Inspiring the next generation of leaders in health and social care
www.leadershipacademy.nhs.uk
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Introduction
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Understanding and developing leadership practice
A foreword by Dr. Clare Price-Dowd
Charlotte Miller Corinne Harvey Lynnette Robinson
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Building foundations for team effectiveness Toni Mank Dianne Graham Janice Wootton
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Making sense of organisational values, engagement and service delivery Sarah Cooper Anne Rolfe Sharon Hurst Jason Brewster
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Delivering system wide co-ordinated care Jodie Millington Laura Whixton Cath Doman Tze Min Wah
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Creating engaging and learning cultures
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Evaluating my leadership behaviours and impact
Michael Holmes
Helen Fearnley Jo Watson
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It’s not the end Jo Dickson
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Welcome
Dr Clare Price Dowd Senior Programme Lead, Evaluation and Patient Experience NHS Leadership Academy
I am delighted to present this book which is the culmination of the exceptional efforts of so many people over two years. Leading is about people and Elizabeth Garrett Anderson epitomised everything the NHS Leadership Academy sought to develop in its programme participants. A courageous and determined individual, working for equality and promoting care with compassion. The work presented in this book carries on her legacy through its innovation, its courage, a never-ending desire to improve and above all its successes! The programme was designed for mid-career leaders, those people who have some of the toughest roles in health and social care combining complexity with competing demands from all levels. The stories presented here are testament to the ‘art of the possible’, - exceptional achievements attained in tough times. It is now more than ever that the services needs these skills, attitudes and behaviours.
ways to lead and also follow when appropriate. Only through combining efficiency with emotional intelligence, tenacity with support and focus with sensitivity will we deliver truly person-centred care to be proud of. Leadership in health and social care holds exciting challenges and opportunities. Completing the Elizabeth Garrett Anderson programme has demonstrated excellence on many levels which I hope will continue to grow in the service of patients, staff, carers and families. We hope that this book will inspire leaders at all levels across our NHS and social care system. Now more than ever, we need to develop our ability to lead systems rather than organisations and this is something that people at all levels need to embrace. We hope to ‘pass the leadership baton’ and help people to build their confidence to step-up and lead excellent care at whatever level they are in their organisation.
Traditional approaches to leadership will not deliver a shared vision and sustainable transformation. During these times of change and constraint there is a need for all staff, whether clinical or not to seek the best
Welcome
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Understanding and developing leadership practice
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Charlotte Miller
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Corinne Harvey
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Lynnette Robinson
Life as as leader in health and social care can be hugely rewarding. However, it is challenging, tiring and often difficult work which requires high levels of stamina, resilience and emotional energy. Leaders must be critically self-aware and critically reflective; understanding their own leadership practice and the impact of their behaviours. It is essential to know how leadership behaviours affect the quality of care and the patient experience; positively enhancing care and how behaviours should be challenged which have a negative impact. Leaders must understand motivation and resilience so that they can withstand difficult situations and, in turn, care for and support others in their care.
Understanding and developing leadership practice
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y name is Charlotte Miller and my current role is as the Assistant Director of Human Resources for Calderdale and Huddersfield NHS Foundation Trust. I have an operational portfolio including being the HR lead for the Surgical Division including all employment relation matters, additionally I have overall line manager responsibility for the resourcing team. I also have overall line management for the Trust’s staff bank and I am the Human Resources lead for the whole nursing agenda including revalidation.
I started my career in Asda working as Customer Services Manager on their trainee management scheme and latterly as a People Manager, I worked at various stores over a 10 year period. After my son was born I wanted a better work/life balance and made the move to the NHS. Starting out in the Huddersfield Primary Care Trust, as a HR Assistant Manager, then prompted to HR Manager before moving to the acute sector in 2006. I was promoted to Senior HR Manager in 2010 and then Assistant Director of HR in 2013. I have undertaken a BSc in Psychology and MCIPD. I am a qualified practicing coach for the organisation.
Reflexivity- using Gibbs (1988) reflective cycle
Organisational Context
Feelings
With approximately 5970 employees and ÂŁ353m turnover, Calderdale and Huddersfield NHS Foundation Trust provides a comprehensive range of secondary care services to the communities of Calderdale and Kirklees.
I did not experience as much connection to the team through the on line surveys as I did with the interviews which is interesting for my professional practice which is often undertaken virtually. Throughout the process I have reflected that I am subconsciously still using a heroic leadership-style, this is not sustainable, either in terms my self-care but also in terms of building a resilient team. I felt surprised at this and a little disappointed as I had thought I had made a conscious effort to change this leadership style as a result of the reflective pieces of work completed through my leadership journey.
The Trust spans two local authorities, both seeing drastic budget reductions and increased spending cuts, in particular reductions in intermediate and residential care homes, resulting in fewer beds available in the wider health economy. Due to a forecasted financial deficit the organisation has seen increased scrutiny from Monitor as its regulator. There is also a full CQC inspection confirmed in March 2016.
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Understanding and developing leadership practice
Reflections on the EGA programme and case-study:
Description I have enjoyed the process of engaging with the team both on a one to one basis and as a whole team. Maintaining and building resilience is going to be a key leadership skill in the NHS particularly with the 5 year forward view. I have found the studying time consuming and I had underestimated the time commitment, especially with working full-time, having a young family, moving house and getting married.
Evaluation Reflexivity has allowed me to understand I do also have a coaching style of leadership and I am keen to invest in people and support them to achieve their full potential. My own skills set adapts well to challenges, problem solving and finding solutions as I react in a calm supportive manner and manage to firefight well, however the flip side is that I can take
over and do not allow others to problem solve for themselves.
incorporated into its suite of mandatory on-line training packages to build resilience in individuals, teams and ultimately the organisation.
Analysis I believe I default to using a heroic leadership-style in challenging circumstances, which does result in getting the job done but does not build individual or team resilience.
Conclusion It is somewhat disappointing for me to realise I still default to heroic leadership when times are challenging as I sincerely want and enjoy practicing a coaching leadership style.
My message tofuture leaders: Is to have the resilience and courage to do the right thing for patients and staff and not be influenced by those concerned only with the financial elements of service provision, ensuring the golden threads of patient care, quality and experience are at the centre of all decision making. Remember whatever role an individual has in the NHS it links with care.
360 Quote Action
“Charlotte is an inspirational leader”
Having reflected I realise I need to consciously think about my leadership style particularly when times are difficult or challenging so that I do not revert to heroic style.
Learning The learning to be taken forward both for self and other line managers is to be mindful of ‘what is it like to be on the receiving end of me?’ This has been identified as an area of leadership development through the leadership journey through narrative and 360 feed-back. Acknowledging the importance of teamwork in building and maintaining team resilience is another area of learning. And finally the importance of self-care for oneself as a leader, but also role-modelling and encouraging staff to practice self-care is another learning outcome which is ironic given that in the NHS we are in the business of care!
Recommendations Recommendations for the organisation are that it needs to demonstrate that self-care is valued and seen as behaviour to be encouraged and role modelled, so that heroic leadership is not the default position as this can lead to ‘burn out’. This fits well within the organisations values. Finally the organisation does not have any formal resilience training, it is recommended that the workforce committee acknowledges the importance of resilience and that this is developed and
Charlotte Miller Assistant Director of Human Resources Calderdale and Huddersfield NHS Foundation Trust
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I
work in Public Health England which is an autonomous agency of the Government which means I am a civil servant although I still consider myself to be part of the NHS having qualified as a mental health nurse way back in 1998.
My role is as a strategic lead for the region leading on improving the nation’s health. This sounds a lot grander than the reality. I work very closely with the public health teams in the local councils within the region as well as colleagues in Clinical Commissioning Groups and NHS England. It is a very challenging operating environment with a significant reduction in resources and the transfer (back) of responsibilities to councils for this agenda still being in early days.
Evidence of impact Leadership is not an easy role and it is not always valued or even recognised. But I have learnt that it is essential in order to ensure there is a sense of purpose, a focus and a shared understanding of why we do what we do. I have learnt this is particularly vital in times of change – and this is the only constant in the public sector field. I have learnt a great deal about the application of leadership in my role and the impact of the absence of leadership around me. It makes the difference between feeling self-worth or feeling worthless. For me, the learning has enabled me to channel frustration into something much more positive and rewarding - I hope for the benefit of others and not just myself.
Learning for the system and for myself Understanding my role as a system leader and recognising the importance of not get overwhelmed by the details. Bringing that knowledge to improve
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Understanding and developing leadership practice
health inequalities and always seeking opportunities to promote public health and wellbeing - even when it is not welcomed.
What I now know about leadership and my behaviour and practices. My skills as a leader have developed through taking the time to really understand the theory as well as the practice. Instinctively I operated at a certain level of leadership, as a middle manager perhaps, without really analysing why I was doing what I was doing. This included positive reinforcement and visible acknowledgement of staff in order to promote good working relationships and better outcomes. It also involved making difficult decisions and sometimes unpopular ones, accepting it was a difficult path to be a friend and a leader. My leadership style has developed and matured and I’m more confident as a result. Self-awareness mapping and taking the time to gain feedback has all contributed to the better sense of self. This has also helped me better understand my weaknesses and begin to put strategies in place to address them. The course has also made me acutely aware of the fundamental importance of a balanced work/home life balance which I’m now striving to re-establish.
“My leadership style has developed and matured and I’m more confident as a result.”
Corinne Harvey Acting Public Health Consultant in Health and Wellbeing Public Health England
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y name is Lynnette Robinson and I would describe myself as a clinical leader. Throughout my nursing career I have been grounded in clinical practice and currently work as a senior clinician within a primary care mental health team in Barnsley. I am passionate about working with clients who have complex substance misuse and mental health problems and have specialised my practice delivering care to this dual diagnosis client group. My leadership background stems from being a clinical lead with an Assertive Outreach Team and dual diagnosis lead within my organisation. This role enabled me to develop my leadership skills in complex multidisciplinary teams and organisations. There has been considerable change regarding roles within my organisation and as a result my dual diagnosis responsibilities were reduced, resulting in gaps in service provision. My role is primarily clinical leadership with no operational management responsibility. I am professionally and personally interested in examining the value of such leadership roles particularly in light of continual challenges to services and the changing ways in which health care is delivered. Research suggests clinical leadership roles are rarely examined when compared to other management domains. However, it is argued that clinical leadership and operational management are clearly very different concepts (Stanley 2006). I am interested in how clinical leaders make the connection between operational management as a way to improve quality. I decided to enrol on the Elizabeth Garrett Anderson programme (EGA) as I recognised my desire to develop leadership skills to drive and sustain real change, engage staff, ensuring that patients have good quality and safe experiences and modelling a culture of patient-focused care. I have worked in mental health services for over 25yrs and have seen many changes in respect of trends in health care leadership approaches. Several years ago there was an increase in clinical leaders, however due to budget cuts these were the first roles to be abandoned. More recently there has been considerable investment in senior clinical leadership roles within the organisation, which reinforces the commitment to improve and sustain quality and patient centred care.
Learning for the system and for myself. The evidence base to illustrate how different leadership theories relate to care continues to develop and evolve, and is an endlessly debated topic within health care (HSJ 2015). However what many
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Understanding and developing leadership practice
authors do agree is that the changing nature of the NHS means that traditional power and control models are no longer appropriate in an environment focused on partnerships and integration. Collective leadership is currently welcomed as the key to creating a culture that delivers high-quality and compassionate care, with evidence suggesting the link between this style and improved care for patients (West et al 2015). This leadership approach is what I personally relate to and have been drawn to as a theoretical framework for my leadership development. The concept of distributing and allocating leadership power to wherever expertise, capability and motivation lie is something that I strive for. I have recognised the importance of staff engagement as the key for such a leadership model to exist and this has been one area of leadership practice which I have focussed upon.
Evidence of impact This course has enabled me to develop my own practice, enhancing my leadership skills working within teams and the wider departmental levels, having gained knowledge and understanding of how the new healthcare leadership model puts leadership qualities and behaviours central to the core purpose of the NHS. The programme has increased my confidence and knowledge and has emphasised the importance of integrity. I have had opportunity to review my leadership impact by several routes, including supervision, personal reflection, feedback, research, work based activities and utilised comments from the NHS leadership academy leadership 360 report to aid deeper reflection.
These routes of reflection has enabled me to have a greater understanding of my personal strengths and development needs, with a key question at the heart of reflection “what is it’s like to be on the receiving end of me”? A particular development need emerged as I have recognised my tendency to avoid operational management responsibilities. I recognise my strengths in clinical practice and identify the importance of value alignment and modelling behaviours to improve patient care. However I also recognise that operational managers have increased responsibilities, such as meeting national targets, managing budgets and staff management, which as a clinical leader I am not accountable for. It could be argued that I am in a privileged position and ideally placed to prioritise patient care, disseminate good practice, and engage staff to influence quality care and patient experience in meaningful ways, whilst engaging operational managers to achieve this aim. Throughout my leadership journey I have developed my skills in staff engagement. Feedback and evaluation has confirmed my skills in this area of leadership, which has been both insightful and affirming.
What I now know about leadership and my behaviour and practices. The programme has assisted my reflection of my role as a clinical leader citing the advantages and limitations enabling review of my personal leadership impact particularly my skills in staff engagement. I have really enjoyed the mix of evidence based practice and practical application, which has allowed me to test out new approaches and get regular feedback.
Key message. It has been hard to juggle academic work with full time employment, having a family and everything else that comes with life. However I have found that I have a desire to keep up to date with current research, development and evidence practice. This is something that previously I was out of touch with. I am committed to keeping abreast with new developments as a way to continually stay in tune with how to improve quality of care. My leadership journey has inspired me to acknowledge my strengths and not dismiss my abilities. It has also tested my resilience and revealed my flaws which I may not have previously acknowledged. The programme has given me the confidence to make the next steps and apply for a job which would ordinarily be out of my “comfort zone”. The next 12 months will be a real test of my ability and I am looking forward to the challenge.
360 quote. “Lynette offers support to members of the team, whilst encouraging shared responsibility when Problem solving. She has given me the self-confidence to progress and challenge my own capabilities to reach my potential. She is consistent and always has the service user and their family at heart”.
I am particularly proud of being able to work closely with senior management teams to identify junior leaders and assist mentorship and individual leadership development. I have a proven my ability to Influence others to achieve change, motivate staff and teams to improve and sustain quality and patient centred care. The programme has given me to the confidence to make the next step in my leadership journey. I have been successful in securing a leadership promotion – senior clinical lead over all community mental health teams. I have made a great leap moving originations and taking on the challenge of a senior position and I believe the programme has equipped me with the skills to take on the role.
Lynnette Robinson Senior Clinical Lead Humber NHS
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Building foundations for team effectiveness
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Toni Mank
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Dianne Graham
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Janice Wootton
Research evidence is pretty conclusive – organisations that structure work effectively around teams are far more successful than those which do not. Effective team working in health and care is associated with the improved wellbeing of patients and staff. For patients • Increased patient safety • Reduced patient mortality • More streamlined and cost-effective patient care • Reduced physician visit and hospitalisation rates • More effective use of resources • Increased innovation • Increased patient satisfaction • Reduced medical errors For staff • Reduced stress • Intent to stay at work • Increased job satisfaction • Lower absenteeism and turnover • Reduced harassment, bullying and violence
Building foundations for team effectiveness
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M
y name is Toni Mank and I am the Head of Improving Access to Psychological Therapies (IAPT) service in Sheffield. I started my career delivering solution focused therapy to families in Crisis within a specialist team in Children and Families Social Services. My leadership journey started here as I have always been passionate about service improvement and service development. Working across organisations and regions I co-wrote a therapeutic parenting programme. I also co-developed group work for children of all ages to improve emotional literacy and self-esteem. I then became a primary care counsellor in a newly formed primary care mental health team before moving on to becoming a cognitive behavioural psychotherapist with the advent of the IAPT service in 2008. The IAPT service revolutionised mental health services in primary care. As a clinician I fulfilled the clinical leadership element of my role and continuously looked for new ways to enhance the service we were providing. I moved in to a Team Manger role in order to influence change on a wider scale and successfully improved systems that dramatically reduced waiting times for patients to enter treatment. I became Head of IAPT in 2014 as I had a vision for the IAPT service and wanted to influence the quality of care for the 13, 000 patients entering treatment each year.
My organisational context Sheffield Improving Access to Psychological Therapies (IAPT) sits within Sheffield Health and Social Care NHS Foundation Trust (SHSC). There are 130 staff in the IAPT service including three professional groups, Psychological Wellbeing Practitioners, Cognitive Behavioural Psychotherapists and Counsellors that deliver evidenced-based psychological therapy for over 13, 000 people each year suffering with stress, anxiety and depression. The main challenge facing the service is continuing to deliver high quality care, achieving the national IAPT standards and continuous quality improvement against increasing financial pressures.
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Building foundations for team effectiveness
Learning for the system and for myself I have applied leadership theory to practice by developing a conceptual model of collective leadership that I have implemented in the IAPT service:
Conceptual Model of Collective Leadership within and across Organisations and Systems:
Through a transformational leadership style, living my values, communicating an aspirational vision and setting clear strategic direction I focussed on engaging stakeholders, facilitating effective teamwork and accountability. This has created a shift in the service culture to collective leadership which is argued to improve the quality of care patients receive. I have learned the critical role that leaders play in shaping culture and how the model can be applied across the wider system by adapting the model from ‘staff engagement’ to ‘stakeholder engagement.’ This is reflective of the increasing need to deliver person centred coordinated care collectively if we are to meet the significant challenges the NHS is faced with. Applying the conceptual model of collective leadership has had the biggest impact on how I lead care as it influences my approach to service improvement and service development. I have established a leadership development forum in the service to inspire leadership in the service at every level. Alongside staff and service users we have co-created a mission statement for the service that connects with the values of the service whilst translating the national standards that we have to meet in to a powerful narrative. I have engaged staff in service changes, actively sharing leadership power to those with the expertise needed. I have also increased the number of away days to ensure that there is time to come together as a service, for everyone to have a voice in shaping the future
Evidence of impact I have learned the importance of being a reflexive leader. Personal development is necessary to be an effective leader and to truly reflect on what it is like to be on the receiving end of me as a leader is critical. I have also learned that embedding a culture of collective leadership requires persistent pursuit; therefore self-care is important to prevent burnout. My confidence has grown throughout my leadership journey and I have learned that there are no limits to what you can achieve in pursuit of the best possible care for patients. There has been a positive impact on the quality of care that patients receive in the service since taking over as Head of Service in June 2014. Over a 15 month period, the average days waiting for treatment have reduced from 59 days to 19 days, the numbers of people entering treatment has increased
from 647 to 1,106 as measured in one month taken from June 2014 and September 2015 and recovery rates for patients have improved by 9% This demonstrates impact at service level but there is also wider impact as we move forward with a growth strategy to implement the learning to other services in other regions.
What I now know about leadership and my behaviour and practices. My development as a leader over the programme reflects the most challenging time of my career and the most rewarding. Stepping in to the role of leading the service soon after the programme had started triggered a steep learning curve as I had to implement significant change at scale within the service. My confidence has grown throughout my leadership journey; the support of the programme including action learning has facilitated this and I have felt empowered.
Your message/advice to future leaders Believe in yourself and what you can achieve, the possibilities are limitless. Let your values guide you in the relentless pursuit of excellence in patient care.
360 Quote “You’re an awe-inspiring Head of Service, IAPT is now without a shadow of a doubt a much better service for both patients and staff!” “The service has gone from under-performing to over achieving in an amazingly short time scale” “You lead by example and are always positive and inspiring. You create a positive culture and instil self-belief. You are a great leader and an excellent role model.” “She inspires others to see her vision and takes steps to achieve it. She inspires others to want to lead.”
Toni Mank Sheffield IAPT Head of Service, Sheffield Health and Social Care NHS Foundation Trust
Building foundations for team effectiveness
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I
have already recommended the NHS Leadership Academy Elizabeth Garrett Anderson programme to my managers at my Trust. My role as Assistant Director of Mental Health means that I needed to develop my leadership skills as the work has been more complex and demanding over the last few years and leadership capability and skills are required to manage the many challenges in the role. I think it is one of the best leadership programmes available and for me at this point in my career it has been extremely useful, and I started the programme in May 2014. I am really enjoying it. For me it’s a good mix of academia and practical application on leadership learning. I think the work-based assignments are thought-provoking – they enable you as a participant to really see the relevance of the learning in the workplace. As a leader I am more reflective generally. I put more effort into leadership rather than general management which I think provides more long-term impact and benefits patient care. I have has gained confidence and knowledge and the programme has emphasised the importance of integrity, diversity and equality for me. The programme has been great for me. It has inspired me to provide value-based leadership, to focus on my leadership team and their potential and challenge activities that do not add value to patient care. It has helped me to collaborate with partner agencies as I am able to apply theory to practice and feel more confident in having certain difficult conversations than previously. For example, since embarking on the programme I’ve challenged complex line management structures and requests for work that do not add value to patients. I’ve also had conversations with my leadership team about resilience and about maintaining a focus on improvements.
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Building foundations for team effectiveness
I feel that I have always been committed to high quality patient care, and that has not changed. But now I have a heightened awareness of the importance of engaging patients in service development and in patient leadership. Although it is hard to combine the academic rigour and challenging schedule with a demanding full-time job, I feel inspired to continue my leadership development in future, and to help others to do so too. My plans would be to develop my coaching ability. I would like to capitalize on my learning for the benefit of other NHS leaders. The action learning sets in particular have been valuable as I have been able to consider my way of thinking and how this can at times be unproductive. I think the most important thing I have learned is to prioritise three or four key work streams at any one time and be more assertive if my time is being used on other things, this enables me to keep focused on the important aspects of my role and therefore increase my personal leadership impact. West et al (2014) describe the collective leadership challenge, stating that every Trust board must understand the leadership capabilities required in the future and understand how collaboration and collective leadership can transform how local health systems provide care. High-quality, compassionate care can reach beyond the boundaries of specific organisations and is a requirement of leadership at all levels within health and social care.
Cummings (2014) describes compassionate leadership as everyone’s business with people throughout the organisation contributing to a “climate of compassion”. She calls for “leaders and teams to align their real, day-to-day working environment, behaviours and culture to their core purpose – the duty of care to patients and staff”. I find these quotes particularly important in my role as there are many competing demands, however being focused on the things that matter to patients is what should be our key priorities every day.
Key issues that have emerged through the Anderson Service development journey for me and my leadership team have been:
organisations with adaptive cultures based on shared values outperform other companies by a significant margin. Meetings end with a statement about whether we have made decisions based on our values and we actively recruit by asking values based interview questions. On a more personal note, the Myers Briggs Indicator (2006) was a key insight for me, particularly when considering natural behaviour styles whilst under stress. During I have learned that in order to create an empowered system, (Power +systems 2008-2010) I need to behave differently as a leader and adapt to a new way of working. For me this is about letting go of some managerial control.
• H ow to continue to embed our values through our key decisions. • H ow to improve our staff and patient engagement strategies. • H ow to become a high reliability organisation in order to reduce patient safety incidents. Learning throughout the modules has been closely related to the actual service improvement work the division has embarked upon and has been extremely helpful in supporting the work through an evidence base. The values based decision making is having a great impact in keeping us focused upon the things that matter. Barrett (2010) suggests that when we align organisational and personal values we “unleash an energy that is tantamount to unleashing the corporate soul”. Kotter et al (1992) say that
Dianne Graham Assistant Director Adult Mental Health Services Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust
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have worked in Health and Social Care over 25 years in various social work and management roles within Integrated Community Mental Health Services, a partnership arrangement between a Local Authority and NHS Partnership Foundation Trust. I managed a variety of Multi- Disciplinary Community Teams and had responsibility for the Local Authority statutory duties for the Mental Health Act 1983. In November 2014, I became the Practice Governance Coach (PGC) for Mental Health Rehabilitation and Recovery services, a move from operational management to quality and service improvement. The organisation has evolved and grown into a large, diverse and complex partnership with four Local Authorities, delivering a vast array of community, specialist mental health and learning disability services across a wide geographic area. It is divided into discrete Business Delivery Units responsible for service delivery to a specified population. The organisation has a reputation for innovation and delivering effective services within its financial resources. To manage the anticipated future financial difficulties and responding to user and carer calls to do things, the Trust has begun a series of major Transformation Programmes. A comprehensive Care Quality Commission inspection is expected in March 2016. The Trust is in the midst of introducing Systems Leadership and recently restructured creating a ‘trio’ arrangement with a clinical lead, general manager and my role of practice governance coach to oversee each clinical pathway. The Rehabilitation and Recovery pathway is diverse includes inpatient rehabilitation wards, Recovery Colleges, Vocational Therapies, Supporting People teams, Dual Diagnosis and Carers Support. I try and spend the much of my time supporting teams to reflect on basically what they do, how they do it, identifying how it makes a difference by engaging users and carers. I also provide organisational assurance regarding the governance agenda working to achieve compassionate, quality services which places individuals at the centre and in control.
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My Learning The programme has been a great opportunity for me to reflect on what is important to me and helped me to re- evaluate my values which I have found energising. I have become a more inclusive and thoughtful leader focused on crafting opportunities to build collaborations with staff and service users to create solutions and acknowledging we are all leaders with a contribution to crafting the solution. Completing the Anderson Team Journey (Aston Organisation Development 2014) was a great chance to explore what a ‘real’ team is and the connection between team effectiveness, staff well- being and delivering quality services (Dawson & West 2012). Thinking about creating time to think, I have worked with various teams to establish a regular focus on the quality of the service delivered, taking time out and creating a safe environment for the team to reflect and evaluate their performance, and how encouraging all staff to participate to explore new innovations. I use a more appreciative approach, building on the positives and used the opportunities of things going not as anticipated, as a chance to learn and grow. My new mantra is team reflexivity and learning improves team functioning and improves services (Garvin et al 2008). Drawing on my Healthcare Leadership Model 360° feedback, the findings of both my Myers-Briggs Type Indicator Report for Organisations and the Barrett Personal Values assessment (2009) I have worked to reflect and learn different ways to appreciate the contribution and diverse views of individuals. I continue to explore the challenges but in a way which embraces and engages diverse views and perspectives contributing to a more comprehensive discussion and solutions.
My Impact I was already aware that I have to really focus when it comes to numerical data, the Module Four Work based evidence pieces gave me an opportunity to improve my ability to interrogate quantitative data and engage more productively in analysing and triangulating rich data, to craft a more comprehensive narrative highlighting the improvements made, outcomes achieved. I am more aware of and have a different attitude to the importance of celebrating success nominating one of my teams for the Trusts Values into Excellence Awards. The sense of pride within the team was a pleasure to observe as was the enthusiasm generated. A key personal development is positively embracing innovation and fostering positive attitudes to change.
way the services operates and develops going forward. I take the time to give constructive feedback and actively seek such from other incorporating and adapting my leadership as I move forward.
My message I found the programme positively challenging, enriching and ultimately a very rewarding journey. My advice is embrace the opportunities of the programme, acknowledge your strengths, build your resilience, it will be worthwhile.
360 Quote “ She promotes and encourages shared leadership across the board, engaging staff at all levels, operates with integrity.�
Using my learning I have encouraged and enabled services to build learning and support networks. I have used a peer learning approach to support teams to prepare for the anticipated Care Quality Commission inspection with peers reciprocally assessing another service to provide a different perspective.
What I know about my leadership, my behaviours and practice I am more aware of the impact of my leadership on others and the impact this has on services and service users. I’ve learnt people may forget what I said or did but not how I made them feel and I have grown and adapted my practice. I now purposefully use an appreciative, coaching approach to empower others, to connect with what motivates and inspires them and create opportunities in which staff have more say and control in how they undertake their roles, the
Janice Wootton Operations Manager Continuing Health Care Calderdale Clinical Commissioning Group
Building foundations for team effectiveness
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Making sense of organisational values, engagement and service delivery
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Sarah Cooper
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Anne Rolfe
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Sharon Hurst
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Jason Brewster
Values matter because when they are visible in everything we do, they can make a real difference to staff engagement and to patient experience. However, values on their own are not sufficient and organisational values, which are shaped by personal values, are used most often in an organisational context to refer to an organisation’s institutional standards of behaviour. The concept of values extends beyond just an organisation and includes those of society. It is through the implementation of values that the real challenge of leadership emerges.
Making sense of organisational values, engagement and service delivery
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I
qualified as a Physiotherapist in 1995 from Sheffield Hallam University, following which I commenced my career at Rotherham as a staff grade Physiotherapist, working through the grades. Following a number of years as Therapy services manager I was excited by the challenge the Head of Clinical Professions post would create for me, in leading and representing a wide range of Allied Health Professions, professional scientists and Pharmacists in the trust agenda. The Rotherham NHS Foundation Trust is an Integrated Acute and Community Trust, as Head of Clinical Professions I am part of the Division of Clinical Support Services Leadership. The Division includes Medical Imaging, Therapies and Dietetics, Pharmacy, Laboratory Medicine and Patient Access. I commenced the Elizabeth Garret Anderson (EGA) programme within a few weeks of moving into the Head of Clinical Professions post, the program has proved essential in developing the Divisional leadership team facilitated by the Anderson Team journey. As a Clinical Leader, prior to commencement on the EGA program, my postgraduate education had been largely focussed on clinical development; with limited training in terms of team development, the importance of team objectives in determining a shared vision and staff engagement. Clear team objectives are detailed as a key contributor to a well-structured team, which in turn is associated with improved patient outcomes (West et al, 2001). In addition, effective team working is demonstrated in teams that have clarity and commitment to team objectives (Borrill and West, 2001). Through completion of the team objective checklist it was evident that the absence of team objectives were negatively contributing to team effectiveness and collaborative working, leading to a focus on the delivery of individual objectives. Through the development of team objectives the Divisional leadership team were able to clarify the way forward for the division and the focus for the next 12 months.
Learning for the System and Myself The learning that has fundamentally changed my leadership style is in relation to staff engagement. The learning associated with this subject area has
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enabled me to understand the importance of engagement and the positive impact staff engagement has on patient’s safety, mortality and experience. I had not made these links prior to the EGA. For example, the relevance of the NHS staff survey in Trust performance was unclear to me, however understanding its relevance as a measure of staff engagement has enabled me to support the development and implementation of strategies to ensure improvements are made in this area. The benefits of improved staff engagement are well evidenced, engaged staff feel more valued and involved in their work (Ham, Ellins and Dixon, 2009). Furthermore, improved staff engagement leads to a positive correlation with patient satisfaction, mortality rates and rates of infection alongside reductions in sickness absence and reduced improved staff retention (Hewison et al, 2013, West et al, 2011). The best performing NHS Trusts in terms of lower levels of patient mortality, improved financial sustainability and more effective resource management have higher levels of staff engagement as determined by the NHS staff survey (West and Dawson 2012). This area of learning also identified the importance of staff engagement in service improvement, in that engaged staff have an increased willingness to move away from traditional working practices and utilise new systems of work (CBI, 2011). However in order to achieve this staff involved with service transformation need to be given a voice, if staff are listened to there is an associated increased feeling of being valued, leading to an increased willingness of them to direct their efforts to supporting the change (CBI 2011). Staff engagement throughout the decision making process creates a commitment to any changes, a clear understanding of the reasoning behind any changes
Making sense of organisational values, engagement and service delivery
and an increased likelihood of the change being accepted and supported (Dromey, 2014). There is widespread evidence to demonstrate that staff are more engaged if they have responsibility for their work and are empowered to influence their work (Towers Perrin HR Services 2003). Engaged staff can enable greater operational control, through an increased likelihood to embrace the use of standard procedures, team work and improvement in addition to challenging poor behaviours all of which contribute to safer practice (The Kings Fund, 2012). The most successful healthcare organisations are providing staff with the tools and resources to undertake effective service transformation as opposed to gaining support from external experts (Kings Fund, 2015b). A lack of staff engagement is the largest single cause of failure in change projects (Robinson M, 2010). Failure to gain staff engagement, leads to change being forced upon staff, often leading to staff opposition (Robinson M, 2010).
Evidence of Impact Throughout the EGA I have had a greater awareness of how my leadership impacts on those within my teams and the wider organisation. As I have moved through the program the Work based evidence has enabled me to consolidate that learning whilst providing real benefits in the workplace.
360째 feedback and the healthcare leadership model 360째 feedback. The latter has been extremely influential in my leadership development and identified areas in which I need to develop as a Leader.
Advice to Future leaders The EGA has provided me a fantastic opportunity to develop my leadership skills whilst the whole program has been beneficial, the requirement to talk to both staff and patients during the program regarding their experience of services and areas for developments has potential had the greatest influence on my services, as a leader we do not always afford the time to do these things which are often not given as viewed with as much value as meetings or report writing, however spending such time can be so efficient in understanding what changes could be made with the greatest impact.
360 Quote Sarah is approachable and understanding, she always makes time to help support others. Her enthusiasm is infectious and she is able to bring others with her to achieve the overall aim.
For me the greatest impact was during my dissertation which focussed on my leadership impact on staff engagement, to evaluate this I undertook semistructured interviews with staff within the services I lead, having the opportunity to speak to staff in this way led to gaining a greater understanding of how it feels to be on the receiving end of the organisation as a more junior member of staff. It enabled me to understand that limitations of staff engagement strategies and the requirement for staff to feel empowered in order for them to be effective. More importantly it allowed me to really understand the burning issues for these staff in order for me to provide support in addressing them.
What I now know about my Leadership, my behaviour and practice. My EGA journey has enabled me to critically evaluate my leadership style, both through an increased use of reflection on my performance and through seeking views of others both through the use of the narrative
Sarah Cooper Head of Clinical Professions Clinical Support Services Rotherham NHS Foundation Trust
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s NICE Lead, I manage and support the organisational processes in relation to NICE guidance awareness and compliance assessment (including the development of action plans). I also provide reports to external parties, such as commissioners, on the activity undertaken with relation to NICE Guidance.
My role within the team is to Line Manager staff, deputise for the Assistant Director of Nursing, and provide leadership and management support to other team members about their subject area and their personal development.
required for the successful adoption and implementation of NICE guidance and through using transformational leadership it enables employees to be more open and committed to undertaking the change.
I completed a mathematics degree from York University in 2002 and started my career as an NHS Internal Auditor whilst completing my accountancy qualification. I then moved into NHS Governance followed by a Compliance role finally working in my current role.
It is also recognised that systems leadership is required through all individuals in the healthcare system having a responsibility for the provision of care through systems and processes. It is based on collective leadership which is where leadership is distributed to all. The benefits of this type of leadership are that individual strengths can be utilised and there is variety and diversity in decision making. There is also recognition that the sharing of leadership throughout the organisation reduces stress as it does not burden one individual and was a forecast of team effectiveness and performance. This is important for NICE as it needs to be seen as being everyone’s responsibility.
My organisational context South West Yorkshire Partnership NHS Foundation Trust provides learning disability, mental health and community services to the people of Calderdale, Kirklees, Barnsley and Wakefield. The Trust also provides some medium secure (forensic) services to the whole of Yorkshire and the Humber. The Quality Improvement and Assurance Lead team provides a trust wide support role in the use of Clinical Audits and Service Evaluation, analysis of Patient Experience, ensuring compliance with the Care Quality Commission (CQC) Standard’s and the management of NICE Guidance. The particular challenges that are faced by the team include providing a service to the whole of the Trust due to its geographical spread and diversity of services and engaging some clinicians in the teams portfolio of work.
Learning for the system and for myself It is recognised that transformational leaders are required for NICE guidance management because it is about stimulating and inspiring staff with vision and creative thinking for staff to be engaged with NICE guidance. It is clearly linked to the commitment of staff to change their behaviour due to the skills those leaders possess to motivate staff to move in that direction. Behaviour change management is
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Evidence of impact Undertaking the Healthcare Leadership Model 360 degree review, along with the influencing styles questionnaire and engagement questionnaire, enabled me to have a greater understanding of my strengths and weaknesses and therefore identify how I can improve as a leader. In addition to the work I undertook on transformational and systems leadership this also enabled me to review how NICE Guidance is managed in the organisation to ensure that it is led by all relevant staff. Where this has occurred well this has meant that there has been a greater undertaking of the need to provide evidence based quality care.
What I now know about leadership and my behaviour and practices. As detailed above, a greater understanding of myself has helped me to have a greater understanding of my strengths and weaknesses and therefore identify how I can improve as a leader.
Making sense of organisational values, engagement and service delivery
Communication plays a large part in ensuring staff are aware of NICE Guidance. This was reviewed as part of my Healthcare Leadership Model 360 Degree Individual Report where it was confirmed that I am good at communicating with different teams to ensure the achievement of the Trusts mission, whilst also being passionate, professional, friendly and approachable. However, it was also acknowledged that due to the depth of knowledge I have for NICE guidance whilst it is noted that I am good at imparting the knowledge this can cause a barrier in communication because I know the subject too well. It was suggested that I need to ensure that I am making the best use of a full range of communicating and influencing methods. The influencing styles questionnaire was completed to identify the styles that I use and therefore how I influence staff in the awareness of NICE Guidance. It was identified that I use ‘reason’ and ‘friendly persuasion’. For ‘reason’, it is recognised that the benefits of this are that there is a confidence in the achievement of the outcome through the use of data and well researched arguments. Although it is also recognised that as this is based on facts and logic, which can be seen as rigid, it does not include feelings and emotion. This can lead to others, who normally engage with feelings and emotion, to not be involved. However, for ‘friendly persuasion’ the influencer listens to all other proposals and ideas and builds on those to identify the final solution. This improves the commitment by all those involved in participating and contributing. However, it is also recognised that this type of influencing may lead to the preservation of harmony and the avoidance of conflict and so those difficult issues may not be resolved. I was relieved that the styles I use can be used for the promotion of NICE guidance. This is also in line with the Myers Briggs Type Indicator that I have been identified as (ESTJ) which stated that I like to communicate using facts and logic. Therefore, there is a need to consider all sides, including emotion, before making decision. It was interesting to note that I previously completed this assessment three years ago and my type has remained the same since that time. Whilst I am reassured that this is in line with the role I undertake I need to bear in mind how these styles may disengage other staff. I completed an engagement questionnaire which showed that the areas I scored highly in were: being a
role model; personal effectiveness; approachability; communication and accessibility. These are all areas that are required for NICE Guidance engagement therefore making me feel that I have the skills to improve staff engagement with NICE Guidance.
Your message/advice to future leaders A key message throughout the course was understanding what ‘it’s like to be on the receiving end of me’ and the impact you could be having with all individuals you deal with. This is really important to remember for all interactions throughout your leadership journey. For me, becoming a leader means that you are in a stronger position to make a different in your work area and are able to inspire colleagues, especially those who wish to also become a leader and develop using tools such as the Leadership Academy courses.
360 Quote Anne is a strong role model and leads by example. She is reliable and manages expectations well. Her credibility with colleagues is good and is a good ambassador for the Trust.
Anne Rolfe Quality Improvement and Assurance Lead – NICE South West Yorkshire Partnership NHS Foundation Trust
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I
have worked for the NHS for 29 years in various nursing roles working mainly in acute services within orthopaedics or elderly medicine. In January 2015 I took up a post in the community setting working as a locality manager. The local healthcare provider (an acute trust also providing community services) serves a population of 469,108 (Office for National Statistics, 2011). The service spans 3,500km2, employs 8,500 people and has a budget of £470 million. Community Services is delivered through a block contract valued at £34 million. My organisation is going though financial difficulty and has a projected deficit exceeding £5 million for the financial year 2015/16. One of the three Clinical Commissioning Groups that we serve has a turnaround team advising where finances can be improved. Our Care Quality Commission Report rated us as “requires improvement” although the report for community services and palliative care was rated as “good” (CQC, 2015). Community Services comprises of community hospitals providing rehabilitation and palliative care; district nursing teams; specialist nurses, including respiratory, heart failure, cardiac rehabilitation, wound care and continence advice and: critical response teams which are multidisciplinary including health and social care providing rehabilitation and enablement services to avoid hospital admission or expedite early discharge from hospital. The Five Year Forward Review (NHS England (2014) sets out changes and describes how services should be delivered in the future with integrated working being pivotal. It is anticipated that teams will work collaboratively and where duplication currently exists, it will be eradicated as teams integrate thus saving money. Day to day my time is spent attending meetings, supporting staff to deliver the service, answering complaints, investigating serious incidents, dealing with human resource issues, development of staff/ teams and learning so that we can improve.
has been challenging, balancing study with full-time work and family life, I received a great amount of support from my fellow students and tutor. Being part of the programme has been the only constant in my professional working life.
Evidence of impact Linked to my learning on the programme two of the teams I worked with and one staff member have received star awards - an organisational internal reward scheme recognising innovative ideas. Winning teams/individuals receive a trophy to exhibit, a photograph and commentary in the staff bulletin and are invited to annual award dinner ceremony. The community hospital received the award for implementing a communal daily exercise programme. The orthopaedic out-patient nursing team won for coding activity that had not been previously been captured resulting in financial benefits to the department and a team member for living the organisation’s values. As a result of the programme, I learnt the importance of giving positive feedback and therefore felt compelled to nominate others so that their good work was celebrated. The programme has given me the opportunity to meet with other healthcare professionals, taught me the power of sharing knowledge and the value of action learning sets. A skill is getting people to work collaboratively and I have successfully encouraged my peers to meet weekly so that we can work on projects to improve the working life of our staff and patient care. When we meet, support is given to one another as the toll of leading disparate groups of health professionals that are geographically challenged is wearing.
Since starting the programme, I have held 5 different posts, been involved in one organisational and 2 directorate restructures. Although the programme
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Learning Learning from 12 completed work based assignments from the programme are summarised below: I dislike numbers and quantitative analysis leaves me cold but when completing module 4 assignments, I was forced to analyse data and I appreciated the value and importance of it as a leader. I was trying to understand the results of district nurses’ caseload review and the data allowed me to dig deeper examining resources more objectively (nursing establishment). It highlighted contributory factors that were potentially leading to time management issues experienced in one particular team. I wanted to improve the team„s effectiveness, and for them to become more self managing and asked the team leaders to question their team„s practice in relation to the data. Team leaders were not forthcoming and I wanted them to work more collaboratively across teams so I encouraged all district nursing teams across the service to undertake peer review. It was deemed successful by staff and changes to practice resulted in improvements to patient care. When I undertook a personal values assessment (Barrett, 2009), the results indicated that I lacked values in the section, “courage to develop and grow”. I undertook the assessment again to identify what values were required. Choosing the value, entrepreneurial, closed the gap. Synonyms for entrepreneurial are innovative, “thinking out of the box”, “blue sky thinking” so when I, or the team have been faced with a challenge, I have encouraged them to think more broadly, increasing our ideas and potentially our impact.
behaviours expected of a good leader (Storey and Holti, 2013). I am reminded of the leadership secrets of Atilla the Hun who under tolerance comments “every hun has value – even if only to serve as a bad example” (Roberts,1987:109). I am more aware of the impact my behaviour on individuals, the service and patients. The programme has taught me to become a more reflective practitioner and with it I have become reflexive – noting how my behaviour changes throughout the day, when I am tired or am with certain personality types. I am now aware of withdrawing from situations that I maybe do not agree with or are unpleasant and the potential impact that has on the teams that I lead as I become less visible or approachable. I undertook the Anderson Team Journey (Aston Organisation Development, 2014) with a team I am no longer in. I would like to take the journey with a newly appointed team I now lead to reap the benefits of “real team” working with positive outcomes for all (West, M. and Lyubovnikova, 2012 and 2013). Embarking on the masters’ programme was a journey of discovery. It was emotionally and physically exhausting but well worth it. My advice to others would be - work on your resilience! A quote, to share, because it helped me when the challenge ahead seemed impossible: “To a fabulous leader and lady, who knows what’s important, speaks what’s important, sees what’s important. Your presence is so important. Believe in the difference you make and all you bring. Celebrate you!”
I am more confident in my abilities and mindful of what I can control: Streatfield (2001:129) describes the paradox of being in control: He advises that leaders are not in control as they cannot predict the consequences of actions but can be in control if they creatively participate in making sense out of situations. He also says that being good enough reduces anxiety. Feeling “good enough” certainly made me less anxious when I chaired a user group for the first time.
What I now know about leadership and my behaviour and practices I have been frustrated at times since learning more about leadership theory as it has made me less tolerant with leaders that do not exhibit the
Sharon Hurst Locality Manager York Hospitals NHS Foundation Trust
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s programme lead for the digital learning in the NHS Leadership Academy I have the dream job of working amongst some of the most talented and inspiring leaders that there are in the health and care system, and in my experience, any industry.
My training is in the space science sciences and after leaving university in London for Yorkshire I followed after my father and took up a career in graphic design in the private sector. As the web became more ubiquitous I moved into the NHS and I spent increasingly more time on human-computer interaction and user experience analysis and research. Now at the Academy since it was formed, I am heading up the digital development and learning portfolio it is my joy to consider with my team how people engage with the internet, how we learn through the digital medium and provide the Academy’s online learning experiences. Leading a team of talented individuals with very varied specialisms I had not yet had any formal leadership development. I wanted to understand how teams interact, develop in efficiency and create culture. Culture as a team and also how they shape the culture of the wider organisation. Francis (2013), Berwick, Keogh and West saw a link between good leadership practice and a positive improvement in patient care outcomes and the experience of care. Failures in leadership were also linked back to poor leadership. The NHS Leadership Academy came into existence as a national strategic intervention to improve the leadership in the NHS and through better leadership, improve patient care. Improving leadership isn’t quick and isn’t easy. The main offering of the Academy is a series of programmes available for health and care workers at all levels of their career. The Elizabeth Garrett
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Anderson programme, discussed in this book is one of those programmes.
My Learning One of the most foundational pieces of learning for me has been in the area of inclusion and openness. I was introduced to the work of William Shultz by Chris Lake, head of professional development at the Academy. Shultz (1994) very clearly writes about his model of inter-personal relationships in *The Human Element*. He describes a set of behaviours two individuals want to receive from the other and give in their work together. These basic behaviours are inclusion, control and openness. In previous roles in the NHS I had always considered inclusion to be a tick-box exercise to ensure we were inclusive in our job application processes. Shultz has taught me that inclusive practice is drastically more than this and significantly more important. I’ve learnt that inclusion is about every individual being able to be acknowledged, to be allowed space to interact, to belong and to be uniquely themselves. Understanding this frees my thinking up to understand that all the 1.3 million staff in the health system should be concerned about inclusion. With this mind set inclusion is not only about a set of protected characteristics. It is about being able to be a human in the world. We are all unique and all uniquely valuable. The way I work has become much more reflective. As an introvert I used to consider myself as having little impact. I am much more aware that all behaviours have impact, even mine. Being reflexive allows for much more opportunity for me to use my behaviours in the best way you can in the moment.
Making sense of organisational values, engagement and service delivery
The way I work with my team, now, values the difference we all bring. As a team we each can work to our strengths and help others with weaknesses through understanding more about ourselves, each other and our preferred ways of interacting with others. With difference comes diverse thinking and in a solutions focused team, that is needed for productivity. As our team grows in it’s understanding of each other and in it’s inclusive behaviours we are freed to be more open and to be more vulnerable around each other. We can work with our rational selves and be aware of our defensive self which makes us rigid and does not change when new challenges come along. As we develop as a team we have seen that we can openly be wrong (and we can be very wrong at times!), be right and still continue working for the good of the team instead of being restricted by our defensive selves because we are accepting of each other.
When you work with others, what is it that makes them valuable in the world? How can you work better and more productively and inclusively with such valuable assets in your organisation?
360 Quote “Jason is a great role model for his subordinates. His combines a mixture of great knowledge in his subject area, to great knowledge in the wider healthcare sphere, to compassionate leading.” (a quote from my Healthcare Leadership Model 360 degree feedback)
As a team we have been through some tough periods and worked on difficult projects within a shifting context and yet we have worked to produce the required outcomes and adapted to new contexts. Gervase Bushe (2011) talks about similar inclusive and open practices as ‘clear leadership’. When we don’t engage with each other and find out what our team thinks, fears and values we stop being inclusive and our leadership becomes less clear. We don’t know what the experience of the team is. When we don’t know these experiences we begin to make up stories for ourselves, filling the gap of understanding. Bushe reasons that collaboration and team work cannot happen in such an environment. Indeed, we have stopped working with others and have replaced the elements that make them unique with our selves, our own opinions, thoughts and stories. We have stopped inclusive practice. And so…
My message Very practically I would urge you to be reflective; Understand yourself more and the impact you have on other individuals. From all of the thousands of impact stories I have seen from the Academy reflection is often a massively valuable tool for change.
Jason Brewster Programme Lead for Digital Learning NHS Leadership Academy
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Jodie Millington
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Laura Whixton
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Cath Doman
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Tze Min Wah
Often, people talk about leading change as common sense with good interpersonal skills and confidence. However, leading change requires specific knowledge (intervention theory and design) and skill (intervention practice) because change is intended to produce specific results or alter specific features of a service or organisation. “ ...To achieve an elevated goal or vision, change must occur. For change to occur, a choice must be made. To make a choice, a risk must be taken. To encourage risk taking, a supportive climate must exist. A supportive climate is demonstrated by day to day leadership behaviour; by setting an example...� (adapted from Larson and LaFasto, 1989)
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fter University I worked as a support worker and quite quickly realised that a career in mental health was where I aspired to be because I wanted to make a difference to peoples’ lives. Helping people achieve their potential is a key driver for me and so I commenced my journey in IAPT in 2008. I worked in a number of different clinical and leadership roles since this time starting as a trainee Psychological Wellbeing Practitioner teaching patients new skills to manage their anxiety and depression. I went on to successfully gain a Postgraduate Certificate in delivering Low Intensity Interventions based on Cognitive Behavioural Therapy. Throughout this role I developed a desire for supporting other therapists in their roles and went on to become a supervisor. I moved in to a Senior Psychological Wellbeing Practitioner role where I became heavily involved in supervising trainees and qualified staff and large scale pieces of service development. I moved in to a team leader role giving me opportunity to become more involved in service improvement and supporting a team of therapists in their roles. What became apparent to me was just how rewarding and valuable it felt to support and develop other therapists in their roles in order to make a difference on a bigger scale. My IAPT journey led to a position in management where I can now lead a whole team of therapist from different backgrounds to hopefully make a difference in the NHS for patients.
My organisational context Sheffield Health and Social Care NHS Foundation Trust (SHSC) provides a number of health and social care services to the people of Sheffield. The IAPT service currently sits within this Trust and provides psychological therapies for people experiencing symptoms of depression and anxiety based within a Primary Care setting. The IAPT service has a number of clinicians who help over 13,000 people each year. Psychological Wellbeing Practitioners, Counsellors and Cognitive Behavioural Therapists usually work from GP Practices to deliver the Service.
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Providing ‘more for less’ in the current NHS context is a continual challenge for our service as we consistently strive to improve the quality of care for patients with less resources. Utilising technology and the diversity of clinical expertise in the service has been instrumental in achieving this.
Learning for the system and for myself A fundamental piece of learning for me has been the importance of partnership working across services to improve patient and staff experiences. The benefits of partnership working are multifaceted (NHS England, 2013) and it has been essential learning the importance of meaningful relationships with partner services to improve how patients access their care Lessons have been learned around how to be creative with resources and flexible across boundaries so that patients get rapid access to the therapies they require at the right time for them. The role leadership can play in improving how different services can work together has been an important learning point for me. It has highlighted the difference leaders can potentially make if you are passionate about improving how services work together.
Evidence of impact An improvement in partnership working has led to a positive impact how patients’ experience their journeys through services across SHSC. I have learnt, through a better understanding of my own skills as a leader, how to engage with staff from different professional backgrounds to continually improve relationships across services.
From working with my team over these last two years I’ve learned more about the skills and experiences they possess to be able to work alongside my team, building on their strengths, to improve the quality of the services we deliver in the IAPT service. It has been important to share learning from the work I have been doing across the organization to create an impact for patients and staff on a bigger scale. The value of doing this can mean that positive ripple effects can occur enabling learning to flourish across other services.
services. Not only can this help improve the experiences for patients accessing services, but it can help improve relationships with other professions which in turn can improve the experiences in work for staff.
360 Quote “Jodie displays enthusiasm and a solution focussed approach rather than rumination on problems, always approachable and positive, enables good team morale which drives enthusiasm at work”
What I now know about leadership and my behaviour and practices The Elizabeth Garrett Anderson Programme has been significant in the development of my leadership capabilities. I started this programme in my first year of management in the NHS and it has provided me the platform to continually learn and challenge myself at every step of my journey. I’ve learned the importance of being reflexive ensuring I am constantly in tune with what is right for patients and staff. As a result of developing my own self awareness my confidence has grown as a leader and I feel inspired to help nurture other aspiring leaders in the NHS. The value of staff engagement has been vital for me over the last two years, building my creative strengths in this areas has helped find ways of improving the service I work in.
My message to future leaders There has been so much learning over the last two years, it’s difficult to pick one key message! The most important message I can share is the value and importance of working in partnership with other
Jodie Millington Team Manager Improving Access to Psychological Therapies Sheffield Health and Social Care
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y name is Laura Whixton and I work as a Quality Improvement Lead for the Children’s and Maternity Strategic Clinical Network for Yorkshire and the Humber. My particular focus is on the children’s part of the programme.
I started work in the NHS as a medical secretary at Doncaster Royal Infirmary, working in Cardiology before moving on to the project team responsible for implementing Choose and Book across the Trust. This was my first taste of project style working and I soon came to realise it was something I enjoyed and wanted to continue doing within the NHS. It was thanks to my fantastic line manager at the time and the Director of Performance that I was given the opportunity to really develop my leadership skills. They saw potential in me so that when the project manager left, I was offered the chance to carry on leading the work myself. It was a scary jump to make at the time, but on reflection was one of the highlights of my leadership journey. When the project came to a close I moved onto Children’s Services within the Trust and came to appreciate the importance of working with children and the impact upon someone’s life long development I could have, even whilst not being a direct care giver. Finally, in February 2014 I left Doncaster and Bassetlaw Hospitals and went to work for NHS England, in my current role, which is project based and focussed on children, just on a wider scale than one Trust.
My organisational context The Children’s and Maternity Strategic Clinical Network for Yorkshire and the Humber is a small team of people from a variety of backgrounds, including clinical, health and public health, who in essence bring together a wide range of partners to collaboratively work on addressing specific health services for children and young people, such as surgery and anaesthesia, transition to adult services and mental health. It is a challenge covering a wide geography as we often have to work virtually, and at the same time relationship building is fundamental to what we do and can achieve.
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Learning for the system and for myself I remember one particular article I read about being a boundary spanner (West et al, 2006). This really struck a chord with me and helped me to identify some areas for development within my particular role, as I strive to collaborate across organisational groups. For example, the caution around our perception of particular ‘out-groups’, or on the flip-side that other agencies we work with may hold about us, and how these can lead to conflict, despite all working to address the same challenge. This highlighted the need to really come to know the many groups and individuals I work with on a first-hand basis, to understand the context within which they work and not assume that just because we all want the same thing it will be plain sailing. Aside from this, one of the strong messages that has stood out and had an impact upon my day to day work, and by extension that of my team, is the persistent focus on patient care. Not being a direct care provider means that we run the risk of losing this focus and becoming side-tracked by the needs of the system not the lives of the children and young people we are serving. We have now set up a whole work programme called CYP Involve which ensures that all we do remains focussed on patients. CYP Involve has meant that we get children and young people directly involved in the work we do and they definitely help keep us on track! This has been invaluable for us and at times reassuring, as what we have heard from children locally has often matched what national guidance has told us. This has demonstrated to us that the whole system, if it listens to the patients as experts can set out a clear roadmap to improvement
Evidence of impact For my team and my organisation I think the biggest impact is as described above, around getting patients
in on the action and the benefits that come from this in terms of ideas, keeping focus and helping people with what matters most to them. As for myself, my dissertation was about the impact on emotional resilience when one’s personal values are aligned with those of their organisation, and personally I feel this is where I have had the biggest impact. I have learnt that how I uphold organisational values can help colleagues develop their own relationship with the organisation and how in turn this is a contributing factor to their own social capital and by extension emotional resilience.
What I now know about leadership and my behaviour and practices The EGA programme has clearly demonstrated, I think, the difference between management and leadership and I feel the person I am now is a more rounded individual who has the confidence to lead people and put my head above the parapet to stimulate change, not just to manage people or work projects. The experience over the last two years and the learning from the programme (such as how to develop a learning culture, a patient-centred focus and team working) has contributed to this confidence.
My message to future leaders That theory is great and has its place, but it is experience and putting theory into practice that provides the real learning.
360 Quote “Laura has a unique ability to keep complex issues simple.”
Laura Whixton Quality Improvement Lead (Children’s), Children’s & Maternity Strategic Clinical Network, NHS England, North (Yorkshire & the Humber)
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y name is Cath Doman and I am the Programme Director for the Vanguard programme, which is testing new care models to transform health and care services in Harrogate and Rural District as part of a national programme of 50 vanguard sites testing five different new care models. I work on behalf of the six vanguard partners in the local area, leading the programme. I qualified as an occupational therapist in 1991 from St Loye’s School of Occupational Therapy in Exeter, and moved straight into a community-based post for Dorset County Council social services department in Bournemouth. From my earliest experiences I was driven to improve services to make them more oriented to the needs of the person rather than the organisations delivering the services. I couldn’t understand then, and still can’t, why the NHS and social care were delivered separately, splitting apart the ability to deliver truly person-centred care. My attempts as an inexperienced member of staff with little professional and life experience, to work across that divide were probably naïve and mostly unsuccessful, however that sense of injustice has driven the direction of my career. After 15 years as a OT, culminating in Principal OT in Doncaster, I moved to my first dedicated service improvement role, leading the adult services modernisation programme for social services in North Yorkshire County Council. Still attempts to bring NHS and social care services closer together were thwarted and it was not a priority for the local NHS to develop this at that time. In 2006, I joined the NHS for the first time, moving into a commissioning role for older people’s services for Bradford and Airedale Primary Care Trust. For the first time, this role felt like it had the potential to have a significant impact on improving services and developing integrated care across health and care services, and so we commenced a programme to integrate care. Today, integration of care is a central ambition in many health and care economies and it seen as a way of delivering better person-centred care as well a more efficient (cheaper and more effective) services. The Kings Fund has led much of the thought-leadership on this agenda, bringing examples from the USA, New Zealand and Spain to name a few as well as highlighting the work of areas in England such as Torbay who had led the agenda that many were to follow.
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My role in Bradford exposed me to the politics and slow-grinding negotiations of Chief Executives testing out their new mantles as system leaders and finding them not as comfortable as the robes of organisational leadership where their word was law and there was no requirement to cede control or question their sovereignty.
My organisational context My current post has brought me the greatest influence in delivering person-centred integrated care. As the Programme Director for one of the nine national Primary and Acute Care Systems (PACS) vanguard sites, I now work across a health and care system, supporting six NHS and local authority organisations to work together to dissolve the boundaries between services and to challenge decades of received wisdom on the best way to achieve a sustainable health and care system that truly empowers people to be healthy, well and independent and delivers care without joins when it is needed. I work for the Harrogate and Rural District Clinical Commissioning Group, Harrogate and District NHS Foundation Trust (acute and community health services), Harrogate Borough Council, North Yorkshire County Council, Tees, Esk and Wear Valleys NHS Foundation Trust (mental health and learning disability services) and the GP Federation, Yorkshire Health Network. As with many other areas, the local health and care economy is challenged. Reducing funding and increasing demand is meaning that the current configuration of services is not sustainable in the long-term and we need to think about alternative ways of delivering care that drives up the quality of care and remains safe and affordable. The Vanguard programme, set out in the Five Year Forward View (NHS England, 2014) is testing out alternative approaches across England, with the aim of identifying new care models that can be replicated nationally.
Learning for the system and for myself My study of leadership theory throughout the Elizabeth Garratt Anderson programme has helped me frame and articulate phenomena that I had an instinctive sense of but didn’t know the theories that underpinned it. By exploring and testing these, it has helped me to develop my insight into more effective approaches to address the wicked problems which beset health and care systems. My major area of interest has been in system leadership because of its pertinence to my recent roles and especially my current role. Chris Ham (cited by Timmins, 2015) defines system leadership as a form of collective leadership: “[It] means everyone taking responsibility for the success of the organisations and systems in which they work, … It is characterised by a belief that leadership is the responsibility of teams, not individuals, and is needed at all levels. Collective leadership enables organisations to develop cultures in which patients receive high-quality care and it supports organisations to work collaboratively for the greater good of the populations they serve.” (p.4)
nature of system leadership, particularly the need to embrace uncertainty and ambiguity, make connections and distribute leadership, helped me recognise that it is difficult and complex and that no one leader could ever have all of the answers or achieve transformational change alone. Most importantly, it confirmed my views that leadership of a system, including the systems within the NHS and between the NHS and social care, needs to occur throughout organisations and that it isn’t the preserve of the most senior managers alone. Working as a leader in the health and social care system is enormously challenging and we often place unrealistic expectations upon ourselves to deliver change alone. This comes from a history and culture of heroic leadership which still persists but there is now recognition that change can only occur with the engagement and involvement of all staff and by distributing leadership throughout the organisation and increasingly, across a whole local health and care system.
The framework developed by Fillingham and Weir (2014, as shown below) describes the complexity and
The characteristics of system leadership (Figure replicated from Fillingham and Weir, 2015, p. 24) Delivering system wide co-ordinated care
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Cath Doman Programme Director New Care Models, Harrogate and Rural District Vanguard Partners
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Delivering system wide co-ordinated care
Evidence of impact The message that has stayed with me since the very first programme residential was Chris Lake’s question about what it is like to be on the receiving end of me. I don’t think that I thought of myself as a leader and therefore didn’t really appreciate the impact I had on people, both negatively and positively. I am much more aware of this now and, I suspect, more effective. Often it is simply giving people your attention that makes the difference and recognising that even if it seems parochial, you need to attend to what matters to them. I also know that I have greater impact. I am much better equipped to get things done through other people that I ever was. I recognise that working with and learning from others makes me a better leader. My self-confidence has grown and I take genuine pleasure in seeing others flourish and grow. I know now that I don’t have to have all of the answers and that is very freeing.
I have strengthened my ability to be reflexive in all situations and to adjust my behaviour to reflect what is happening. I am more able to separate the personal from the professional and take challenge or criticism less personally. Flowing through everything I do, even ten years on from delivering direct patient care, is the belief that person-centred care must be at the core of everything I do. I often reflect, perhaps after a trying day of meetings, whether I have made a difference today. Have I made even a small step towards achieving better care and a system that focuses on enabling people to remain healthy, well and independent? This continues to drive me along with a continuing sense of injustice created by separate health and care systems which continues to refuse to recognise that it is not possible to separate the psychological, social and physical health needs of a person.
Your message to future leaders My role working across six organisations has demanded a new approach. I have to achieve change through relationships and demonstrating continually that I am a system leader. I no longer have commissioning levers at my disposal, nor do I have control over operational services. So my impact is through influence and connections. I also have to recognise that different organisations are in different places in relation to whole system transformational change and support them in whatever way they need, to help the whole system slowly take steps forward together.
What I now know about leadership and my behaviour and practices. The area I have developed most is the recognition that I cannot achieve things alone and can only get things done through the engagement and involvement of other people, working together as leaders. My ability and confidence in operating across a whole system has grown significantly and I am now more able to achieve results because I am better able to bring people with me.
Leadership is not always about charismatic people leading the charge from the front. It is often about staff throughout organisations doing the right thing, driven by their values and a commitment for keeping the interests of the patient front and centre of everything they do. It is about being open to ideas and being prepared to change direction if something isn’t working. My main message, however, is that the NHS and its social care partners are part of a complex whole system which needs to be led as such. The days of individual organisations working in isolation are long gone. The more the emerging leaders of today embed that belief in everything they do, the greater the chance we have of delivering truly personcentred care.
360 Quote “ Cath knows and understands her area of work incredibly well. This means she has credibility and is able to influence within her own organisation and also partners”
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I
am Dr Tze Min Wah, a consultant interventional radiologist specialising in interventional oncology (IO) based at Leeds Teaching Hospitals Trust (LTHT) and also an Honorary Clinical Associate Professor at the University of Leeds. IO is a new clinical discipline and the emerging as the 4th pillar of cancer care complimenting surgical, radiation and medical oncology to provide integrated cancer care to patients. It provides minimally invasive image guided cancer treatment using a range of innovative technologies such as the heat e.g. radiofrequency ablation, microwave ablation and cold e.g. cryoablation based energy to treat a range of cancers. I have led the development of the IO cancer service since its inception from 2003 at LTHT. This is one of the UK’s largest programmes with a world class reputation. In addition, I am also the national chair of Interventional Oncology UK (IOUK) group within the British Society of Interventional Radiology (BSIR) and facilitated their launch in 2015. I am leading the IOUK team to influence the national agenda to achieve better treatment access for patients, research/education and service delivery/ policy
My organisational context The LTHT organisational culture is experiencing a radical change from a historical ‘command and control’ culture to a more empowering one after the arrival of the new executive team in October 2013. The new culture champions the Leeds way- ‘patientcentred, empowered, fair, accountable and collaborative’. It aims to engage the workforce in order to drive system change and ensure sustainable service improvement in an organisation with a challenging financial backdrop. The historical culture had contributed to poor facilitation of the development of innovative Interventional Oncology (IO) cancer service, the 4th pillar of cancer care at Leeds Teaching Hospitals Trust (LTHT). I have led the development of IO cancer services since its inception from 2003 and it is now one of the UK’s largest programmes with a world class reputation. The LTHT-IO team is a multidisciplinary team and consists of administrators/coordinators, nurses, operating department practitioners, radiographers
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and consultant anaesthetists and radiologists. The adaptive challenge for the LTHT-IO team is that I have no direct management role and individual team members are line-managed under separate arrangements. This can appear lead to potential competing interests in resource allocation; lack of role clarity and understanding of the vision for this programme. The patients’ feedback just prior to my Anderson journey highlighted the lack of visibility of this innovative cancer treatment and inequality of access to this IO treatment. As part of my Anderson Leadership journey over the last 18 months, I have strived to lead the development of the LTHT IO cancer service in order to achieve greater visibility and to facilitate better patient access to the IO service as well as better team based working.
Evidence of impact This Anderson leadership journey has given me significant insight into my own leadership behaviours in particular my influencing styles over the last 18 months as I lead the development of the LTHT IO cancer service. I have utilised a range of system leadership repertoires to develop the LTHT-IO service engaging both internal and external stakeholders as well as facilitating better team based working to deliver quality patient centred cancer care at LTHT. On a personal level, the Anderson journey has provided the insight into my own leadership capability that has facilitated my journey to take on the national role as the IOUK chair and to empower others to be part of the journey. I have influenced the national agenda e.g. enhancing its visibility through working with external partners; promoting equitable treatments access and cross fertilisation of best practice amongst the IO experts/innovators. At the team level, using the knowledge and tools learned from my Anderson journey Ihave facilitated a better team based working over the last 18 months. The effective team based working has delivered high
quality IO services to patients and were highly commended for the service we delivered in two different categories - Innovation and Leading in Leeds at the LTHT Time to Shine Awards ceremony in October 2015.
organisation. In addition, better integration across the all layers of the system is vital supported by our managers.
At the organisational level, I am conscious that the least effective influencing tactic e.g. ‘legitimising’ or ‘validation’ from the top had been used to overcome the challenges faced during the development of the LTHT-IO programme for service delivery in particular in the quest of influencing the middle management in the early stages of organisational cultural change where the ‘command and control’ culture still lingered in the background. On reflection, I would strive to better engage with managers using my dominant influencing behaviour as evidenced by the feedback from the semi-structure interviews as well as influencing behaviours questionnaires from various stakeholders e.g. rational persuasion, inspirational appeal, collaboration and consultation in the future which aligns with improvement of the organisational culture and will negate the need to use the less desirable legitimising and coalition influencing tactics.
The best thing I have done to date is to have participated in the Anderson leadership journey as I have truly discovered who I am. I have learned that in order to be a successful system leader, one has to have an insight into their leadership influencing behaviours. One of the important ingredients to mobilise human potential in order to integrate all the layers of the systems across the internal and external stakeholders, requires effective influencing behaviours that can engage people effectively i.e. create magical connection that can inspire others to go extra miles to achieve the common goal.
What I now know about leadership and my behaviour and practices. ---
Your message/advice to future leaders ‘Try to discover who you are and what you truly stand for, so you can enjoy being an authentic leader during your leadership journey in both your personal and professional life to create the kind of magical impact that can unleash the ultimate human potential’.
Learning for the system and for myself The LTHT IO programme has gained significant visibility across the organisation and this facilitated better patient care as evidenced by feedback on the patient opinion website-‘Cryoablation has been the best management of my problems, and this treatment has preserved my kidney, allowing it to function and serve me well, far better than any dialysis machine could and has thus kept dialysis at bay, and costs down, …It has given me back my life – but more than that, it has given me quality of life..’ (Lee, 2015). ‘If this was a Trip Adviser review, I would be using words like “stunning”, “5 star service”, “would definitely return”…. If I was a judge on Britain’s Got Talent, I would press the golden buzzer and put Dr Wah and her team straight through to the live semi-finals where she would go on to win it!’(Mark1, 2015). Values-based leadership is the crucial ingredient in empowering and engaging the team to deliver sustainable change and service improvement and living out the organisational values by the executive team is important to set the scene for the
360 Quote “You are real and authentic in the sense that you often articulate the hardest truth in a way that is empowering people to change and you do not try to be someone else or play one against another”.
Tze Min Wah PhD, MB ChB, FRCR, EBIR, FESUR, FCIRSE, FHEA, Pg Cert. Clin Educ. Clinical Lead for LTHT IO Programme IOUK Chair (British Society of Interventional Radiology) Consultant Radiologist & Honorary Clinical Associate Professor (University of Leeds) Diagnostic and Interventional Radiology Department Institute of Oncology St. James’s University Hospital Leeds Teaching Hospitals NHS Trust Leeds
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Creating engaging and learning cultures 44
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Michael Holmes
Engaged employees are valuable assets to any organisation. Developing engaged teams, however, isn’t always easy as we cannot handpick our team members. Likewise, the team cannot handpick their team leaders. In today’s health and social care organisations, people are expected to be contributing team players, sometimes on several teams simultaneously. A leader’s ability to be regarded as a contributing, valuable team leader has a significant part to play in the engagement, dynamic and satisfaction of the team.
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I
n 2015 I celebrated my 20th anniversary of graduating from medical school. A strange feeling but my reflection on those twenty years left me feeling pretty good about my career choice – I’ve worked with some fantastic people in amazing organisations and learned so much from patients for which I am incredibly grateful. Following graduation I worked in a number of different specialities before choosing to become a GP. I finished my speciality training in 2002 and became a partner with Haxby Group Practice the same year. 14 years later and I am still there – during that time there have been political and contractual changes but the patients and my colleagues have been constants throughout. The practice has changed though and so has my role. The practice is beyond recognition. In 2002 it would have been classed as a large practice providing care for 20,000 patients from 4 sites with 12 partners and around 50 staff. However shortly after the contractual changes in 2004 as a team we recognised that the environment had changed for good and that if we were to survive we had to adapt. We recognised the need to become larger and that diversification was the key to survival. We embarked on an amazing journey which saw us delivering services in primary care previously only delivered in hospitals, winning contracts to develop 3 new practices in the City of Hull and branching into the world of Community Pharmacy hitherto completely unknown territory. In 2016 the practice now serves 50,000 patients from 10 sites in 2 cities with 22 partners and staff of over 200.
seeing patients, 1 day performing vasectomies in primary care, 1 day at the RCGP as clinical lead for At Scale General Practice and the remaining 2 days in a clinical leadership role within the practice – focussing on performance, the delivery of high quality personcentred care and shaping relationships between with other practices and other healthcare sectors.
There were many factors that drove this transformation – yes, of course, political and economic factors are omnipresent but they sat in the background whilst the overriding motivators were the desire to deliver high quality clinical care and to face the challenges that modern primary care offers in a proactive way.
The focus on values alignment in module 4 has had a huge impact on me personally and the work I do. In 2015 Haxby Group merged with another practice in York. One of the first things the two organisations did was align their values – my experiences on the EGA helped me contribute significantly to that process and moreover understand its importance. Having established those shared values everyone within the organisation gained a greater understanding of why the merger was taking place and how the new organisation would work. Knowing that key values revolving around patients, learning and inclusivity were integral to the new organisation meant is was less daunting and a much more comfortable place to be.
My personal journey has also delivered much change. Initially a full-time clinician I have over the years developed an interest in leadership not only within the practice but also externally – having held leadership roles with a Primary Care Trust, a Foundation Trust, a CCG and now with the Royal College of General Practitioners. Currently my working week is varied – spending 1 day as a GP
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Learning for the system and for myself The EGA program has been one of the richest sources of learning I have experienced. The way the learning was structured in terms of individual, team and organisation has enabled me to focus on all aspects of my performance and make sense of all the environments I encounter. A deeper reflexive understanding of myself and how I interact with others has resulted and without doubt made me a better clinician as well as a leader.
“Organisational Pride is a key aspect of employee engagement” (Pritchard, 2008)
P RIDE Professionalism - To act with professional integrity at all times Patients - To include a patients’ perspective in clinical practice related decisions Progress- To focus on organisational development and growth Relishing Diversity- To embrace the diversity and talent within the organisation Inclusivity - To value the strength of the entire team Development & Learning - To hold education and development central to all we do Equilibrium - To strive for balance - professionally, personally, organisationally Each Other - To value your colleagues and try to see more than one perspective
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These values are now embedded in the organisation – it is not difficult to see the impact of the EGA within them. In terms of my work in the within the practice, in the inter-organisational space and indeed within other organisations they remind why I am there and ensure my motivation is clear.
Evidence of impact (self, team, organisation) During my time on the programme I have become more aware of how organisations in the NHS work and the importance of the relationships between individuals and within teams and organisations. These relationships are key to ensuring high quality patient care but also that organisations flourish and are healthy places to work. Leadership, for me, has become something that cannot be underestimated or fitted in between other tasks. I hope I have been able to bring some of my learning back into my organisation. My colleagues have begun to recognise clinical leadership as something that will bring benefit to the practice. I have been given dedicated time for leadership activities and the practice is hopefully beginning to see impact. We have begun looking at new data to improve the way the public can access primary care adopting a demand-led ethos rather than supply-led. We are using existing clinicians and new clinicians in innovative ways to deliver patient care – yes improving efficiency but also a creating a more responsive service and one that is sustainable as we move into a challenging future. The gift the EGA has provided me has been a greater understanding of how to communicate the need for change, to engage with colleagues, capture their imagination and enable them to participate. The concept of Relational Leadership is, for me, paramount - creating the conditions for the development of trust betweenindividuals is so important whether providing compassionate clinical care or developing organisations (Carmeli, 2009).
What I now know about leadership and my behaviour and practices. My learning has enabled me to understand what is required to develop the key ingredients for creating an organisation based on the collective leadership approach described by Michael West (2012). An important element of this is that everyone in the organisation is collectively responsible for the success of that organisation. This has without doubt changed my approach to the organisational development at practice level but has also impacted on a systemwide basis. The suggestion that primary care as a whole must take responsibility for itself has helped me undertake a leadership role in attempting to unify primary care across the whole of the Vale of York with a view to collaborating with other healthcare sectors. This ultimately may lead to shared, systemwide outcome measures meaning care is truly coordinated, efficient and most of all personcentred.
Message to future leaders Everyone working in the NHS is a leader. This programme has just helped me realise how I lead how I can improve and moreover how I can support others to do the same. It’s challenging but so rewarding; I’ve made new colleagues, new connections but most of all new friends – this learning experience has changed my life and the direction of my career. If you’re thinking about enrolling – just do it….you’ll never regret it!
360 Quote “Mike is a great creative thinker, influencer, shaper who works through consensus-building and leads by example”
Michael Holmes, GP Haxby Group, York
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Helen Fearnley
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Jo Watson
The way that we manage ourselves is a central part of being an effective leader. It is vital to recognise that personal qualities like self-awareness, selfconfidence, self-control, self-knowledge, personal reflection, resilience and determination are the foundation of how we behave. Being aware of strengths and limitations in these areas have a direct effect on how we behave and interact with others. Without an awareness of or behaviours, it will be much more difficult to behave in the way research has shown that good leaders do. Our behaviours have a direct impact on our colleagues, the teams we work in, and the overall culture and climate within the team as well as across the organisation; affecting the care experience of patients. Working positively on our personal qualities will lead to a focus on care and high-quality services for patients and service users, their carers and their families. Evaluating my leadership behaviours and impact
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C
alderdale and Huddersfield NHS Foundation Trust in West Yorkshire. It employs over 5,000 staff and provides elective and emergency hospital care and primary care services to two local authority areas.
I am a specialist nurse who led the Tissue Viability service, which is responsible for providing expert advice and treatment for patients and colleagues regarding the prevention and management of wounds such as pressure ulcers, leg ulcers and complex surgical wounds. The team consisted of 5 specialist nurses, 2 equipment co-ordinators and an admin clerk.
me and have been very supportive of me. As a team we have benefited from the skills and knowledge that I gained throughout the course. The surveys that we undertook demonstrated an improvement in team communication, decision-making and team effectiveness. One of the team noted that we are seeing more possibilities for improving patient care because we are open to change.
The team is responsible for leading improvement in pressure ulcer prevention across the organisation. This has proved challenging in terms of balancing increasing clinical workload with the need to lead and collaborate with other teams to improve patient care who are faced with their own challenges such as nurse staffing shortages.
Organisation
Evidence of impact Self This programme has enabled me to analyse and understand my leadership practice and behaviours by developing self-awareness and curiosity through reflection and reflexivity. My confidence in my abilities has also improved as I’m much more aware and mindful of my strengths, preferred ways of working and the impact that this can have on others. For instance I have improved my listening skills as well as facilitation skills, which has been invaluable for team development and delivering improvement projects by encouraging participation and considering multiple perspectives. From a personal perspective my learning and development has helped me to secure promotion at another organisation
Team My team have been on the Anderson Journey with
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The skills I have developed have enabled me to engage and collaborate with other teams more effectively in order to facilitate improvement. My leadership case study examined the impact that I had had in leading a project to reduce pressure ulcers on two wards with above organisational average incidents. This was achieved by developing professional partnerships, providing expert clinical advice and training and supporting my peers through questioning, listening and agreeing strategies
Learning for the system and for myself Prior to the Anderson programme I had considered myself to be a good listener, however, the programme has helped me to reflect upon what it’s like to be on the receiving end of me through the use of 360 degree feedback and challenging my personal assumptions through the use of questioning and active listening. I express myself more explicitly, which is a challenge for an introvert! However, this has facilitated engagement with discussions, decision-making and service development. It has also helped me to appreciate the benefits of equality and diversity, which includes the patient voice. Rather than telling others what to do I ask others what we could and should do in order to deliver effective person-centred care.
From a systems perspective I now look for opportunities to engage with other organisations within the system and beyond the system. This includes learning from other systems and organisations as well as developing partnerships to help deal with complex problems. For example my team works in partnership with colleagues in the local Clinical Commissioning Group and Local Authority to support care homes. Another important lesson for leaders is about how we treat our colleagues; a combination of leadership and management approaches is necessary at times, however, demonstrating care and compassion for colleagues has helped to demonstrate and role model appropriate behaviours and has improved commitment and engagement.
What I now know about leadership and my behaviour and practices. Prior to undertaking the Anderson programme I had received very little leadership training and I wasn’t very confident in my abilities. My personal values include respecting and valuing others and demonstrating compassion and I wanted to develop skills that resonated with these values. Over the course of the programme my confidence in my abilities has increased and I feel much more assured. This has been achieved through 360 degree feedback, peer supervision, coaching and reflection. I am a more reflexive practitioner and more mindful of the importance of not just what you do as a leader but how you do it. The use of a reflective journal has helped to develop my practice by considering my thoughts and feelings and the impact my behaviours may have on others. I also appreciate the benefits of
seeking and receiving feedback. I am much less defensive about my practice and have developed a curiosity about my behaviours. This has facilitated some honest conversations which has improved trust and effectiveness for the team and myself. I have acquired a toolbox of techniques that supports my practice. One of the most useful tools has been the Time to Think model, which has facilitated more insightful and productive team meetings – I also use the principles of this model when interacting with colleagues. The BIFF tool, that supports effective feedback provision, has also proved invaluable in facilitating the development of trust and demonstrating professional integrity and compassion for colleagues. One of the most important changes that I have made relates to self-care. I regularly meet with a peer to discuss leadership issues and provide mutual support and coaching to explore options or solutions to issues.
Helen Fearnley Lead Tissue Viability Advanced Nurse Practitioner, Vascular Penthouse Bradford Royal Infirmary Bradford Teaching Hospitals NHS Foundation Trust
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I
am a specialist nurse working for a Clinical Commissioning Group (CCG). I lead a small number of other specialist nurses who though not directly delivering patient care influence the care patients receive by supporting, educating and facilitating other healthcare professionals to deliver care that is evidence based to current best practice guidelines.
We particularly impact on care given by those working in a primary care setting around the management of long-term conditions. This role requires leadership in order to get other healthcare professionals to change their practice whilst my own role requires me to influence decisions about aspects of care commissioned by commissioners for the people of a large industrial city. I have been a nurse for over twenty years in different clinical areas and I realise how important leadership is in today’s NHS which is constantly faced with change on a daily basis. For this reason I have undertaken the Elizabeth Garrett Anderson Course offered by the NHS Leadership Academy in order to improve the effectiveness of those I lead, those I work with and for and to improve the quality of care for patients.
My organisational context The context was within a small clinical nurse team, which sits as a part of a much larger medicines management team working in a CCG. Five specialist nurses make up the section I lead. The team has been in a constant state of flux as part of NHS organisational changes and resulted in three employer changes in two years. The team felt that they have been through quite a lot of transition and destabilisation, feeling undervalued, and disengaged from the organisation. The work of the team is centred on improving long-term condition management by supporting and facilitating other healthcare professionals. The team does not undertake direct patient care but they do have a great impact on the quality of care received by patients through the education and support they provide to other healthcare professionals, encouraging them to work to the current best practice evidence and clinical guidelines. However the team does work within an organisation that
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makes decisions about the care commissioned in a large city where those decisions have a huge influence on patient services and outcomes engagement is vital (Francis 2013, Firth-Cozens 2004).
Learning from the system and myself For me, one of the main learning outcomes has been around the value of trust in engaging staff and patients. Being open, honest and transparent and leading with integrity is crucial to develop person centred care and engaging stakeholders. Authentic leaders are highly self-aware, genuine, reliable and trustworthy whilst being able to focus on developing followers strengths creating an engaging organisational context (Avolio et al 2004). This form of leadership forms a pattern of behaviour that draws on both a positive psychological and ethical essence to develop self-awareness with an internalised moral standpoint with a relational transparency engaging with followers to endorse positive self-development (Walubwa et al (2008). Using an authentic leadership approach at all levels leads to more trusting relationships and better engagement not only with staff but with patients and other stakeholders. I have realised that NHS and organisation’s values are not always practiced by its employees. Much behaviour is transactional in nature rather than transformational, telling people what to do rather than engaging them in the decision process. There are definitely lessons to be learnt at all levels around effective communication that develops and sustains trust and engagement not only with the staff but with the wider city community. All staff within the organisation would benefit from some form of leadership training (Northouse 2013). This would aid decision making especially in the future where tough
choices may need to be made around healthcare provision. This approach can gain greater commitment from those involved and reduce conflict due to the trustworthiness of relationships built.
can reduce the development of rumors which may undermine any initiative being undertaken and ensure that any espoused values of the organisation are portrayed in all leadership behaviours.
Evidence of impact
360 Quote
I feel I have made a particular impact around being authentic when I come to leading my team. Within the team, engagement and trust has improved particularly around having more open and honest communication in which staff feel safe, confident and supported to express any concerns they may have. It has been good to see how those I lead have begun to develop leadership skills themselves, specifically around engaging the other healthcare professionals they support and educate and that trusting relationships have been formed.
“Joanne is a good communicator, very supportive of her team and has a clear vision and impressive integrity. She ensures the members work to the best of their ability and leads by example. She is considerate and courteous and interacts well with people from different organizations, ensuring that she and the team understand the pressures that exist and work collaboratively and productively to obtain the best results. She has led her team through periods of stress and uncertainty within the larger organization and has their respect and support.�
Engagement with other stakeholders has improved with the team and it is now renowned at an organisational level for its expertise in this area particularly in relation to engaging GP practice staff
What I now know about leadership and my behaviours and practices I have raised my self-awareness and discovered how much my own beliefs and values impact on my leadership style. I have realised that my values are in line with those of the NHS as a whole and my organisation’s constitution. Leadership style is significant to developing trust though no one size fits all the outcome of failing to recognise the value of trust could have implication for heath outcome (Rowe 2005).
My message to future leaders Being open and honest in discussions with all stakeholders however uncomfortable that may be
Jo Watson Lead Primary Care Development Nurse Sheffield Clinical Commissioning Group
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It’s not the end
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Jo Dickson
There are many other stories of ordinary leaders with extraordinary impact that are not recorded in this book. As a cohort of leaders that have grown together we understand the value of sharing stories and the impact stories have. We encourage you to add your own, and the stories that inspire you, to this book. And so the journey continues...
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“Let’s get it started” (Black Eyed Peas) #AndersonProg Found out I’m going to be in cohort 6 starting in April - so excited and ready for a new challenge.
T
his is where my journey began the Elizabeth Garrett Anderson Programme felt very much like something that had been made for me! I’d started a Masters programme before, but had not completed it. I didn’t think it had related enough to the work I was doing, and I didn’t think it was having any positive impact on my abilities as a leader and manager, nor on increasing my organisational impact. I’d been working at Leeds Teaching Hospital (LTHT) for a number of years, and had seen many changes in this large acute teaching hospital trust. I felt very removed from the patient at this time, and wanted to understand how I could take on a more senior leadership role whilst ensuring that my personal values as a nurse were maintained. I wanted to understand how I could improve care for patients when this wasn’t necessarily “hands on” in nature. I’d recently changed jobs and was working full-time in a non-clinical (IT) department, surrounded by people who didn’t have a clinical background: were we in it for the same reasons? Did I share their values and vision? The past two years has definitely confirmed that my career is taking the right path for me, and the development of myself and the organisation over this time has confirmed that healthcare leadership roles across departments (clinical and non-clinical) is really important in driving improvements in the quality of patient care.
“You are not alone” (Michael Jackson) My Twitter feed is a good reflection of my journey through the EGA programme; initially, my tweets are very much about a small group of people known to me. I felt the clinical informatics role I was in was a very ‘lonely’ one and that I needed to find other
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clinical people, people just like me, in order to ‘fit in’. The EGA course has taught me I don’t! There is so much similarity between the challenges, obstacles, opportunities and successes that we all face that actually it is so much easier than I thought to find like-minded people!
#hc2014 sometimes being an informatics nurse feela like missionary work #randomthought #nursing “A change is gonna come” (Sam Cooke) Leeds Teaching Hospitals Trust joined twitter in June 2014 and I was surprised by how much of an impact this had on me. I thought this was such a significant change to the culture of the organisation. LTHT had previously actively discouraged staff from using social media and focussed on the negative impact of it, making myself and others worried about being visible across the trust as well as outside of it. This small change made me feel like real change was coming; true cultural change, and everybody being part of it, collaboration, empowerment, and the subsequent collaborative development of the Leeds Way. Suddenly I felt able to use the skills I was learning on the EGA programme to join with a group of like-minded people in my organisation to improve care for our patients, and this has proven to be correct with massive positive improvement across the organisation and its staff.
“Stop, Look, Listen” (The Stylistics) At the end of 2014, I was asked to represent clinicians in LTHT as part of an organisational bid for funding from the “Safer Hospitals Safer Wards” fund, and NHS England initiative to fund technology implementations which would integrate electronic health records and aimed to have direct impact at frontline levels. The involvement in these bids made me see my personal value amongst those I work with. The 1st round funding application was attended by a very big group, people I’d not really interacted with before at very senior levels in my organisation, and I found myself using the things I was learning on the EGA to analyse their leadership styles; I was definitely learning as a result of this programme and I was putting that learning into practice to improve my own leadership style.
“Under Pressure” (Queen) The EGA residential asked us to consider what was our style; introvert or extrovert. So many of the
people in the group were extrovert and at first I was worried about this. I knew I was an introvert as my natural style, did this mean I couldn’t be a good leader? Of course not! The EGA course has taught me that “it takes all sorts”, there is no such thing as a ‘perfect leader’, and anyone who thinks they are definitely isn’t. In order to make positive change happen, it takes all kinds of people with all kinds of styles, and that’s not even accounting for those times when people are under pressure and act differently anyway! Around this time I was asked to be involved in a video for the trust, talking about untypical nursing leadership roles. It didn’t come naturally to me (my introverted angel on the shoulder really wasn’t keen on this one!), but I know that my career route isn’t typical and I felt I had met others who had similar concerns about taking a non-operational route into senior nursing roles who would benefit from having our stories shared.
“All Together Now” (The Farm) Corporate Nursing @LTHTCorpNurse Our informatics nursing team sharing their work and how it will have a positive impact for our staff and patients #LeedsNMCon15 My personal journey through the Elizabeth Garrett Anderson has in many ways mirrored the organisational change at LTHT, and this fact has definitely helped me in understanding and developing my role as a ‘middle leader’, building a clinical team within the department, and also facilitating the development of the wider team in Informatics. 2015 saw the clinical team be accepted to present at the LTHT Nursing Conference on the importance of electronic health records in the patient care journey, and the wider team being nominated for local and national awards related to the importance of shared electronic records in improving the safety and quality of care. Being part of a team who really believes in their role and its importance for patient care has been a massive positive in my own leadership development as well as being an important change to the way that the IT team are perceived more widely within the organisation.
Great to be involved in something so important for transformation of health services. Leeds Care Record @LeedsCareRecord Digital Health - “Leeds leads the way on shared records”
“It’s now or never” (Elvis Presley) Well not quite…… The EGA programme completion has coincided with me making a massive personal decision, and in my leaving the organisation which I have been working at for 17 years. In Autumn 2015, on the same day that I attended a ceremony where I was announced as one of Nursing Times ‘Leaders 2015’, I was also offered a new job which I would never previously (to the EGA programme) have even considered I was capable of! The Nursing Times award was one of the proudest moments of my life, and something I never imagined achieving. The new job confirms my commitment to being a clinical leader in informatics and has given me the ability to join the (still small in number) ranks of nursing leaders in this type of post. And so my journey continues…. I’m very proud of being a ‘non-typical’ nursing leader, working in an emerging field of clinical practice, learning and developing every day to remain a positive role model for colleagues who are ‘a little bit geeky’, but who still want to have a real positive impact on improving patient care by using technology. The EGA programme is complete (phew!), but its ongoing impact on my personal leadership journey definitely isn’t.
Gavin Fergie @GavinFergie It’s not science fiction its informatics @ JoD1905 @Unite_CPHVA #CPHVA15 don’t be scared
Jo Dickson CCIO / Clinical Informatics Partner Nuffield Health
It’s not the end
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It’s not the end
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Produced by The Elizabeth Garrett Anderson programme Cohort 2.6 tel: 0113 322 5699 email: enquiries@leadershipacademy.nhs.uk web: www.leadershipacademy.nhs.uk