‘Good leadership doesn’t mean top down’ Vijaya Nath Assistant Director, The King’s Fund @VijayaNath1

‘Good leadership doesn’t mean top down’

Vijaya NathAssistant Director, The King’s Fund

@VijayaNath1

www.hqip.org.uk


• Introductions• Leadership for QI• Measurement from

descriptive to prescriptive

• Creating Cultures for QI

The King’s Fund 2014

• Research & Analysis to generate, develop and evaluate ideas in the UK and across the world

• Develop Individuals, Teams & Organisations through building Leadership capability to improve healthcare

• Promote Understanding of healthcare & health policy

• Bring people together who work in and around Health & Care – clinicians, politicians, academics, patients-to learn, share knowledge & debate


• Measurement, standardisation, precision and inspection can be traced back to the Stone Age, to Babylonian civilisations and to the Roman Empire.



• The Edwin Smith Papyrus

• Ancient Egyptian Medical Text

• Movement from descriptive to prescriptive


• PDCA Plan , Do, Check, Action.

• Quality ‘ fitness for purpose’ ‘internal customer

• Total Quality Management (TQM)

• Cause and Effect• ‘Zero defects’

• Worker responsibility.

• Demming

• Juran• Feigenbaum• Ishikawa• Shigeo Shingo

• Crosby


• ‘Four Habits of High Value Health Care Organisations’

• Professor Richard Bohmer , visiting fellow The King’s Fund

• N.ENGL J Med 365:22 NEJM. Org Dec 1 2011


• Specification & Planning• Infrastructure design

attention to microsystem

• Measurement & Oversight

• Self Study


• Measurement & Oversight- for many driven by external regulation for these it is their internal DNA

• Collect more & more detailed data than what's required above

• E.g. Intermountain 200 plus measures 2/3 internally developed or refined.


• Leadership is the most important influence on culture

• In 2011 we published ‘No More Heroes’ - distributed leadership

• Staff engagement is one of the most important influencers of patient outcomes and experiences of being cared for (‘Rediscovering our purpose’, 2012)


‘All staff take responsibility for the success of the organisation in delivering continually improving, high quality and compassionate care ‘

Developing Collective Leadership for Healthcare, The King’s Fund, 2014


Previous philosophies/ norms need revisiting

• Role of ‘the Dr’• Micro System/delivery

team – Aviation• Team working over

individual performer• Informed

patient/patient leader• QI• Gender & full Diversity

of workforce (AI)

Cultural change (Bate et al (2000, Organisation Science)

• Fragmentation Integration• Tribal Team• Internally focused External focus• Factionalism Federation• Control Collaboration• Domination Accommodation• Imposition Negotiation• Resentment Tolerance• I, them and us We, us and us• Disparaging others Valuing self and others• Lid on secrecy Lid off and open• Conflict avoidance Working through• Division Partnership and networked

How will the board oversee the creation of leadership capabilities?

A Leadership Strategy Must Deliver These

© Center for Creative Leadership, 2014. Used with permission.

A Leadership Strategy


• What is your organisation’s Quality Improvement Strategy ?

• How does Clinical Audit get valued ?


• Set goals &values from bottom up not top down

• Focused standardisation

• Establish transparency in methods & data(local measure &target creation &open data sharing


• Support autonomous professionalism within bounds

(internal peer to peer comparison ,peer to peer control)

• Treat routine care as research enterprise –Feedback systems at all levels . Continuous Improvement never there


• Clinical Audit &Quality Improvement requires Leadership

• Wrapping Leadership around QI achieves extraordinary results

• It is a journey not an event , it will deliver patient centred care


• Thank you • Questions• Stay in touch• Be Brilliant because you are!

Documents

‘Good leadership doesn’t mean top down’ Vijaya Nath Assistant Director, The King’s Fund @VijayaNath1