Clinical Clinical LeadershipLeadership- what is it and how do I do it?- what is it and how do I do it?

Ian GovierIan Govier

opportunitynowhereopportunitynowhere

Health ScareHealth Scare Headlines!

Headlines!

Since the inception of the NHS, Since the inception of the NHS, more than 50 NHS public inquiries more than 50 NHS public inquiries have been conducted to address have been conducted to address catastrophic failures in patient care. catastrophic failures in patient care.

The same 5 common themes The same 5 common themes emerge from each inquiry.emerge from each inquiry.

Walshe & Higgins (2002)Walshe & Higgins (2002)

Disempowerment of Disempowerment of staff and patients staff and patients

Disempowerment of Disempowerment of staff and patients staff and patients

IsolationIsolationIsolationIsolation

Poor Poor communicationcommunication

Poor Poor communicationcommunication

Inadequate Inadequate leadership / leadership /

managementmanagement

Inadequate Inadequate leadership / leadership /

managementmanagementFailure of Failure of systems systems

and and processesprocesses

Failure of Failure of systems systems

and and processesprocesses

“More than one in ten people admitted to hospital are harmed unintentionally by its care. It is believed there is a one in 300 chance of accidental

death through errors in care.”

Effective clinical Effective clinical leadership leadership

improves improves patient carepatient care

• When I was a child I wanted to….When I was a child I wanted to….

• I came into the health service I came into the health service because:because:

• If I wasn’t working in my current If I wasn’t working in my current position, I’d like to:position, I’d like to:

• I‘d like to achieve ……. this I‘d like to achieve ……. this afternoon:afternoon:

Let’s look at Let’s look at Leadership!Leadership!

Leadership: The MythsLeadership: The Myths

It’s rareIt’s rare

It’s found It’s found mainly mainly at the top at the top

It’s about It’s about being being

superhumansuperhuman

John Harvey-Jones (2002)John Harvey-Jones (2002)

““Leaders in the NHS Leaders in the NHS need imagination, vision need imagination, vision & charisma, & charisma,

allied with allied with outstanding communication outstanding communication

skills & the skills & the ability to fire ability to fire their staff with enthusiasm”their staff with enthusiasm”

““Lots of ordinary health Lots of ordinary health care staff are leaders – it is care staff are leaders – it is in the very nature of the in the very nature of the

job. job.

Good care involves winning your Good care involves winning your patient’s confidence, convincing them to patient’s confidence, convincing them to

keep to their treatment regimes and inspiring keep to their treatment regimes and inspiring them to battle their way back to health”them to battle their way back to health”

(Crouch, 2002)

Who are Who are the leaders?the leaders?

The The Leadership / Leadership / Management Management

Dilemma!Dilemma!

• Managers maintain paths Managers maintain paths

• Administrators tidy pathsAdministrators tidy paths

LEADERS MAKE PATHS!LEADERS MAKE PATHS!

Management is efficiency Management is efficiency in climbing the ladder… in climbing the ladder…

……leadership determines leadership determines whether the ladder is leaning whether the ladder is leaning

against the right wall. against the right wall.

Transformational Transformational LeadershipLeadership

An approach to leadership which An approach to leadership which seeks to bring about success and seeks to bring about success and sustainable growth within groups sustainable growth within groups

through a change within the through a change within the consciousness of participantsconsciousness of participants

Leadership and Leadership and Performance OutcomesPerformance Outcomes

Transformational Leadership has a significantly Transformational Leadership has a significantly greater impact than Transactional Leadership on:greater impact than Transactional Leadership on:

StaffStaff

TeamsTeams

OrganisationsOrganisations

Source: Bass, B.M. (1998) Transformational Leadership: Military, Industrial & Educational Impact. London:Lawrence Erlbaum

Transformational Leaders have:Transformational Leaders have:Staff who:Staff who:

• have higher levels of satisfaction, motivation, and performance have higher levels of satisfaction, motivation, and performance • have lower levels of stress & burnouthave lower levels of stress & burnout

Teams that….Teams that….

• are more innovative, collaborative and effectiveare more innovative, collaborative and effective

Organisations which…Organisations which…• respond more quickly and productively to changerespond more quickly and productively to change• are more effectiveare more effective• have healthier, more humane cultureshave healthier, more humane cultures

(Bass,1998)

What do you What do you consider to be consider to be

the the characteristics characteristics

of effective of effective Leaders?Leaders?

Clinical Clinical

Leadership Leadership

The The Challenges!Challenges!

Permanent White Water Permanent White Water (Vaill, 1996)(Vaill, 1996)

Exemplary Clinical LeadersExemplary Clinical Leaders

(Kouzes and Posner, 2002)(Kouzes and Posner, 2002)

ChallengeChallenge

InspireInspire

ModelModel EnableEnable

EncourageEncourage

Exemplary Exemplary Clinical LeadersClinical Leaders

ChallengeChallenge

““The one indisputable The one indisputable fact that characterises fact that characterises

organisational life, is that organisational life, is that

CHANGECHANGE is inevitable.”is inevitable.”

(Beverley Alimo-Metcalfe, 2005)

Two choices regarding Two choices regarding CHANGE:CHANGE:

GET ORGANIZED GET ORGANIZED or or

‘go with the ‘go with the flow’flow’

(Yoder-Wise, 1999)(Yoder-Wise, 1999)

Challenges to Challenges to Developing PracticeDeveloping Practice

““The greatest The greatest difficulty in the difficulty in the world is not for world is not for

people to accept people to accept new ideas, but to new ideas, but to make them forget make them forget their old ideas!” their old ideas!”

John Maynard KeynesJohn Maynard Keynes ‘Are you kidding? I like it

here!’

The truth is that our finest The truth is that our finest moments are most likely to occur moments are most likely to occur

when we are feeling deeply when we are feeling deeply uncomfortable, unhappy, or uncomfortable, unhappy, or

unfulfilled. For it is only in such unfulfilled. For it is only in such moments, propelled by our moments, propelled by our

discomfort, that we are likely to discomfort, that we are likely to step out of our ruts and start searching step out of our ruts and start searching

for different ways or truer answers.for different ways or truer answers. M.Scott PeckM.Scott Peck

What would What would you like to you like to

challenge / challenge / change change in in your clinical area?your clinical area?

Beware of Beware of Change Saboteurs!!Change Saboteurs!!

Time for Time for

a a BreakBreak

Exemplary Exemplary Clinical LeadersClinical Leaders

InspireInspirea shared a shared

VVIISSIIOONN

The most important The most important task of leadership is totask of leadership is to

define and nurture define and nurture

a shared a shared VVIISSIIOONN that energises and brings that energises and brings

out the best in people out the best in peopleJames A. VaughanJames A. Vaughan

is almost ais almost a contradiction contradiction in terms! in terms!

A A VVIISSIIOONN-less-lessleaderleader

(lacking in vision or inspiration)(lacking in vision or inspiration)

(John Adair, 2002)(John Adair, 2002)

Let’s look Let’s look at some at some

VVIISSIIOONNSS!!

To make people happyTo make people happy

To enable people & businesses throughout To enable people & businesses throughout the world to realize their full potentialthe world to realize their full potential

To experience the emotion of competition, To experience the emotion of competition, winning & crushing competitorswinning & crushing competitors

To be the world’s favourite airline To be the world’s favourite airline & the undisputed leader in world & the undisputed leader in world

travel for the millennium travel for the millennium

By 2015, through the efforts of the Assembly Government, the NHS, local authorities, their

partners, the community and individuals, Wales will have minimised avoidable death, pain, delays,

helplessness and waste.

We needWe need

World Class World Class LeadersLeaders

to deliverto deliver

World World Class Class

HealthcareHealthcare

Delivering this challenging strategy Delivering this challenging strategy will require the full engagement of will require the full engagement of

clinicians and other professionals…clinicians and other professionals…

……leading and shaping services, leading and shaping services, ensuring that high standards of care ensuring that high standards of care

will be the key driver for change. will be the key driver for change.

Visions without Visions without actions are actions are

merely merely hallucinations!hallucinations!

The vision must be The vision must be followed by the venture followed by the venture

It is not It is not enough to enough to

stare up the stepsstare up the steps

What is my What is my

VVIISSIIOONN for my clinical for my clinical

/ work area?/ work area?

Welsh Regional Welsh Regional Burns Unit Burns Unit

So many of our dreams at first So many of our dreams at first seem impossible, then they seem seem impossible, then they seem improbable, but when we summon improbable, but when we summon

the will, they soon become the will, they soon become inevitable. inevitable.

Exemplary Exemplary Clinical LeadersClinical Leaders

EnableEnable

To become a leader one To become a leader one must believe in one’s own must believe in one’s own ability to achieve results ability to achieve results

for one’s self, but the real job for one’s self, but the real job of the leader is not of the leader is not

doing it but doing it but ENABLING ENABLING others to do it.others to do it.

Saskin & Rosenbach 1993Saskin & Rosenbach 1993

Where once leaders were aloof Where once leaders were aloof decision-makers, today they are decision-makers, today they are

dedicated collaborators & networkers dedicated collaborators & networkers whose role is to whose role is to ENABLEENABLE & give & give power to their team rather than power to their team rather than

wield power to their own ends. wield power to their own ends.

Leaders on Leadership – an intimate view of life at the top of Europe plc Development Dimensions International (DDI), Research Report, January 2006

How can I How can I more effectively more effectively enableenable others? others?

Exemplary Exemplary Clinical LeadersClinical Leaders

ModelModel

The biggest disease today is not leprosy or tuberculosis but rather the feeling of

being unwanted, uncared for and

deserted by everybody

Compassion and CareCompassion and Care

Everyone thinks Everyone thinks of changing the of changing the

world, but no world, but no one thinks of one thinks of

changing changing themselves.themselves.

Leo TolstoyLeo Tolstoy

““If you want If you want to to

see change, see change, be the change be the change you you

want to want to see”see”

A patient is the most A patient is the most important person in our Hospital. important person in our Hospital.

They are not an interruption to our work. They are not an interruption to our work. They are the purpose of it. They are the purpose of it. They are not an outsider in our They are not an outsider in our Hospital. They Hospital. They

are part of it. are part of it.

We are not doing them a We are not doing them a favour by serving them. favour by serving them.

They are doing us a favour by giving They are doing us a favour by giving us the opportunity to do so. us the opportunity to do so.

To be a more effective role To be a more effective role modelmodel, what would , what would

colleagues ask me to:colleagues ask me to:

• stop doing;stop doing;

• do more of;do more of;

• do differently?do differently?

Exemplary Exemplary Clinical LeadersClinical Leaders

EncourageEncourage

...is about the principles & ...is about the principles & practices that support the basic practices that support the basic

human need human need to be appreciatedto be appreciated for what we do & who we are.for what we do & who we are.

(Kouzes & Posner, 1997)(Kouzes & Posner, 1997)

EncouragingEncouraging

How can we How can we promote promote

‘excellence ‘excellence in practice’ in practice’

unless we first unless we first acknowledge, acknowledge,

and then and then

PRAISEPRAISE??

Really believe in your heart of Really believe in your heart of hearts that your fundamental hearts that your fundamental

purpose, the reason for purpose, the reason for being, is to enlarge the being, is to enlarge the

lives of others.lives of others.

Your life will be enlarged also, Your life will be enlarged also, and all of the other things we and all of the other things we have been taught to concentrate have been taught to concentrate on, will take care of themselves. on, will take care of themselves.

Who am I going to Who am I going to encourage / praiseencourage / praise

within the within the next 24 hours? next 24 hours?

Exemplary Exemplary Clinical LeadersClinical Leaders

ChallengeChallenge

InspireInspire

ModelModel EnableEnable

EncourageEncourage

Final Final

ThoughtsThoughts

If we always do what If we always do what we’ve always done… we’ve always done…

……we’ll always get what we’ll always get what we’ve always got! we’ve always got!

What am IWhat am Igoing to going to do differently do differently

after today?after today?

……I’ll probably I’ll probably

do nothing about it!do nothing about it!

If I do nothing If I do nothing about it in 24 hours… about it in 24 hours…

The The

‘Star Fish’ ‘Star Fish’ Principle Principle

and and finally…finally…

We do not lead by being We do not lead by being corporate, professional corporate, professional or institutional… or institutional…

……we lead by we lead by being being

humanhuman

Thank YouThank You

DiolchDiolch