulars with regard to finance: 2002

Hospital at Night (HAN): 2004 Modernising Medical Careers (MMC): 2005 Ara Darzi reports: 2006 Best Research for Best Health (BRBH): 2006

Tooke report: Aspiring to Excellence: 2008

The Francis Report: February 2010 The White Paper. Equity and Excellence: Liberating the NHS. July 2010.


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National structure

Houses of Parliament

Strategic Health Authorities

NHS Trusts including:

Acute and Foundation Trusts

Mental and Ambulance Trusts

Non NHS

Organisations

E.g. private hospitals

Independent

Regulator for

NHS FoundationTrusts

Department of Health

including Secretary of State

Primary

CareTrusts

Primary care:

GP, NHS Direct, walk-in,

dentists, opticians,

pharmacists


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Local structure

Trust Board

Executive Board

Clinical Board Middle tiers

Department (service line unit)

Service line reporting and management(SLR and SLM)


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Governance and Quality

Now the same thing

Pillars were out

Now back in (projects)


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Quality Projects

Patient experience and complaints

Patient safety: Morbidity & mortality, riskmanagement and infection control

Research

Finance including PBR and CQUINS

Staff concerns, medical education, continuing

development, revalidation, appraisal,performance (including job planning)

Clinical effectiveness including clinical audit


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Other skills

Legal and ethical: MCA 2005, limitations ofcare

Data handling


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Segment 3: Theories of Leadership


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Some examples

Trait theories: Individuals born intoleadership and could only be inheritedhugely discredited

Path-goal and transactional Charismatic

Nearby

Synergistic approach vertical(transactional) versus horizontal(motivational)


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Other issues

Control and power: may be lost in largeorganisations

Emotional intelligence: this is based on theconcept of the ability of leaders andmanagers to understand and manage theiremotions and relationships (empathy,

pragmatism)


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Motivation

Vision Passion though may be misdirected Trust - difficult, transparency. The following is not consistent with trust: hidden agendas; inconsistent

standards; misplaced benevolence towards erratic individuals; falsefeedback when the truth would have been better; rumour/gossip

Stability. Able to follow when required and able to listen Power: power identity or power reputation. Positive issues should be found in adversity and failure put into

perspective and learnt from

Perseverance One needs to establish the definition of looking down, lookingsideways and looking up. Particularly for doctors, the differencebetween authority and arrogance needs to be established.


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Change management

A. Pattern of change (reference: Elizabeth Kubler-Ross, initially describedfor bereavement): Action points for Denial (including shock) Stage

Give information Confirm the change willhappen Explain what to expect and how to adjust

Action points for Resistance Stage Listen, empathise and respond to concerns Remind of reality Expect falling productivity

Acceptance of reality Action points for Commitment Stage

Set long term goals Team-building, reward and celebrate

Look forward Action points for Exploration Stage

Prioritise/focus with short and long term goals Follow up Reward


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Change management

B. Stages of engagement

Innovators (2.5%)

Early adopters (13.5%): do not need evidence

Early majority (34%): need evidence

Late majority (34%): go with the flow

Laggards (16%): get there eventually

START WITH INNOVATORS/ EARLYADOPTERS


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Change management

C. General principles in managing change Description of background and urgency Creation and communication of vision Emphasis of the benefits/risks of change versus no change Identification of all stakeholders Analysis of those who will lose out

Discussion with individuals personally Identification and formation of working group Clarity with regard to changes in behaviour an attitude. Things to start/stop doing

and things to do more/less of Facilitation of change. Removal of obstacles and encouragement of innovation.

Utilisation of education tools and operational processes Development of regular update meetings

Development of reward system and encouragement; adoption of modelbehaviour into institutional behaviour Design of temporary systems for neutral (transition) zone (e.g. temporary

procedures/policies); utilisation of this period to identify innovation


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Medical Leadership Competency Framework(Becoming better known as NHS Leadership

Framework)

The Academy of Medical Royal Colleges, together with the NHSInstitute for Innovation and Improvement published their own takeon clinical leadership in 2009 - a competency framework based onthe concept of shared leadership* . There is an expectation andwidespread agreement that the framework will be embedded ineducation and training curricula at all stages of medical education in

the UK. Dentistry will no doubt follow suit.

The MLCF is not intended to be prescriptive, or indeed the final wordon leadership, but it does provide us with a language with which toconverse about leadership and a common sense of purpose inconstructing training programmes or development opportunities. All

clinical leadership development activity in the London Deanery willbe mapped onto this framework.


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Demonstrating personal qualities

Developing self-awareness Interface with colleagues, patients/relatives, managers. Multi-source feedbacks; ask people!

Managing yourself Time management Clinical skills; innovations for acquisition Managerial skills e.g. organising meetings, chairing meetings, implementing change;

consultants should identify issues which may be dealt with by SPAs, particularly mandatoryitems such as training (supervision) and clinical governance (quality); trainees should identifynon-clinical issues which need attention e.g. clinical audit

Continuing personal development Seek opportunities; think of forums other than formal CPDs; acknowledge mistakes

Acting with integrity Awareness of acting: providing dignity to a colleague who may be experiencing difficulties SCENARIO 1: Pre-retirement colleague who may be making clinical mistakes, has not

accumulated CPD SCENARIO 2: Junior doctor (recently bereaved) is consistently arriving late for clinical duties


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Working with others

Developing networks Immediate network: Individuals or groups who may have differing opinions about

common issues affecting the department/specialty. Wider network: Individuals or groups who may benefit from knowing about the

department/specialty problems, or who may be able to influence Identify networks and ways of communicating e.g. managers and medical

personnel to arrange ways of working e.g. for covering annual/sick leave

Building and Maintaining Relationships Ensure that there is empathy from each group for each other

Encouraging Contribution Identify expertise in different individuals in each clinical and non-clinical situation Designate roles for these individuals

Working within Teams

Aims: common purpose, leadership, roles and responsibilities of all individuals Identify all clinical situations when you can employ the principles above


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Managing Services

Planning Identify benefits and risks of plans, organise trackers to identify hurdles and identify

resources if needed Ensure that there is measurable quality assurance to ensure that plans will lead to improved

quality Ensure audit to maintain quality Draw up a plan to deal with one of your major departmental anxieties and organise a

checklist which maps to the bullet points above

Managing resources for the plan above Identify the resources (manpower and equipment) in your department/specialty to ensure

service delivery Devise a way of detecting when service not delivered Devise a way of detecting when resources not used effectively Develop a portfolio of service delivery issues and ways of detecting service and resource

problems

Managing people: synergistic approach Managing performance and tackling difficult issues Analyse information about performance (department and individual) and act to improve

performance SCENARIO 1 : The department is failing in a target SCENARIO 2: A colleague is ignoring managerial issues


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Improving services

Ensuring patient safety Identify and quantify the risk to patients Use evidence to identify options to minimise risk Monitor the effects and outcomes of change SCENARIO: consider an intervention e.g. admission, ward rounds,

discharges; devise a way of measuring the outcome on patient safety

Critically evaluating the interventions above Devise quality checks for the interventions Analyse quality checks in real time and through audit

Encouraging improvement and innovation for the interventions above Question the status quo Act as an exemplar for innovation Analyse educational tools and operational processes

Facilitating transformation for the interventions above Articulate, promote, motivate and focus a group to accomplish change Identify your role; identify groups and forums to facilitate change


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Setting direction (strategy)

Identifying the contexts for change Demonstrate awareness of the political landscape (understand and

interpret relevant legislation and accountability frameworks e.g. externalvisitations for standards, quality indicators)

Prepare for the future by scanning for ideas and best practice that willimpact on health outcomes

Develop and communicate aspirations

Identify ways of communicating ideas; be involved in strategy meetings atdepartmental/divisional/directorate/ trust level

Applying knowledge and evidence to support such change Gather data in order to challenge existing practices and influence others in

appropriate forums; communicate as above

Making decisions Participate in/ contribute to organisational decision-making processes;

involve key people who make decisions; seek delegated responsibility Evaluating impact of implemented ideas

Test/evaluate new service options using measurable criteria; overcomebarriers to implementation with education tools/ process changes


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Summary

Know why

Landscape: history and structure

Governance and quality: projects Basic theories to help deliver

Leadership and Management CMT 201011

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