Kate Hilton Fiona Mc Queen IHI Faculty Nothing

Kate Hilton & Fiona Mc. Queen IHI Faculty – Nothing to Disclose Building Leadership Skills for Middle Managers March 27, 2018

Kate Hilton & Fiona Mc. Queen Kate Hilton, JD, MTS Faculty, IHI Open School, Re. Think Health & George Washington University Prof Fiona Mc. Queen BA DMS MBA RGN Chief Nursing Officer, Scotland We have no conflict of interests or disclosures in relation to this presentation.

Getting to Know You Raise your hand if you’re a: – Health care professional

Getting to Know You Raise your hand if you’re a: – Health care professional – Senior leader

Getting to Know You Raise your hand if you’re a: – Health care professional – Senior leader – Middle manager

Getting to Know You Raise your hand if you’re a: – Health care professional – Senior leader – Middle manager – Student or resident

Getting to Know You Raise your hand if you’re a: – Health care professional – Senior leader – Middle manager – Student or resident – Faculty

Getting to Know You Raise your hand if you’re a: – Health care professional – Senior leader – Middle manager – Student or resident – Faculty – Other!

Getting to Know You Raise your hand if… – You’re actively involved in quality improvement projects at your organization

Getting to Know You Raise your hand if… – You’re actively involved in quality improvement projects at your organization – You lead and manage improvement teams

Getting to Know You Raise your hand if… – You’re actively involved in quality improvement projects at your organization – You lead and manage improvement teams – You’re a middle manager in those efforts, responsible for day-to-day clinical care and support services

Getting to Know You Turn to the people at your table and answer one of these questions: – Please share what brought you to this session today. What are you hoping to learn? – In what ways are you managing from the middle? – What challenges do you face?

Objectives After this presentation, participants will be able to: Articulate the role of the middle manager and his/her contribution to quality improvement Establish a real team with the right people Develop a shared purpose Put enabling structures in place to build team capacity

The Middle Manager’s Role APATH Y VAGUE OBJECTIVES

Engage and empower patients and carers – Learning through all interactions Quality of care and patient safety above all else Ensure psychological safety of staff and apply wellbeing methodology Quality improvement Processes and infrastructure and measurement approaches Foster staff development and growth through the learning organisation QI culture and a learning organisation Embrace transparency unequivocally – Learning when things don’t go as expected Strategic Framework

Performance Manager Why, what, how, where, who, when Innovator Resource Allocator Coach Advocate Ambitious, Inspiring, Intrapreneurship Negotiator Talent Scout Collaboration, Compassion, Coherence Change Agent Improver

Responsibilities of the Middle Manager Understanding self and others Sharing power and building trust Delivering improvement and measuring outcomes Understanding the system Building and developing the team Delivering sustained performance Creating purpose and conditions to learn and collaborate Identifying issues and planning improvement approaches Process control and review

What is culture and safety culture, and how will I know if I have it? • Culture - A phenomenon that encompasses the norms, values, and basic assumptions of the entire organisation § How the organisation behaves when “no one is watching” • Safety Culture - A knowledge and belief that you will not be punished or humiliated for speaking up with ideas, questions, concerns or mistakes.

The Clinician and Manager Set the Stage Set the stage actively and positively every time. It has a profound influence on what it feels like to be in the room, and hugely influences the willingness of people to speak up. The tone is set in seconds. “I don’t have any pride invested here. I just want to get this right, so if you think of anything helpful or see me doing anything wrong, please let me know. ”

TEAM Patient/clie nt TEAM

Dream Team Scream Team

3 Criteria for Effective Leadership Teams 1 - Achieves real outcomes for the many constituencies they serve AIM Achieved 2 - Builds capacity for sustainability & future efforts; gets better, smarter and more capable over time 3 - Develops individual leaders as stewards of the whole as a consequence of working together INDIVIDUAL Growth CAPACITY Built

Research on the Conditions to Generate Successful Team Collaboration Ruth Wageman J. Richard Hackman

Three Conditions That Enable A Team’s Effectiveness

Three Conditions That Enable A Team’s Effectiveness

A Real Team

A Real Team ü Leaders know who is on the team and who is not

A Real Team ü Leaders know who is on the team and who is not ü Team meets regularly and membership is constant

A Real Team ü Leaders know who is on the team and who is not ü Team meets regularly and membership is constant ü Every team member is critical to success

Strong & Weak Ties Weak ties: People outside of your network Strong ties: People who share your network

The Right People What to look for: ØBrings Others Along ØRelational ØTenacity to Try New Approaches ØComfortable with Uncertainty ØPassion and Commitment ØHistory of Collaboration ØWilling to Share Leadership ØConsensus Builder ØLearning Bias

Three Conditions That Enable A Team’s Effectiveness Bounded, stable & interdependent The right people with capabilities to lead interdependently

Three Conditions That Enable A Team’s Effectiveness

Why Develop a Shared Purpose?

Why Develop a Shared Purpose? Defines activity of the group, not any one individual Keeps people committed through collective buyin and ownership

Condition 2: A Compelling Purpose Clear: We know what the outcomes would look like if we were to achieve it

Condition 2: A Compelling Purpose Clear: We know what the outcomes would look like if we were to achieve it Challenging: Has to engage the best of what people are capable of, a real stretch

Condition 2: A Compelling Purpose Clear: We know what the outcomes would look like if we were to achieve it Challenging: Has to engage the best of what people are capable of, a real stretch Consequential: Rooted in values, real impact on the lives of others

Three Conditions That Enable A Team’s Effectiveness Clear, challenging & consequential

Three Conditions That Enable A Team’s Effectiveness

Condition 3: Enabling Structures Interdependent roles Real teamwork Norms of conduct

Skills & Resources

Examples of Roles Meeting roles – Logistics coordinator, facilitator, time-keeper, note -taker Team roles – Liaisons to particular stakeholders, data coordinator, communications coordinator, experts in safety, experts in a subject matter

Examples of Real Teamwork Solves problems Makes decisions Creates structures and opportunities that enable others to join in Members consult and coach one another about challenges they face

Examples of Norms of Conduct Discussion norms – Listening, candor, transparency, confidentiality Meeting management norms – Start/end on time, stay on task, turn off cell phones Decision making norms – By vote, consensus or deferring to individual Enforcement mechanism – Hold one another accountable as a team

Three Conditions That Enable A Team’s Effectiveness Diverse roles Real teamwork Norms of conduct

Summary: Three Conditions That Enable A Team’s Effectiveness Bounded, stable & interdependent The right people with capabilities to lead interdependently Clear, challenging & consequential Diverse roles Real teamwork Norms of conduct

Sample Team Launch Agenda Personal stories (3 minutes person) – Why you aspire to lead this improvement – What it means for you given your personal values and commitments Develop team purpose and delegate drafting to individual Review & volunteer for roles and associated responsibilities Identify initial set of norms to revisit Dig into key priorities and teamwork

Objectives Are you able to: Articulate the role of the middle manager and his/her contribution to quality improvement Establish a real team with the right people Develop a shared purpose Put enabling structures in place to build team capacity

Additional Resources Amy Edmondson, Teaming: How Organizations Learn, Innovate & Compete in the Knowledge Economy Deborah Ancona & Henrik Bresman, X-Teams: How to Build Teams That Lead, Innovate & Succeed Stephen Covey, The Seven Habits of Highly Effective People

Take a Deeper Dive into the Concepts we Shared Today: The next offering of the 10 -week online course begins in September 2018 Contact info@ihi. org to learn more