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High Impact Leadership
May 2017
Derek FeeleyIHI Chief Executive
Jason LeitchChief Clinical Officer, NHS Scotland
Boss vs Leader
Interdependent dimensions of High-Impact Leadership3
High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for
Healthcare Improvement; 2013. Available on www.ihi.org.
Warren Bennis4
“Leadership is about getting
people to want to do the right
thing.”
“Good leaders make people feel that they’re at the very heart of things, not at the periphery.
Everyone feels that he or she makes a difference to the success of the organization. When that
happens, people feel centered and that gives their work meaning.”
New mental model? 5
6
It can’t be like this, either. . . . .The Choluteca Bridge, after Hurricane Mitch
Some fundamentals
(Embracing) Complexity
Shaping Culture
Collaboration
1. Accepting complexity
Leading in complexity
Some tools
Snowden, HBR 2008
10
Leadership of complex systems
• Destabilise the existing system
• Set some order generating rules
• Allow solutions to emerge
• Beware the persistence of deep structures and archetypes
• Accept paradox and contradiction
5. The power is not where you need it to be
4. You will not have all of the answers
3. You’ll need a diversity of approaches
2. The solutions are non-linear
1. You will have to address complexity with complexity
Presume that….
2. Culture eats strategy for breakfast
“The only thing of real importance that leaders do is to create and manage culture.”
- Edgar Schein
Explicit Culture – Heroes, Symbols,
Structures
Implicit Culture – Values,
Beliefs, Assumptions,
Purpose
Schein on Culture
Culture is a result of what an organization has learned from dealing with
problems and organizing itself internally
Your culture always helps and hinders problem solving
Culture is a group phenomenon
Don’t focus on culture because it can be a bottomless pit. Instead, get groups
involved in solving problems
Leadership and Culture
Leadership and culture must be looked at collectively – neither can be understood by itself
Leaders should be conscious of culture otherwise it will manage them
Culture is a function of leadership and leadership is a function of culture
Cultural understanding is essential if leaders are to lead:– When leaders create groups and organizations they create cultures
– Once cultures exist, leaders determine criteria for leadership (who will and will not be a leader –and how)
What do these have in common?
NASA Challenger
BP Gulf Spill
Mid Staffordshire NHS Trust
Humble Inquiry
“The Gentle Art
of Asking Instead
of Telling”
Humble Inquiry
“If a goal of conversation is to
improve communication and
build a relationship, then telling
is more risky than asking.
Asking temporarily empowers
the other person and temporarily
makes me vulnerable.”
Don’t walk past
3. Collaboration22
23
Discussion
What are your leadership fundamentals?
What (if anything) struck a chord for you in what I have said – and why?
What did you disagree with – and why?
High-Impact Leadership BehaviorsWhat leaders do to make a difference
High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for
Healthcare Improvement; 2013. Available on www.ihi.org.
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
IHI High-Impact Leadership Framework
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
IHI High-Impact Leadership Framework
Create Vision and Build Will
Develop Capability
Deliver Results
Driven by Persons &
Community
Engage Across Boundaries
Engage Across Boundaries
Shape Culture
Create Vision& Build Will
Develop Capability
Improvement Science Leadership for Improvement
IHI Improvement Advisor Waves
Quality Improvement Fellowship
IntroductoryKnowledge
AdvancedKnowledge
AdvancedKnowledge
Improvement Capacity Building:Scotland’s Approach
Scottish Improvement Leader (ScIL)
Improvement Collaboratives
Deliver Results
NHS Greater Glasgow & Clyde PICUVAP Rate per 1000 Ventilation Days
Jan 2013 – Sep 2015
NHS Forth Valley Pressure Ulcer CountNovember 2010 – May 2015
NHSScotland Hospital Standardised Mortality Ratio
January 2011 – September 2016
Driven by Persons & Community
Almost 7,200 stories shared
775 + staff listening
Over 250 service changes made as a result
80% of stories have a response
Source: www.patientopinion.org.uk – February 2017
Engage Across Boundaries
Scottish Stillbirth Rate (per 1000 births) 2000 - 2015
‘My neonatal colleagues in Edinburgh tell me that they notice more small babies in the cots now - they would previously not have made it to the unit of course…’
Dr Catherine Calderwood, Chief Medical Officer for Scotland
Shape Culture
Principle 3:
“The change goal must be defined concretely in terms of the specific
problem you are trying to fix, not as culture change.”
Edgar H Schein Organizational Culture & Leadership 4th Edition
High Impact Leadership (part 2)
May 2017
Derek FeeleyIHI Chief Executive
Jason LeitchChief Clinical Officer, NHS Scotland
http://www.ihi.org/resources/Pages/IHIWhitePapers/HighImpactLeadership.aspx
High Impact Leadership Behaviours
….over 1,700 leadership walkrounds have been conducted in Scotland.
Since 2008…….
Scotland’s Hospital Safety Huddles
Continuously improve quality and safety every day
Improve staff engagement and empowerment
Improve patient and family experiences
I always felt supported in my role – the huddle
has made it better
Gives me an overview of the whole hospital -who needs help Feels like we are
one team working together
Gives me real time information that is
being acted on
Population around 50,000
Coatbridge
10 miles east of Glasgow
40% of population living in one of Lanarkshire’s “15 most
deprived data zones”
18th century centre of Iron Making
27-30 Month Review
In Scotland..... 73% of children are meeting their developmental milestones
at their 27-30 months review
In Coatbridge......81% of children are meeting their developmental
milestones at their 27-30 month review
Source: NHS Lanarkshire
How did they do it?
Practitioner Leadership
Health Visitor Engagement
Early Years Collaborative Support
Improvement Methodology
High Impact Leadership Behaviours
1. Which behaviours are hardest?2. Which behaviours are easiest?3. What will you do differently when
you get back to your team?
Thank You!
Derek Feeley
President and CEO
dfeeley@ihi.org
@DerekFeeleyIHI
Jason Leitch
National Clinical Director,
Scottish Government
jason.leitch@gov.scot
@jasonleitch
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