Caring to Change Compassionate Leadership and Innovation in

Caring to Change: Compassionate Leadership and Innovation in Healthcare Sussex Community NHS Trust September 2017 Michael West 1

‘Compassionate leadership for compassionate. Compassion health services’ • • Attending: paying attention to staff – ‘listening with fascination’ Understanding: finding a shared understanding of the situation they face Empathising Helping: taking intelligent action to help 2

Developing people, improving care: A national framework for action on improvement and leadership development in NHS funded services (November 2016)

The framework’s goal The goal of the framework is to help create five conditions common to high quality, high performing health and care systems in every local health and care system in England • Collective, compassionate and effective leaders at all levels • Knowledge of improvement methods and ability to use them at all levels • Leadership equipped to develop high quality local health and care systems • Enabling, supportive and aligned oversight • Support systems for learning at local, regional and national levels

Leadership that promotes … innovation, continuous learning and quality improvement Chassin & Loeb (2013). High reliability health care. Millbank Quarterly, 91, 459 -490.

Learning and innovation • Staff focused on continually improving what they do • Staff focused on ensuring zero harm • Reflective practice and learning in all areas • Staff enabled at all levels to learn about best practice • Effective schemes to promote QI and innovation • Recognition and reward for QI and innovation in every department/team/function Inspiring Vision and Strategy Skills, capabilities, systems and processes Autonomy and Support Innovation Commitment to Innovation Enthusiastic Team and Cross. Boundary Working Positive Inclusion and Participation

Key Elements for Innovation Inspiring Vision and Strategy Skills, capabilities, systems and processes Autonomy and Support Innovation Commitment to Innovation Enthusiastic Team and Cross. Boundary Working Positive Inclusion and Participation https: //www. kingsfund. org. uk/publications/caring-change

Leadership prioritising an inspirational vision and narrative … focused on high quality, continually improving and compassionate care while modelling in their everyday behaviours the values of the organisation (with compassion as the core value) ‘To deliver continuously improving, high quality and compassionate care to all in our community’ ‘To be the safest hospital in England

Leadership with a commitment to … effective, efficient performance – characterised by a focus on (5 or 6) clear, agreed, challenging and aligned team goals and objectives at every level with helpful and timely feedback on performance BMJ Quality and Safety, Sept 2013 http: //www. lums. lancs. ac. u k/nhs-quality

Key Elements for Innovation Inspiring Vision and Strategy Skills, capabilities, systems and processes Autonomy and Support Innovation Commitment to Innovation Enthusiastic Team and Cross. Boundary Working Positive Inclusion and Participation https: //www. kingsfund. org. uk/publications/caring-change

Autonomy and Support … … good people management fostering high employee engagement – enabled by authentic, open, supportive, positive, inclusive, appreciative and compassionate leadership http: //www. dh. gov. uk/health/2011/08/nhs-staff-management/

Collective Leadership • Leadership the responsibility of all - anyone with expertise taking responsibility when appropriate • Shared leadership in teams and across teams • Interdependent, collaborative leadership - working together to ensure high quality health and social care • Leaders and teams prioritising quality of care across the system/organisation • Consistent approach to leadership within the leadership community – continually improving, high quality and compassionate leadership http: //www. kingsfund. org. uk/publications/developing-collective-leadership-health-care West, M. A. , Lyubovnikova, J. , Eckert, R. , & Denis, J. L. , (2014), Collective leadership for cultures of high quality health care. Journal of Organizational Effectiveness: People and Performance, 1, 240 – 260. http: //dx. doi. org/10. 1108/JOEPP-07 -2014 -0039

People management and engagement • Patient/service user satisfaction highest where staff have clear goals • Staff views of leaders linked to patients views of care quality • Staff satisfaction/commitment predicts patient/service user satisfaction • High work pressure - patients/service users report too few staff, insufficient support, privacy, respect. • Poor staff health and well-being, high injury rates, audit ratings • Good HRM practices - low patient mortality http: //www. dh. gov. uk/health/2011/08/nhs-staff-management/

Positive emotion and culture • Leader positive affect, climate and performance • Processing negative emotion – ‘affective shift’ • Dealing with quarrelsome or disruptive behavior and poor performance

Key Elements for Innovation Inspiring Vision and Strategy Skills, capabilities, systems and processes Autonomy and Support Innovation Commitment to Innovation Enthusiastic Team and Cross. Boundary Working Positive Inclusion and Participation https: //www. kingsfund. org. uk/publications/caring-change

Employee Engagement in the NHS Leadership Supervisors’ Support Team Working Job Design Work Pressure Having an interesting job Feeling valued by colleagues Overall Engagement • Advocacy • Intrinsic Engagement • Involvement Employee Reactions Health and Well-being Stress Hospital Performance Quality of Services Financial Performance Absenteeism Patient Mortality Rate Patient Satisfaction http: //www. kingsfund. org. uk/publications/leadership_review_12. html

3. Employee engagement success factors www. kingsfund. org. uk/publications/staff-engagement A compelling strategic narrative Inclusive leadership and management styles Putting staff in charge of service change • Successful Trusts develop a clear narrative on their purpose and aims • Successful Trusts have invested in retraining staff to adopt inclusive management styles • Successful Trusts give staff responsibility for leading service change • Salford aimed to be the safest hospital in England • For example, Oxleas has introduced a substantial programme to retrain middle managers in facilitative leadership • The happiness of all our staff, through their worthwhile, satisfying employment in a successful business • Notts Healthcare NHS FT develops leadership aligned around strategy and values • Wrightington, Wigan and Leigh works with Unipart to support staff-led change • Salford’s quality directorate supports teams of frontline staff in testing improvements Values and Integrity • Staff survey evidence highlights importance of values and trust in senior leadership • Perceptions of unfairness are our best predictor of intention to leave • In particular, fairness of procedures, bullying and discrimination. Stable senior leadership Many of the Trusts with highest levels of engagement have had the same senior leaders for over a decade: CEO of Oxleas in post since 2002, CEO of Salford in post since 2002, CEO of Frimley Park in post since 1998, in comparison with an average CEO tenure of less than two years.

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Key Elements for Innovation Inspiring Vision and Strategy Skills, capabilities, systems and processes Autonomy and Support Innovation Commitment to Innovation Enthusiastic Team and Cross. Boundary Working Positive Inclusion and Participation https: //www. kingsfund. org. uk/publications/caring-change

5. Team working, cooperation and integration

What is a Team? Typically no more than 12 members who: – Have shared objectives in common – Need to work together to achieve these objectives – Have defined roles in the team – Meet regularly to review performance and to improve

Key elements for effective team working • Clear purpose, identity and boundaries • Clear, agreed, challenging objectives • Role clarity • Positivity, optimism, cohesion and efficacy • Effective communication • Appropriate involvement in decision making • Constructive debate • Good inter-team working

Benefits of TBW in Health and Social Care Reduced hospitalisation and costs Increased effectiveness and innovation Increased well-being of team members Multi-disciplinary teams deliver high quality patient care and more innovation • Lower patient mortality • Reduced error rates • Reduced turnover & absence • • Lyubovnikova, J. & West, M. A. (2013). Why teamwork matters: Enabling health care team effectiveness for the delivery of high -quality patient care. In E. Salas et al. (eds. ). Developing and enhancing teamwork in organizations. San Francisco: Jossey Bass.

Team leadership • Offer an inspiring vision and clear direction • Ensure regular and positive team meetings • Encourage positive, supportive relationships • Resolve and prevent intense conflicts • Positive group attitudes towards diversity • Be attentive and listen carefully to the team • Lead inter-team cooperation • Nurture team learning, improvement & innovation 24

Reflexivity Teams are 25% more effective and innovative to the extent that they routinely take time out to reflect upon their objectives, strategies, processes and environments and make changes accordingly. Schippers, West & Dawson, 2012, Journal of Management Tannembaum & Cerasoli, 2013, Human Factors

Systems Leadership – Across Boundaries • A compelling shared vision of transforming the health and well-being of communities • Frequent personal contact between leaders who need to work together to build trust and make real progress to deliver for their communities • A shared commitment to work together for the medium and long term (not only short term objectives) • A shared covenant to surface and resolve conflicts quickly, fairly, transparently and collaboratively • An overt commitment to behave altruistically towards each other’s organisations, mutually supporting system success to transform the health and wellbeing of communities 26

How will the organisation ensure the creation of leadership capabilities? A Leadership Strategy The challenges health care is facing require new strategies New strategies imply new leadership capabilities These are both individual and collective leadership capabilities This requires new and collective leadership cultures Must Deliver These © Center for Creative Leadership, 2014. Used with permission.

We have designed a two-year programme to be delivered in three phases Programme outcome To implement a collective leadership strategy to embed cultures that enable the delivery of continuously improving, high quality, safe and compassionate care. c. Nov 15 to Sept 16 https: //improvement. nhs. uk/resources/cu lture-and-leadership/ 28 c. Sept 16 to Mar 17 c. Mar 17 to Dec 17

Phase 2 - Design This work is designed to be an interactive PDF that enables you to access the resources you require quickly, and without having to read the entire document. 29

Culture Phase 2: List of evidence-based interventions Vision and Values based Recruitment Values Based Appraisal and Performance Management Values-based transitions and on boarding process Succession planning (with link to 9 Box Grid) Values-focused curricula Annual talent cycle Goals and Performance Leaders role job design Inclusive recruitment Regular (annual) leadership forecast update Goal setting and goal reviews Team goals Development on providing feedback on goals, behaviour and performance 360 feedback for development Compassionate Performance Management Support and Compassion Recruiting and promoting for compassion Developing compassionate leadership Emotional Intelligence Development Inclusion - listening with fascination and compassion Peer coaching Mentoring Inclusive leadership development Diversity and Equal opportunities training Compassionate behaviour training Identity-based talent management Team Work Strategic recruitment for diverse teams Selection for team orientation Selection for team leadership capability Leaders developing leaders Board/Executive Team development Team leadership training Team working training Team-based appraisals Working with shared team-leadership (peer coaching) Skills for ensuring accountability for team working quality After action reviews and team reflexivity Building team based working System Leadership Learning and Innovation Developing cultures for innovation Leading for QI Secondments Leading for innovation Developmental assignments Action Learning Sets Recruit for commitment to innovation & QI Development for leading innovation and Change

3 1 Using some or all of the toolkit….

Supporting the use of the tools – Join the community! We are exploring the use of action learning sets to support use of the tools and we will continue to develop our community of practice If you would like to get involved, please contact: nhsi. culture@nhs. net Stay up to date at: https: //improvement. nhs. uk/resources/ culture-and-leadership/ http: //www. kingsfund. org. uk/projects/ changing-culture-collective-leadership 32

‘Compassionate leadership for compassionate. Compassion health services’ • • Attending: paying attention to staff – ‘listening with fascination’ Understanding: finding a shared understanding of the situation they face Empathising Helping: taking intelligent action to help 33

e. mail m. west@kingsfund. org. uk Twitter @westm 61 @astonod Thank you