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Cascading Leadership: Creating Organization
Opportunity
National Health Leadership ConferenceTuesday June 5, 2012
Jocelyn Bennett, Senior Director, Urgent and Critical Care
Jody Tone, Nursing Unit Administrator, General Internal Medicine
Rio de Janeiro
Rocky Reach Dam, Columbia River OR
Development of Emerging Leaders
• The next generation of leaders is already working for you- start now to groom our future
• Successful leadership development begins with strong executive engagement and development of healthy work places
• Direct attention towards personal development of individual talent within the organization
Dion et al, Developing Tomorrow’s Nurse Leaders. DecisionCritical.com
Sherman & Pross, Growing Future Nurse Leaders to Build and Sustain health Work Environments. Onlin Journal of Issues in Nursing
If You’re Not Developing… You’re Not Leading!
Releasing Time to Care©•An international initiative from the National
Health Services in the UK that increases the time nurses spend with patients, improving the patient experience, and contributing to a safer environment
•A front-line, top-enabled approach to improving patient care and work environment
•Based on Lean principles •Structured, continuous quality improvement•A way to build leadership at the front line
Modules of The Productive Ward
Knowing
Knowing How we Are Doing
Knowing How we Are Doing
An approach to measure and track, and help determine if the changes you make are meeting with the core objectives
Well Organized Ward
Simplify the workspace and reduce waste using lean principles. “Everything in the right place, at the right time, ready to go”
Patient Status at a Glance
Using visual management to show important patient information inorder to improve communication, pt experience and patient flow
RTC Outcomes
• Increased percentage of direct care time for patients
• Decrease number of patient falls and pressure sores
• Increased transparency and accountability through visual displays of quality measures
• Improvement in patient satisfaction• Improvement in nurse satisfaction
Leadership
“ Leadership is about engaging with nurses, listening to them and developing the structures and processes that will enable them to grow and develop”
Donner, G.& Wheeler, J. New Strategies for Developing Leadership
Leadership and RTC
• RTC promotes leadership development:– by giving nurses more control over their work environment– by providing tools to improve their work environment– the opportunity for leaders to mentor and coach staff
• Empowers staff:– to get rid of waste in the environment so they can spend
more time on direct patient care– to design safer more reliable care processes– to solve problems by providing information
RTC - EvaluationGoal: To understand the impact of RTC on staff
nurse engagement and leadership development.
Sample/Methods• Pilot unit evaluation (16 months post initiation)• 3 focus groups (N= 19)• Facilitated by the 2 RTC co-leads
• Interview guide based on NHS Staff Sustainability Factors
NHS Sustainability Model and Guide
Reference
Staff Sustainability Factors
1. Training and Involvement• Support and engagement
2. Behaviours/Attitudes• Ideas and empowerment
3. Senior Leaders• Trusted and enabling
4. Clinical Leaders• Trusted and enabling
LEADING
PARTICIPATING
CLI
NIC
AL
LEA
DER
SHIP
OR
GA
NIZA
TION
LEA
DER
SHIP
Cascading Leadership
ENGAGING
LEADING
PARTICIPATING
CLI
NIC
AL
LEA
DER
SHIP
LEAD
ERSH
IP
Leading • Clinical leading valued
• Leading what is relevant
• Levelling the hierarchy
• Leading beyond
Participating• Engagement
• All participation is active
• Control over practice
Culture Shift• Lead from where you stand
• Ownership
• Peer expectation
Enablers
• Release time
•Tests of change
• Hardwiring improvement
• Visible organizational leadership
Cascading LeadershipO
RG
AN
IZATIO
N
Participating• Engagement
– Precursor to participating– Role of early adopters– Multiple methods essential– “Bottom up” process – Integrated with other work (i.e. Practice Council)
• All participation is active– Direct and indirect participation– Participating in being informed – Voice
• Control over practice– Staff choices (i.e. timing of FASST Rounds)
The bug list….What Bugs You?
Leading (1)• Clinical leading valued
– Role of clinical co-leads– Facilitated engaging – Ideas are shared with the co-leads
• Leading what is relevant– Shared leading relative to role and practice – Engaging leaders beyond the unit
Leading (2)
• Levelling the hierarchy– Shift in attitude about manager’s role
• “we work together on unit issues i.e. staffing, orientation of new staff, providing feedback to each other”
– Interaction with other formal leaders• Leading beyond
– Leading others, acknowledgement of expertise – Supporting beyond
Culture Shift• Lead from where you stand
– Shared leadership from the middle – Tools and supports to lead
• Ownership– From “my” to “our”
• Within the unit• Beyond the unit
– For sustainability of changes• Peer expectation
– Aspirational – Role of “we”
Enablers• Release time • Tests of change
– RTC work is part of the PDSA cycle - if it doesn’t work, try something different
• Hardwiring improvement – Things are becoming routine, built as routine
• Visible organizational leadership– Issue dependent– Outcome versus process focussed – Structures for participation exist
Conclusions
• Engagement enables growth on the continuum from participating leading with ownership of:– Processes– Outcomes
• Senior leadership– Enabling, available and accessible support
• Built in release time - ROI
Next Steps
• Monitoring metrics
• Staff leadership development
• Evolving role of the unit manager
• Replication across the organization
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Questions?Contact information
Jocelyn Bennett Senior Director, Urgent and Critical Care416-586-4800 x2397jbennett@mtsinai.on.ca
Jody Tone Mount Sinai Hospital Nursing Unit Administrator 600 University Avenue416-586-4800 x2397 Toronto On., M5G 1X5 jtone@mtsinai.on.ca
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