Primary Care Leadership Collaborative 2016 Impact Day 1 · ^Coaching is the art of facilitating the...
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Primary Care Leadership Collaborative 2016 – Impact Day 1
Transcript of Primary Care Leadership Collaborative 2016 Impact Day 1 · ^Coaching is the art of facilitating the...
Primary Care Leadership
Collaborative 2016 –
Impact Day 1
• Professor John Howard –
Head of Education and Quality for Primary and
Community Care, Postgraduate GP Dean and
Deputy Postgraduate Dean
Introduction
@NHS_HealthEdEng #EoEPCLC
• Dr Rachel Morris –
Lead for Professionalism – School of
Clinical Medicine, University of Cambridge,
GP, Executive and Team Coach and Trainer
Location of project group &
discussion groups
• Box 1 – Jen Ashton Blue - afternoon
• Box 2 – John Howard Pink - afternoon
• Box 3 – Mark Attah Orange - afternoon
• Box 4 – Rachel Morris Green - afternoon
• Box 5 - Sabira Mohammed Yellow - afternoon
• Box 6 – Tom Norfolk Red - afternoon
• Katy Steward
Associate at The Kings Fund,
Leadership Development
The Evolution of Leadership
@NHS_HealthEdEng #EoEPCLC
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Collective leadership Cultures of engagement, collaboration and support
Dr Katy Steward
StewardOD (Assocs) Leadership and Culture Consulting
@katysteward
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NHS Culture is the sum of leadership behaviours • Do we care for our colleagues and patients, listen and
show respect, or treat people brusquely?
• Do we work in silos and as individuals, or work in teams, working with other team and, seeking out and including the people who will make difference to patients?
• Are we transparent and open about goals and decisions or secretive and fearful?
• Do we as leaders make people feel valued and respected or that their contribution is unrecognised and not valued?
The starting point
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The evidence base http://www.research.lancs.ac.uk/portal/en/publications/-(ea12cae6-5b75-4d15-bfc8-5edbb2ceb755).html
http://www.kingsfund.org.uk/publications/developing-collective-leadership-health-care
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Leaders embodying Compassion
Too much top down leadership
• Low levels of innovation
• Incomplete change - People do things for the wrong reasons and become disenchanted with idea of change
• Low levels of engagement - when people no longer believe senior leaders will do what they say they’ll do they become disenchanted
• Failure to invest in innovation as a sector - addiction to magic bullets and poorly ideas from outside health which are poorly adapted to health, rather than giving organisations the time to reflect and innovate
In healthcare the scale and pace of change is overwhelming
Treating the patient as a whole person requires collaboration between agencies
We need collective leadership – moving away from hierarchical, top down leadership models • Leadership the responsibility of all – anyone with expertise
taking responsibility when appropriate
• Distributed leadership in organisations and systems
• High levels of engagement
• Interdependent, collaborative coalitions – leaders working together putting the vision for the patient at the heart of all they do
• Shared - consistent leadership norms across the team, network or organisation – building leader connections
• Teams collaborating with other teams
‘All staff take responsibility for the success of the organisation in delivering continually improving, high quality and compassionate care’
DAC
Leadership
Organization
Outcomes
What is leadership?
©2012 Center for Creative Leadership. All rights reserved.
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Leading cultures of high quality care – the evidence base 1. Prioritising an inspirational vision
& narrative – focused on quality
2. Clear aligned goals & objectives at every level
3. Good people management & employee engagement
4. Continuous learning& quality improvement
5. Team-working, cooperation and integration
6. Via a values-based, collective leadership strategy
Dixon-Woods, M., et al, (2013), Culture and Behaviour in the English National Health Service; overview of lessons from a large multimethod study. British Medical Journal Quality and Safety, 23, 106-115.
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1. Vision and NHS values of high quality care 1. Vision sets a clear ambition for the future to guide
and inspire the whole organisation Aspirational and forward looking With an emotional connection People believe in it and makes clear commitments
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• A core ideology – the core purpose and values, defines the character of the team, remains constant
• To make technical contributions … for the welfare of humanity (HP)
• Creating a just world … without poverty (Oxfam)
• An aspirational future – an audacious goal • Being … the safest hospital in the NHS (Salford Royal)
• To develop leaders …. for high quality, continually improving, compassionate care (StewardOD)
Team vision
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2. Clear objectives and helpful feedback Stretching, motivating, challenging Clear objectives linked to the delivery of
continuously improving, high quality compassionate care Improvement Leadership development and
culture Feedback on performance At every level
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3. Supportive, positive people management and engagement Patient satisfaction highest where
staff have clear goals
Leaders make conversations meaningful with staff and reinforce purpose
Staff are put in charge of service change
Appropriate levels of accountability and empowerment
High work pressure - patients report too
few nurses, insufficient support, privacy
Leaders tackle poor behaviours
http://www.dh.gov.uk/health/2011/08/nhs-staff-management/
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4. High performing teams
1. A clear purpose and vision which relates to delivering high quality care
2. Clear challenging shared objectives with performance feedback
3. Clear roles
4. Social processes eg conflict handling are prioritised and members discuss jointly the kind of relationships they want
5. All members take responsibility for creating positive dynamics in and between meetings
6. Interactions with other team members are empathic and all members skilled in listening attentively, speaking up honestly
7. Good induction processes which are regularly reviewed
8. Constructive, skilful leadership of the team for productive and open discussions
• Does the board have improvement objectives?
• Does the board promote the values of innovation?
• Are staff focused on continually improving patient care?
• Do all staff intervene to ensure high quality of care?
• Are staff enabled through visits, training and peer review to learn about best practice?
• Is there training for responsible, safe innovation – lean, QI (WWL, Salford)
5. Learning and innovation
Developing an approach to collective leadership
Developing a collective leadership strategy
Discovery phase
A thorough analysis
of the current
siltation and an
informed view of
what's needed in
the future
Design phase
Specifies the
requirements for
individual and
collective leadership
in the next three to
five years
Delivery phase
Details the
strategies and
programmes that
will build the
capability needed
22 http://www.kingsfund.org.uk/publications/developing-collective-leadership-health-care
Thank you
Contact details:
Dr Katy Steward
Twitter: @KatySteward
@NHS_HealthEdEng #EoEPCLC
10:45 – 11:00
Refreshment Break & Networking
@NHS_HealthEdEng #EoEPCLC
• Andrew McDowell –
Director of The Performance Coach
@AndrewTPC
Where does change start?
What we’re going to cover
1. Some questions
2. What is coaching?
3. The rationale for coaching
4. A technique
5. Practice
6. Some applications
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Conversations
• In what ways do you think “coaching” might be considered a leadership behaviour?
• What do you feel the business case is for making coaching a part of the culture in the NHS?
• How would you rate your coaching skills at the moment? – Strengths – Development areas
What do you already know about coaching?
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“Coaching is unlocking the potential of another to maximise their performance.”
John Whitmore
“You cannot teach a man anything. You can only help him discover it within himself.” Galileo
“Coaching is the art of facilitating the development, learning and performance of another.”
Myles Downey
“Coaching is about supporting someone to change their relationship to a problem.”
Andrew McDowell
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Coaching definitions
Sport
Focus: Individual and/or Team
First main influence
Motivation
Improvement
Inner game
Business
Focus: The organisation
Strategy
Performance
Remedial change
People management
Education
Focus: The person & the organisation
Learning & development
Developing skills
Self reflection
Knowledge - Wisdom
Psychology
Focus: The individual
Personal development
Counselling & Therapy
Insight & self awareness
Psychometric tools
Different influences on Coaching
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Organisation
has authority
Individual has
authority
MANAGEMENT
What COACHING
How
LEADERSHIP
Why
Leadership, management and coaching
Source: The Performance Coach
Leadership of Others Strategic Intent Direction / Purpose System Outlook Management of Others Operational Outlook Performance Mgt Procedures Rewards Quality Assurance Requirements ‘Rules of the Game’
Leadership of Self Vision and Insight Meaning / Purpose Holistic Outlook Management of Self Intrinsic Motivation Discretionary Effort Creativity Intuition Perspectives Drive / Enthusiasm ‘Playing the Game’
Context Role / Intent
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“the art of enabling others to have their own insights”
Source: David Rock
Manager / Coach Team member
05 Support commitment to a plan of
action as a result of the
conversation?
04 Supporting the generation of
new perspectives for what
they could do?
03 Expand awareness about
what is happening now?
02 Establish a specific
goal for the
conversation?
01 Gain clarity about
important topics
for conversation?
Elements of a simple coaching conversation
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The TGROW Model
TOPIC Initial
understanding
GOAL Outcome for the
session
REALITY What is
happening now?
OPTIONS What is possible?
WILL / WRAP-UP Plan and support
commitment
Source: John Whitmore
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What do you want to talk about?
What do you want from this conversation?
What is really happening now?
What could you do?
What will you do?
Topic
Goal
Reality
Options
Will
Summary: Process of a coaching dialogue
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Feedback….
• What was the most difficult thing about being the coach?
• What was the benefit from being the coachee?
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What are my
resources?
What are my
previous
experiences?
What else is happening?
What am I
noticing?
What else? When?
What else
could you do?
How could you do that? Who else
is involved? What have
others done?
What else? What
would
someone
else do?
Where could I
find out more?
Raise Awareness Increase Responsibility
Where?
Talk through
an example?
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Raising Awareness and Increasing Responsibility
Source: Andrew McDowell
Your Turn….
• Identify a specific area relevant to your project that you want to focus on ….. Have a coaching conversation with a partner about that topic with a view to progressing it
– Coach: use TGROW
– Coachee: be Authentic
– 10 minutes coaching session
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Ingredients for Coaching Conversations
Active listening Being respectful and curious
about the other person’s
experience
Ownership Inviting the person
to generate their
own ideas about
what can be done
Encourage Reflection Using open questions to help
the person explore and
broaden their perspective
Goals Exploring what the
person wants to
achieve and why it’s
important to them
Action Encouraging the
person to take
small steps in
their chosen
direction
Preparation Reducing distractions and
planning how to have the
conversation
Encourage
Reflection
Ownership
Action
Active
Listen
Goals
Preparation
Better
Convo
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Applications and evidence
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Organisational Change
“Participation in the coaching was associated with increased goal attainment, enhanced solution-focused thinking, a greater ability to deal with change, increased leadership self-efficacy and resilience, and decrease in depression. The positive impact of coaching generalised to non-work areas such as family life.”
Grant (2016)
Journal of Change Management
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Preventing Burnout
“Coaching …. provides a results-oriented and stigma-free method to address burnout, primarily by increasing one’s internal locus of control. Coaching enhances self-awareness, drawing on individual strengths, questioning self-defeating thoughts and beliefs, examining new perspectives, and aligning personal values with professional duties”
Gazelle (2014)
Journal of General Internal Medicine
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Health Coaching
“Health coaching training for clinicians provides them with new mindsets, communication skills and behaviour change techniques that transform the clinician– patient relationship and enables patients to become more active participants in their care. This training improves patient experience and health behaviours, provides self-management support and can reduce demand and costs.”
Newman & McDowell (2016) Future Hospital Journal, Royal College Physicians
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www.betterconversation.co.uk
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If you see a benefit in Coaching you could…
• Access coaching from the EoE Coaching Register
• Use coaching during your projects
• Try out using a coaching approach with your colleagues
• Try out using a coaching approach with your patients
• Get trained as a coach
• Visit www.betterconversation.co.uk
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Action planning – Closing the knowing and doing gap
What have I learned? What are the main concepts, principles or skills that I have learned or I am interested in learning more about? What will I put into action? What are the key actions that I will take to apply my learning during this programme/ through my project? How will I be accountable? What will I do to ensure I take action, whose support do I need, who will I agree to check in with about my progress?
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About The Performance Coach The Performance Coach is an international leadership and coaching consultancy, who have been proud to be working with the NHS for the last 15 years, delivering a wide range of senior and clinical leadership development programmes with a variety of NHS organisations. TPC ran the first coaching training programmes with the NHS Institute for Innovation and Improvement, is leading on health coaching and the clinical application of coaching within Health Care System, and is supporting Trusts, CCGs and CSUs to develop their coaching, leadership and OD capability. Our work is guided by our core values to support organisations to create sustainable solutions - and enabling leaders at all levels to own their own development and learning agenda in support of better patient outcomes. For further information:
Dr Andrew McDowell, The Performance Coach
M: 44 (0) 7984 464 407 T: 44 (0) 203 637 0970
E: [email protected] W: http://www.theperformancecoach.com
The Performance Coach, 52 Brook Street, London, W1K 5DS
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@NHS_HealthEdEng #EoEPCLC
• Jamie Wylie
GP Partner in Norfolk, Course
Director and Senior Presenter,
Red Whale
Taking People with you –
Power and Politics
Taking people with you
Dr Jamie Wyllie
“Culture eats
strategy for
breakfast”
Mark Fields: Ford Motors
Peter Drucker: Management Guru
An operational definition of culture
The sum (or pattern) of the
interactions of a group
“Culture change” – what are we asking for?
Different interactions
between staff
and with patients
An operational definition of culture - in practice
Interactions
Conversations
Culture
So how do we change our conversations?
Intent
Preparedness
Improvisation
Reflection
Time out!
What conversation do you need
to change?
How are you part of the
pattern?
What small change will you
make?
Write it down!
Dr Smith found his new colleague a little hard to read...
Power and
Politics
Buchanan and Badham’s definition
Power: getting other people to do what you want
Politics: power in action
Look out for politics when…
Big numbers
High stakes
High uncertainty
Politically aware
Politically
unaware
Acting with integrity
Game playing CARRYING
REA
DIN
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Wise
Innocent
Clever
Inept
How can we use this in the real world?
Self awareness
Adjusting live
Reflection
Phone a friend!
Time out!
Think about a recent
interaction…
Which behaviours did you use?
Which axis will you adjust next
time?
Write it down!
In Summary…
• Change is hard!
• We can do it one conversation at a time
• Politics gets everywhere (that matters)
• We can get better at these interactions
• Effective politics will help you bring people
with you!
@NHS_HealthEdEng #EoEPCLC
• Mark Attah –
Associate GP Dean - Bedfordshire
Round up & Reading List
Information
