Managing and motivatingColleagues in a shrinkingWorld

Dr Mike Roddis 21 October 2011 1

Topics to cover today

Leadership styles and motivation

Clinical engagement – what the NHS says

What leaders do vs. how leaders do it

Motivating people and how to do it (or not)

The shrinking world and what it means

Case studies

2

Leadership styles and motivation: one approach

Question:

Can you motivate others or can you only produce a climate in which they motivate themselves?

3

Leadership styles and motivation: one approachDaniel Goleman. Leadership that gets results. HBR March 2000

Style:

Coercive

Authoritative

Affiliative

Democratic

Pace-setting

Coaching

Climate:

Negative

Most strongly positive

Positive

Positive

Negative

Positive

4

Leadership styles and motivation: one approach

Native style

Innate preference

Adaptability

Changing circumstances

Different individuals

Effect on outcomes

5

Clinical engagement: an NHS buzz-phrase

Engaging Doctors: Can doctors influence organisational performance? Hamilton et al. AOMRC and DH 2008

“The essence of clinical leadership is to motivate, to inspire, to promote the values of the NHS, to empower and to create a consistent focus on the needs of the patients being served. Leadership is necessary not just to maintain high standards of care but to transform services to achieve even higher levels of excellence.”

6

Clinical engagement: Where are you now?

The Medical Engagement Scale

Organisational opportunity scales which reflect the cultural conditions that facilitate doctors to become more actively involved in leadership and management activities

Individual capacity scales reflecting perceptions of enhanced personal empowerment, confidence to tackle new challenges and heightened self-efficacy.

7

What leaders do vs. how they do it

What you do: competencies

The Medical Leadership Competency

Framework

How you do it

Transformational leadership questionnaire

(Prof Beverly Alimo-Metcalfe)

8

Engaging transformational leadership(Real World Group)

9

Motivating people and how to do it – some tips

Motivate yourself

Align your goals with that of your people

Try to understand what motivates themTalk to themListen to themObserve themDon’t make assumptions about them

Adapt your systems to support the process

10

Motivating people and how to do it – some tips

Hold 121 meetings

Develop skills in delegation

Praise good performance and affirm positive contributions

Focus on behaviours not personalities

Reward what you see rather than focusing on what you feel

Use appraisal and performance management systems actively

Explain how behaviours contribute to success.11

The Shrinking World

Service restrictions

Service reconfigurations

12

Service restrictions

Absolute budget cuts

Efficiency gains

New ways of working

Changed balance between the professions

13

Service reconfigurations

Networks

Rationalisation/centralisation

Public sector mergers and takeovers

Private sector involvement

14

Case study – 1

The problem: A Partnership Trust with a 20% decrease in income from

commisssioners

Chief Executive removes £3M from the medical staffing budget and suggests traditional cuts with ward closures, recruitment freeze etc

The Trust has 90 consultants, 70 SAS staff

60 – 70 trainees

15

Case study – 1

The solution:

Agree trainees remain untouched

Shed 50 SAS posts

Reduce medical support to one post per consultant

Establish consultant-delivered service

No reduction in workload

Savings achieved

16

Case study – 2

The problem:Two merged DGHs with duplicate services

Enormous cash deficit

No history of joint clinical working

No culture of clinical engagement or medical involvement in management

Possible forced implementation of service reconfiguration

17

Case study – 2

The current position:

No service changes

On-going conflict and disputes across the sites

Multiple internal workshops and reviews

External facilitation and mediation failed to bring about change

Future of all clinical services remains in doubt

18

Why were the results so different?

19

In conclusion

Factors associated with high levels of motivation:

Clinical engagementPositive leadership climateMedical staff and board goals alignedExtensive internal consultation on plansEffective communicationStaff opinions and expertise actively soughtEffective delegation and empowerment

20

With other end of the spectrum:

Disengagement

Poor morale

Cynicism

Bitterness

21

Chronic embitterment:(taken from paper by Dr Janet Ballard to the European Association of Public Health Medicine 2010)

Embitterment:

“An emotion encompassing persistent feelings of being let down, insulted or being a loser, and of being revengeful but helpless.”

22

Chronic embitterment:

Features: History• Manifests itself in the context of a relationship

that has ‘gone wrong’.

• Events cited as evidence of having been let down or badly treated by superiors or by the organisation as a whole

• Lack of resolution of event(s)

• Present distress attributed directly to event(s)

• Strong convictions about fairness, justice or anticipated support

23

Chronic embitterment:Contributory factors

Personal:• Strong personal aspirations (especially strong

principles and

sense of justice)

• Perceived breach of the psychological work contract

Organisational:• Nature of precipitating event(s)

• Attempts to resolve the precipitating events and their aftermath

• Lack of adequate attention to organisational justice24

Chronic embitterment:Management of the organisation

Increase awareness of the condition (including causes and consequences)

Reduce collusion with rumination (balancing need not to be perceived as dismissive)

Encourage open and responsive communications

Prompt response to investigations/grievances

Attention to procedural justice

25

Chronic embitterment:Management of the individual

Coaching to:

• Acknowledge the problem (including behaviours)

• Reduce unhelpful behaviours

• Develop strategies to reduce rumination

• Review personal goals

• Reduce likelihood of escalation

26

Thank you