E5: Challenges and opportunities in ... · Changing practiceChanging practice • Changing what...

E5: Challenges and opportunities in leadershipopportunities in leadership

Putting leadership at the heart of workforce wellbeing

Professor Gillian Leng, Deputy Chief Executive, NICE

Areas to coverAreas to cover

Wh t th id b t• What the evidence says about effective leadership

• Benefits of employee• Benefits of employee wellbeing.

• What organisations need to do• What organisations need to do• Economic benefits and the

case for investmentcase for investment.

NICE overviewC o e e

Evidence‐basedDissemination and adoption support: Audiences:Evidence based 

products:Guidance

Quality standards

adoption support:NICE  Evidence Services

NICE websitePathways

NHSPatients and the public

Public healthAccredited evidencePrescribing adviceIndicator sets 

AppsE‐alerts

Implementation toolsReturn on investment

NICE Fi ld T

Local governmentSocial care

CommissionersNICE Field Team

NICE workplace health guidelinesg• Workplace interventions to promote

smoking cessation – April 2007smoking cessation April 2007• Promoting physical activity in the

workplace - May 2008 M i l i k b• Managing long term sickness absence and incapacity for work - March 2009

• Promoting mental wellbeing at work -g gNovember 2009

• Workplace policy and management practice to improve the health andpractice to improve the health and wellbeing of employees - June 2015 –older employees added March 2016

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Context for workplace wellbeingContext for workplace wellbeing• Strong evidence that work is generally good for people's g g y g p p

physical and mental health and wellbeing • Work meets important psychosocial needs in society and

i t l t ' id tit i l l d t tis central to someone's identity, social role and status • Benefits do depend on the type of work involved! • There is a positive association between wellbeing job• There is a positive association between wellbeing, job

satisfaction and an employee's job performance.

What does the evidence say that organisations should do to achieve benefits for employees,

and employers?

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and employers?

The under-pinning evidencep g

• Three evidence reviews examined the effectiveness of: – interventions undertaken by line managers/ supervisors– organisational interventions

A lit ti i i d f t th t h l (• A qualitative review examined factors that help (or hinder) line managers to enhance the health of the people they manage

• Five expert testimony papers included experience from a small and a medium sized organisation (evidence gap)S ifi ti i l d d ti l h lth d• Specific perspectives included occupational health and the trade union perspective.

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Supervisor supportSupervisor supportThere was strong evidence from 18 studies, in a variety of workplace settings (mainly health-related) that there is:workplace settings (mainly health related) that there is: • a small to medium positive relationship between

supervisor support and employee well-being (generally d b j b ti f ti b t l lmeasured by job satisfaction but also employee

emotional exhaustion and self-reported health) • an association between supervisor support and sicknessan association between supervisor support and sickness

absence. The direction of the relationship depends on the context and precise nature of supervisory supportive behaviourbehaviour.

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Supervisor relationshipsSupervisor relationships

There was consistent, butThere was consistent, but moderate, evidence from three studies in a mix of settings, that a strong relationship based on a reciprocal exchange between

i d l isupervisors and employees is positively associated with job satisfaction and other measuressatisfaction and other measures of well-being.

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Leadership styleLeadership styleThere was moderate evidence from three studies, including two separate surveys of nurses and from

Authentic leadership is an approach to leadership that emphasizes building the 

l d ’ l h hy

a large-scale survey of adult employees that an authentic leadership style (involving

leader’s legitimacy through honest relationships with followers which value their input and are built on an leadership style (involving

acting in a way consistent with espoused

pethical foundation. Generally, authentic leaders are positive people with truthful self‐

t h torganisational values) is positively associated with job satisfaction and well-being.

concepts who promote openness. 

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g

Positive leadership behaviourPositive leadership behaviourThere was moderate evidence from five studies that specific leadership behaviours are associated with employee well-being These include:behaviours are associated with employee well being. These include:

– Regularly consulting with staff on daily problems and procedures – Flexible or modified work scheduling – Highly visible and accessible senior management– Highly visible and accessible senior management – Providing praise and recognition for a job well done – Giving the information to employees that they need

Pushing through and carrying out changes– Pushing through and carrying out changes – Ethical and relational behaviours– Professional commitment

Creating an emotionally supportive environment– Creating an emotionally supportive environment– Critical thinking – Explaining workforce goals and sub-goals thoroughly

Giving employees sufficient power in relation to their responsibilities

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– Giving employees sufficient power in relation to their responsibilities – Taking time to be involved in employees’ personal development

RewardsRewards

There was evidence from oneThere was evidence from one wide-scale survey of managers that the use of contingent rewards (such as praising good performance) was more effective i ti iti ttit d tin promoting positive attitudes at work than using contingent punishments (eg reprimandingpunishments (eg reprimanding poor performance).

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“Evidence is inherently yuncertain, dynamic, complex,

contestable, and rarelycontestable, and rarely complete”

Lomas, J; Culyer T et. al 

Conceptualizing & Combining Evidence For Health

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Conceptualizing & Combining Evidence For Health System Guidance; CHSRF, May 2005

Guideline recommendationsGuideline recommendationsThe Workplace policy and management practice guideline included 11 recommendations covering:included 11 recommendations covering:

– Organisational commitment– Physical work environment– Mental wellbeing at work– Fairness and justice– Participation and trustp– Senior leadership– Role of line managers

Leadership style of line managers– Leadership style of line managers– Training of line managers– Job design

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– Monitoring and evaluation

Workplace pathwaysWorkplace pathways

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Senior leadershipSenior leadership

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Leadership and line managersLeadership and line managers

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Overarching recommendationsOverarching recommendations• Provide consistent leadership from the

top, ensuring the organisation actively supports a positive approach to employee health and wellbeing and that policies and g pprocedures are in place and are implemented. Thi h ld b t f th d• This should be part of the everyday running of the organisation, as well as being integrated in management performance reviews, organisational goals and objectives.

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Supporting employeesSupporting employees

• Consider helping employees to access screening and other health services to which they are entitled.

• This could include providing information about services such as cervical screeningabout services such as cervical screening and eye tests and allowing time off to attend appointments.

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appointments.

Line managers & leadershipLine managers & leadership• Ensure line managers are aware that supporting employee

health and wellbeing is a central part of their role for examplehealth and wellbeing is a central part of their role, for example by including it in line managers' job descriptions and emphasising it during recruitment.

• Display the positive leadership behaviours that are asked of line managers, such as spending time with people at all levels in the organisation and talking with employeesin the organisation and talking with employees.

• Act as a role model for leadership and proactively challenge behaviour and actions that may adversely affect employee health and wellbeing.

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Guidance and quality standardsGu da ce a d qua ty sta da dsA comprehensive set of recommendations for a particular condition or service area

Evidence Guidance Quality

StandardsStandards

‘Sentinel markers’Sentinel markersA prioritised set of concise, measureable statements designed to drive quality improvements across a

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drive quality improvements across a pathway of care.

Workplace quality standardsWorkplace quality standards

• Healthy workplaces:• Healthy workplaces: improving employee mental and physical healthmental and physical health and wellbeingWorkplace: long term• Workplace: long-term sickness absence and managementmanagement

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Workplace health cost calculatorWorkplace health cost calculator• As a result of our cost effectiveness

analysis the guideline has a costanalysis, the guideline has a cost calculator (or ready reckoner).

• For businesses considering introducing new workplace policy and management practices.

• Managers enter data relating to the g gspecific intervention they are considering for their own organisation.

• Organisations see the cost benefits ofOrganisations see the cost benefits of interventions in terms of staff absence and staff turnover.

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Two approaches to analysisTwo approaches to analysisModel 1: break-even effectiveness rate• Analysis of staff absence, staff turnover and worker productivity against

benchmark data. • Uses costs and benefits of an intervention to estimate of the level of

ff ti hi h i h ld d t hi t b keffectiveness which a given scheme would need to achieve to break even.

Model 2: maximum spend for break-even• Analysis of staff absence and staff turnover to see the total impact of any

intervention.• Figures used must relate to the direct impact of the workplace intervention,

ignoring secondary effects or interactions. • Uses benchmark data to estimate the maximum cost for a scheme (per 1,000

staff) at which it could be expected to still break even financially.

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Example of the model

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Changing practiceChanging practice • Changing what people do is challenging!• Need to start with a good understanding of the reasons for

current practice or behaviour• Behaviours depend on individuals but they are part ofBehaviours depend on individuals, but they are part of

multiple systems – teams, organisations and the wider healthcare system.

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“Changeisnotmadewithout inconveniencewithoutinconvenience,evenfromworsetobetter”better .

Richard Hooker1554-1600

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The COM-B system Psychological or physical ability

to make a change

yBehaviour occurs as an interaction between three necessary conditions

to make a change

Reflective and automatic mechanisms that motivate a change

Physical and social environmentPhysical and social environment that enables a change

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Michie et al (2011) Implementation Science

Uptake of the recommendationsUptake of the recommendations

Recommendation: Make health and wellbeing a core priority for the topRecommendation: Make health and wellbeing a core priority for the top management of the organisation. Employers should encourage a consistent, positive approach to all employees’ health and wellbeing.

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Uptake of the recommendationsUptake of the recommendations

Recommendation: Allow staff time off to attend smoking cessationRecommendation: Allow staff time off to attend smoking cessation services during the day without loss of pay.

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ConclusionsConclusions • NICE has produced a range

of evidence based guidanceof evidence-based guidance to improve the health and well-being of employees

• The guidance is underpinned by a strong business case forbusiness case for investment

• Associated quality standards and measures will be published next year.

• Good leadership is crucial!

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Good leadership is crucial!

E5: Challenges and opportunities in leadershipopportunities in leadership

Medicine, Nursing and Health Sciences

Shining light on the “dark side” of medical leadershipg g pAn Australian study

Professor Erwin Loh MBBS LLB(Hons) MBA MHSM PhD FRACMAChief Medical Officer, Monash HealthClinical Professor, Monash University2 November 2016

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CHIEF EXECUTIVE

Office of the Chief ExecutiveChief Allied Health OfficerHead of Public Affairs & Monash Foundation

Monash Health Executive 

Chief Operating Officer Executive Director Innovation, Patient Safety & Experience / Chief

Executive Director Residential Care & Support Services/ Chief Nursing &

Executive DirectorResearch Strategy

Executive Director Financial Services / Chief Financial Officer

Executive Director Information Development

Executive Director People & Culture

Executive DirectorCapital & Infrastructure

Executive Director Corporate Services & Governance / Chief Legal Officer

Advisor Chief Executive AffairsExecutive Advisor Business Reform

Emergency Management & Business Control

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Experience / Chief Medical Officer

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Centre for Clinical Effectiveness

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Chief Nursing & Midwifery Officer

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ProgramsR id i l C

Clinical TrialsMonash Health Translation Precinct (MHTP)

Research Governance

R h St t

Officer

BudgetClinical CostingFinancePayrollRevenue

Information Technology Services

Electronic Medical Record

Diversity & Inclusion

Employee Development

Employee Health & Wellbeing

E l R l ti

CapitalEngineeringInfrastructureProperty

Chief Legal Officer

AuditComplianceCorporate Governance

Freedom of Information

InsuranceCommunity Care Children’sMental Health Specialty Medicine, Cancer & Intensive Care Surgery & interventional ServicesWomen’s & Newborn

Innovation & RedesignPatient ExperienceStrategy & PlanningLibraryMedical EducationMedical Workforce Appointment Credentialing

Residential CareSecuritySites Hostels & Nursing Homes

Support Services

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InsuranceLegal ServicesMedicolegalCommercial Employment

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Sites Casey Hospital Community Cranbourne Integrated Care Centre Dandenong Hospital Kingston CentreMonash Medical CntrMoorabbin Hospital

gSimulation CentrePrograms Pathology Pharmacy Radiology

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Moorabbin Hospital

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https://government.unimelb.edu.au/research-project-engaging-professionals-in-organisational-governance

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The clinician

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The manager

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The clinician manager

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