Leadership and the positive management of change

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Leadership and the positive management of change

• Steve Onyett
• Senior Development Consultant- CSIP SW/
• Visiting Professor- UWE
• Steve.onyett_at_nimhesw.nhs.uk

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Just part of the challenge

• At the local level, joint action to support
  health and well-being needs to be driven through
  strong effective leadership within PCTs and local
  authorities These changes, .. should facilitate
  better joint working. They need to be backed by
  strong leadership at chief executive and board
  level, and by individuals who have clear
  responsibilities for improving peoples health
  and well-being. (Our health, our care, our say
  2.53, 2.54).

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The nature of change required

• Social care and primary health care services are
  embedded in our communities. They are part of the
  pattern of our daily lives. We will shift the
  whole system towards the active, engaged citizen
  in his or her local community and away from
  monolithic, top-down paternalism (1.39).

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Complex
Complicated
Simple
From - Plsek, P. Complexity, culture and large
systems change presentation
Source Brenda Zimmerman, PhD
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Questions? (after Chapman, 2004)

• Are we spending too much time trying to apply
  complicated solutions to complex problems? What
  approach would we adopt if we accepted that
  systems cannot be controlled nor its behaviour
  predicted?
• How do we get to know what other perspectives
  there are on this issue and how do we understand
  them?
• How can we learn what is most effective here for
  ourselves? How would we know?
• What relationships are key to moving forward and
  how can we nurture them?

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Law of the Situation

• Leadership is transient and contextual
• Where knowledge and experience are needed the
  person who can is the right person to do it.
• Leadership should not be determined by position
  power.

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• The soft stuff is
• The hard stuff

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Organisational culture is

• the norms and expectations regarding how people
  behave and how things are done
• It includes implicit norms, values, shared
  expectations, and assumptions

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From Paul Bate. A receptive context for change.
What we know about organisations that provide a
receptive context for change.
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Constructive and defensive cultures in mental
health services

• Constructive cultures are those characterized by
  organizational norms of individualism and
  supportiveness. Constructive cultures encourage
  interactions with people and approaches to tasks
  that will enable staff to meet their higher-order
  satisfaction needs.
• Defensive cultures are characterized by norms of
  conformity and submissivenessencourage or
  implicitly require interaction with people in
  ways that will not threaten personal security

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Organisational climate is

• a global impression of ones organization and
  personal impact of the work environment, which
  influences the individuals work behaviours and
  job-related attitudes
• Includes emotional exhaustion, personal
  accomplishment, job satisfaction, organisational
  commitment

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So what?!

• organizational culture had both direct influence
  on work attitudes job sat and commitment and
  indirect influence through organizational climate
  e.g. emotional exhaustion and depersonalisation.
  
• Work attitudes significantly predicted one-year
  staff turnover rates. These findings support the
  contention that both culture and climate impact
  work attitudes and subsequent staff turnover.
• Aarons and Sawitzky, 2006

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Aarons, G. A. and Sawitzky, A. C. (2006)
Organizational Climate Partially Mediates the
Effect of Culture on Work Attitudes and Staff
Turnover in Mental Health Services.
Administration and Policy in Mental Health and
Mental Health Services Research
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ToolSpider ChartAssessment of current culture
for innovation
Risk
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Resources
Relationships
0
-5
Information
Rewards
Targets
Tools
Group 1
Group 2
Group 3
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Trusting Relationships
Shared Vision
Conflicting Needs
Shared Values
Pressures/Stress
Integrity
Change/Uncertainty/Dishonesty
Clear Communications
UnclearCommunications
Reliable Information
Complex/Poor Data
Familiarity
Lack of Time / Prior Experience
Distrusting Relationships
Source Richard Lauve, MD (VHA Inc.)
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Systems failure- Chapman, 2004

• A key insight from systems theory is that
  different individuals and organisations within a
  problem domain will have significantly different
  perspectives, based on different histories,
  cultures and goals. These different perspectives
  have to be integrated and accommodated if
  effective action is to be taken by all the
  relevant agents.
• This insight conflicts directly with the command
  and control culture that dominates government and
  public administration. The use of command and
  control inevitably fails within complex systems
  and alienates people by treating them
  instrumentally.

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In his powerful Critique of Cynical Reason,
Peter Sloterdijk (1987) observes that the whole
of postmodern society is living within an
internal dialogue or cognitive environment of a
universal, diffuse, cynicism. As a predominant
mindset of the post-1960s era, Sloterdijk takes
the cynic not as an exception but rather as the
average social character. It is argued that at
both the personal and institutional levels,
throughout our society there is a widespread
disturbance of vitality, a bleakening of the life
feeling, a farewell to defeated idealisms, and a
sense of paralyzing resentment. DAVID
COOPERRIDER, 1999
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Appreciative Inquiry
Is about developing the competence to CHOOSE a
way of thinking

• Appreciative Inquiry is the cooperative search
  for the best in people, their organizations, and
  the world around them.
• It involves systematic discovery of what gives a
  system 'life' when it Is most effective and
  capable.

From An opportunity to learn more about
Appreciative Inquiry Presentation by Anne Radford
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We manifest what we focus on and we grow toward
what we persistently ask questions about
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It works to build the positive core of the
organisations involved.

• Organisations need a lot less fixing and a lot
  more affirmation.
• Appreciation builds relationships, collective
  intelligence, and freedom to innovate

From An opportunity to learn more about
Appreciative Inquiry Presentation by Anne Radford
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It should not deny issues of power and inequality
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..and is respectful of peoples realities as
experienced
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The Power of Appreciation..

• ..rests with its self-reinforcing and
  self-generative capacity
• Srivastva and Cooperrider, 1999
• This requires inclusion, safety in participation
  and good communication
• Effective teamworking and leadership where this
  is modelled and enacted

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The 2004 NHS National Staff Survey

• 91 of staff (up from 89 in 2003) responded
  positively when asked Do you work in a team?
• However this shrunk to 43 (compared to 41 in
  2003) when the survey explored whether the team
  in question fulfilled criteria for a well
  structured team

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Real teams

• Less than 10 members
• Need to work together to achieve their task
• Have different and defined roles within the team
• Have a team identity

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Effective teams have..

• The minimum number of team members required to
  get the job done.
• Clear aims
• Participation in decision making
• Norms for excellence
• Support for innovation

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• When it comes to understanding organisational
  existence from the perspective of human action,
  the is no better clue to a systems overall
  well-being than its guiding image of the future
• Srivastva and Cooperrider, 1999

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Have the right team leading right

• The most common reason for failure of large
  systems to change is the failure of the senior
  leadership team to function as an effective team
  with the right balance of skills, healthy
  relationships, and deep personal commitment to
  the achievement of the goals
• (Reinertsen et al, 2004, p.3).

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Four Column Matrix
Strategic Goals
System Level Measures
National Targets
Projects
Develop transformational goals that connect with
the values that brought people into healthcare in
the first place
Develop system level measures that track progress
against these goals
Show how externally set targets sit within the
context of the strategic goals to build ownership
to delivery
Align project level goals with the strategic
goals of the system to create a sense of purpose
and channel energy
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Establish a system-level vision for improvement
with ambition and commitment.

• Leaders need to commit personally to these aims.
  This means taking a stand and framing the
  objectives as promises to users and the people
  that support them.

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Aims framed as promises to users
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Aims framed as promises to users
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Jake Chapman on Systems Practice- to quote

• interventions would be ongoing and based upon
  learning what works, rather than specifying
  targets to be met
• the priority would be to improve overall system
  performance, as judged by the end-users of the
  system not just by ministers or civil servants

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Jake Chapman on Systems Practice- to quote

• the policy-making process would focus on the
  processes of improvement, rather than the control
  of the agencies involved
• engagement with agents and stakeholders would be
  based more upon listening and co-researching than
  on telling and instructing responsibility for
  innovation and improvement would be widely
  distributed
• implementation would deliberately foster
  innovation and include evaluation and reflection
  as part of the overall design.

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• These days, what managers desperately need is to
  stop and think, to step back and reflect
  thoughtfully on their experience. events or
  happenings, become experience only after they
  have been reflected on thoughtfully
• Jonathan Gosling.
• The Five Minds of a Manager. Harvard Business
  Review. 2003

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The effective teamworking and leadership programme

• 7 day action learning based programme
• For 21 people dependent on each other to achieve
  positive outcomes for a defined group of users
  (including the users and their supports).
• Includes whole group work on improving team
  effectiveness.
• Funded by Leadership Centre and rolled out by
  CSIP Development Centres

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Key features

• Working across boundaries
• Leadership linked to improvement and the task in
  hand
• An emphasis on clarifying shared objectives and
  values
• Developing a shared experience of the users
  perspective
• Using tried-and-tested models for improvement
  those based on clinical know-how- e.g. solutions
  focus, motivational interviewing

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The effective teamwork and leadership programme
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Does it work? To quote

• Overwhelmingly, participants response to the
  day-by-day experience of their development
  programmes was positive. Throughout the course
  their comments indicated that they valued the
  opportunity to interact with other team members
  away from the work environment, enjoyed both
  networking and the chance to meet new people, and
  find out more about them. participants selected
  action learning sets as being particularly
  useful. They found these covered real issues and
  problems, had connections with their practice,
  and enabled them to come away with definite
  action plans (Rees and Shapiro, 2005).

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