Team Planning and Delivery Event Friday 18th September 2009
Networking activity – Valerie Iles• Which box of the Matrix do you focus on most frequently?• Which box of the Matrix do you think the programme is strongest in?
Planned/ deliberate
Spontaneous Emergent/ crafted
Thinking ahead
1Analysing situation and designing intervention
2Engaging players in developing a spirit and purpose
3Finding out what really happens around here
Real time 4Project managing the implementation programme
5Living in the moment, responding to events in the spirit of the plan
6Noticing what is happening, the day to day decisions
being taken Reflecting and learning
7Evaluating the
implementation
8
Reflecting on the dynamics
9Putting together and telling the story
Aims:
•Articulate the vision for the programme Develop explicit values and behaviours to support thisDiscuss what success will look like
• Reflect on the operating context for the programme
Carry out horizon scanning
• Discuss how to run an effective programme Ensure full engagement and involvement of all the team Discuss style and practical arrangements for the SMT
• Plan team development that supports the team to be visibly skilled in programme approach and methodology by January CLD event
Reducing reliance on external support Creating the environment for the development of the faculty
Ground rules for team development sessions
• Honest• Constructive• Forward looking – learning from the past• Directive – to focus resolution• Supportive• Objective & Reflective – ability to stand back• Not talk over each other• What is said in the room stays in the room • Agreed and committed to actions
Agreed 26th August 2009
A Recap
• Discussed achievements – a sense of personal and team pride
• Agreed actions to deliver the programme
• Learning to work together as a programme team
• Identifying and meeting personal and team development needs
Approach today
• Maintain a positive and proactive focus
• Build on progress to date
• Continue to move forward as a team
• Don’t get bogged down in the detail (use the parking boards if needed)
CLARHC Vision
• To continuously improve the quality of patient care by accelerating the implementation of evidence based research and innovations into practice
Strap line:
• accelerating research into better care
VisionVision is the core of leadership
Vision is seeing the potential purpose in the chaos of the moment, but which could bring to birth new possibilities for a person, company or nation.
Vision is seeing what life could be like when dealing with life as it is.
Vision deals with those deeper human intangibles that alone give purpose to life.
In the end, vision must always deal with life’s qualities not quantities
William Van Dusen Wishard
‘Vision without action is hallucination.’
Beverly Malone
CLARHC Aims
• Improve the delivery of innovative research to provide the highest quality of patient care
• Devise and evaluate a systematic approach for the rapid adoption of clinically effective interventions
• Develop a model for the conduct and application of health research that is transferable across the NHS
• Develop research capacity and capability across northwest London
Team Values
• Take 5 minutes to identify values for the team• Share your values• Agree team values
Team Behaviours
• Take 5 minutes to consider behaviours that support the agreed values
• Share and agree team behaviours
Senior Management Team
• Working together……
Running a programme that delivers results
• Operating context and horizon scanning
Ganesh to insert slides
after Rosabeth Kanter 1999
Successful 21st Century Organisations:Concepts:
•encourage ideas and technology driven by innovation
Competence:
•develop skills and abilities
Connections:
•create collaborative strategic relationships
The 3 A’s
• Alignment – core business
• Agility – processes
• Attitudes – culture, leadership, management
Maintaining a Balance
Anatomical
Physiological
Balancing the two approaches
Anatomical Physiological In practice both are necessary
Change is a step by step process
Outcomes cannot be predetermined
You need to set direction but be flexible
Initiated top down Change come from bottom up
Top down support is needed for bottom up change
Objectives set in stone in advance
There is no end point Objectives need to be set and success at each milestone celebrated, in practice improvement never ends
It goes wrong because of poor planning and project control
It goes wrong because of people issues
Planning and control are important but commitment of people is vital
Leading Change- 8 steps to transforming your
organisationEstablish a Sense of Urgency
Examine market and competitive realities Identify and discuss crises, potential crises, or major opportunities
Form a Powerful Guiding Coalition Assemble a group with enough power to lead the change effort Encourage the group to work as a team
Create a Vision Create a vision to help direct the change effort Develop strategies for achieving that vision
Communicate the Vision Use every vehicle possible to communicate the new vision and
strategies Teach new behaviours by the example of the guiding coalition
Empower Others to Act on the Vision Get rid of obstacles to change Change systems or structures that seriously undermine the vision Encourage risk-taking and non-traditional ideas, activities, and
actions
Plan for and Create Short-Term Wins Plan for visible performance improvements Create those improvements Recognize and reward employees involved in the improvements
Consolidate Improvements and Produce Still More Change Use increased credibility to change systems, structures, and
policies that don't fit the vision Hire, promote, and develop employees who can implement the
vision Reinvigorate the process with new projects, themes, and change
agents
Institutionalize New Approaches Articulate the connections between the new behaviours and
organizational success
Develop the means to ensure leadership development and succession
Source: Kotter, John P. "Winning at Change" Leader to Leader. 10 (Fall 1998): 27-33.
Leading Change: Why transformation efforts failSource: Kotter, John P Harvard Business Review, 2007
Applying this this to a healthcare context
…..and a dynamic and challenging programme
ComplicatedComplicated ComplexComplexSimplSimplee
Source: Brenda Zimmerman
•Formulae have only a limited application
•Raising one child gives no assurance of success with the next
•Expertise can help but is not sufficient
•Every child is unique
•Uncertainty of outcome remains
Raising a Child
Recipe is essential
Recipes are tested to assure replicability of later efforts
No particular expertise; knowing how to cook increases success
Recipes produce standard products
Certainty of same results every time
Following a Recipe
A Moon Rocket
Formulae are critical and necessary
Sending one rocket increases assurance that next will be ok
High level of expertise in many specialized fields & coordination
Rockets similar in critical ways
High degree of certainty of outcome
Throwing a Rock or a Bird?
y = x2 – b
f = ma?
“attractor”
Source: Paul Plsek, based on Richard Dawkins
We know:A very complex system can be (is) guided by a few simple rules
Which means:– Build a good enough vision – provide general direction
pointing, absolute boundaries and resources or permission rather than trying to plan everything in detail
– Simple rules (often unstated) also maintain the system at status quo
– Greatest leverage for innovation and change comes by modifying simple rules
Defined as wicked problems
• Instability is a necessary catalyst for change
• Impose general (or simple) rules to condition the system, stand back and allow solutions to emerge
• Be prepared to deal with paradox, contradiction and conflict
Horst Rittel & Melvin Webber
Don’t micro-manage or over engineer
Remember
Culture eats strategy for breakfast
Running a programme that delivers results
Making Strategy Work
Planned/ deliberate
Spontaneous Emergent/ crafted
Thinking ahead
1Analysing situation and designing intervention
2Engaging players in developing a spirit and purpose
3Finding out what really happens around here
Real time 4Project managing the implementation programme
5Living in the moment, responding to events in the spirit of the plan
6Noticing what is happening, the day to day decisions
being taken Reflecting and learning
7Evaluating the
implementation
8
Reflecting on the dynamics
9Putting together and telling the story
• Which box of the Matrix do you focus on most frequently?• Which box of the Matrix do you think the programme is strongest in?
Change in practice: observations
• Row 1 often done in a spirit of blame • Row 3 hardly undertaken at all
• Resentment at being ‘given box 1 and expected to start in box 4’• Even if rest done well, box 5 is where it goes wrong
• Casts of mind (often invisible, often aggressive)
• Importance of increasing capability in rigorous, disciplined, creative use of change concepts
Need to move from:
Box 1: Analysing a situation and designing an intervention
Box 4: Implementing the plan
Box 7: Evaluating the implementation
To:
Box 1: Analysing a situation and designing an intervention
Box 2: Opening up perspectives and awakening responsibilities to participate
Box 3: Continuing on a journey to somewhere, yet to be determined
Row 1 – using all the boxes
Reflection and feedback
• Take 5 minutes to consider some of the messages and how you take forward some of the messages and concepts in your work as a team
A practical exercise – developing the CEO letter
• What do you want to say?
• From this list what are the key priorities?
• In groups - Develop the detail of the priority messages
• Feedback and agree actions
Debrief
• How did that feel?
• What went well?
• What could have been better?
• What happens now?
A few thoughts in summary
• The process of transition
• Development as a team
• Personal authority and accountability (empowerment)
• Taking control as team – how much can you reduce the fire fighting?
The process of team development
Norming Storming
Forming
Performing
• and Adjourning and Mourning
Bruce Tuckman 1965
Translation to Situational Leadership
Selling Participating
Telling
Delegating
Tannenbaum and Schmidt
Management Style
Tannenbaum and Schmidt
Use of authority by Manager
Freedom for Subordinates
‘Do not confuse motion with action.’
(aka a Rocking Horse)
Alfred A Montapert
Moving from chaos and stress?
For discussion over lunch
• Prioritisation and planning– Communication– Conflict resolution
• Role of the management, governance and advisory groups – Are you making best use of these in decision making?
• How do you decide as a team who does what at a programme level?– Representing other themes– Communication
Remember this challenge?
• What are we trying to accomplish?• What investments are we willing to make?• What activities should we de-emphasise?• What conflicts are we willing to resolve?• What risks are we willing to take?• How much disruption to the organisation
are we willing to support to make the transition to a better performing system?
Carol Haraden, IHI
Feedback and agree actions
Refection and review
Steven Covey
Adapted f rom 7 Habits of Highly Eff ective People
Levels of communication
High
Low High
Low
Trust
Co-operation
Defensive
Creativity
Respect
Communication – where are you as a team?
Adapted from Seven Habits of Highly Effective People
Stephen Covey
Familiarity
Reliable Information
Clear Communications
Integrity
Shared Values
Shared Vision
Trusting Relationship
s
Change/Uncertainty/Dishonesty
Conflicting Needs
Pressures/Stress
Complex/Poor Data
UnclearCommunications
Lack of Time /Prior Experience
Distrusting Relationships
Source: Richard Lauve, MD (VHA Inc.)
Creating trust
Extent to
which I believe
you care
about me
Extent to which I believe you are competent and capable
Trust
RespectDistrust
Affection
high
highlow
Adapted from Peter Scholtes, The Leaders’ Handbook
Circle of influence
Circle of Concern
Steven Covey
7 Habits of Highly Effective People
Circle of influence
Circle of Concern
Steven Covey
7 Habits of Highly Effective People
Proactive Focus
Circle of influence
Circle of Concern
Steven Covey
7 Habits of Highly Effective People
Reactive Focus
Circle of influence
Circle of Concern
Steven Covey
7 Habits of Highly Effective People
•Direct control
•Indirect control
•No Control
‘...give me the courage to change the things which can and ought to be changed, the serenity to accept the things which cannot be changes, and the wisdom to know the difference.’
Becoming self sufficient
• What do we mean by this?
(group discussion)
For the Project Teams and Partnership
Current model
• Centrally driven & led
• Project based support
• Short term external resourcing
• Short term access to skills development
Future model
• Locally owned & led
• Continuous & sustained implementation across the partnership
• Requires headroom & ongoing resourcing
• Skills development embedded
Developing local capability - understanding the transition
Local CapabilityLow High
Imposed structure
High
Low
Locally developed
improvement structures
Passive acceptance
of programme
structure
Local adaptation of programme
structure
Lack of understanding
of the programme
• Recognition of the need for change
• Discomfort with the status quo
Developing the capability and capacity
Using tools and techniques through a
systematic plan
• Embedded sustainable improvements
Moving to continuous improvement
Supporting the transition
• What is the role of the Programme Team?
• NW London Partnership and participating organisations?
• What should be the role of the CLARHC Faculty?
Change and learning
Comfort ZoneComfort ZoneNo learningNo learningNo changeNo change
Panic Zone
•people close people close upup
•they freezethey freeze
•they don’t they don’t learnlearn
Change and learning
Discomfort Zone
•uncertainty uncertainty •learninglearning
PanicZone
Comfort ZoneComfort Zone
‘Leadership and learning are indispensable to each other.’
John F Kennedy
What do we know about the way people learn?
• Tacit knowledge - what we learn from involvement in the world, emotional experience, experience and example of others
• Explicit knowledge - what we learn through language and discourse, representing and reflecting experience, representing this in images, metaphor and seeking explanation through conceptual reasoning and theory
Kolb
Reflective observation
Active experience
Felt and sensed experience
Abstract conceptualisation
Explicit knowledge
Tacit Knowledge
Key parts of the learning cycle
Representing in story, picture,
analogy
Practising, doing or interacting with others
Sensing and experiencing emotions
Conceptualising, framing intention and attention
Expanding and contracting self
awareness
Heron
Assimilative thinking
Accommodative thinking
Divergent
thinking
Convergent
thinking
Convergent thinking - providing explanation, focus for attention and guides to action
Assimilative thinking - locating experience in structure of meaning
Divergent thinking - exploring many explanations goals and strategies
Accommodative thinking - Fitting general concepts to specific experiences
Kolb
Key parts of the learning cycle
Internalisation - using concepts to make sense of experience
Combination - organising information into knowledge
Externalisation - giving form to experience, words, imaginary and analogy
Socialisation - Sharing experience, role models and implicit mental models
Experiential learning - learning by both discovery and by testing and adaptive problem solving, improves existing model
Nonaka and Takeuchi
Unconsciously incompetent
Unconsciously competent
Consciously competent
Consciously incompetent
Competence
Awareness
Development of Skills
Benner, P. (1984). From novice to expert
The journey
Novice
Advanced Beginner
Competent
Proficient
Expert
Benner, P. (1984). From novice to expert
Becoming self sufficient
• What do you need to do as a team?
Discuss in pairs
• What is your individual contribution?– Think about your training and development
needs
Summary and agree next actions
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