Leading for Tomorrow’s NHS

School for Health Durham University6 December 2007

Dr Neil Goodwin07831 886834

National context for public services

The priority now is to step up reform of public services to meet new demands from an older population with higher expectations, engaging the public on their rights and responsibilities as service user, and harnessing technology to improve efficiency and responsiveness.

Extract from Long-Term Opportunities and Challenges for the UK: Analysis for the 2007

CSR

The challenges for the UK NHS

1. Achieving sustainable financial recovery against advances in costly technology and economic downturn

2. Meeting consumer expectations and creating bespoke services for diverse communities

3. Leading and delivering faster efficiency and reform and across 10 & 20 care

4. Developing effective commissioning and partnership working

5. Sustainable engagement of clinicians in change, management and leadership

The challenge for NHS hospitals?

My problem is reconciling my gross habits with my net income.

Errol Flynn (1909-1959)

Actor

Leadership is a threefold process

1. Interpersonal dynamic process2. Creating an agenda for change

using a strong vision3. Building a strong implementation

network to get things done through stakeholders and other people

The leadership problem

Leadership as a form of social influence is hard to distinguish from many other influences in relationships between people.

Leadership as sensemaking

The leader who struggles with the internal and external complexities of their organisation and wider operating system, and who helps others struggle with those complexities, is helping people with the process of sensemaking.

Defining sensemaking

Sensemaking is what it says it is, namely, making something sensible.

Weick (1995: 16)

Leaders pursuing sensemaking

The leader’s sensemaking role is aboutaligning:

- the problem;- the policy; and- the local politics;

in order to create successful change inthe local context.

I could have played it like a man to further my career, but in the end I said sod it.

 

Estelle MorrisSecretary of State

for Education, England 2001-02

Emotional Intelligence

Emotional intelligence (EQ) is the practice of using thinking about feelings to guide behaviour. The cornerstone of emotional intelligence is self-awareness.

See: Goleman D. 1998. Working with Emotional Intelligence. Bloomsbury

It’s certainly been a period of reflection, to analyse how I have acted…Anybody who doesn’t feel affected by something as traumatic as that has lost their sensitivity…I have learnt my lesson about these matters…I have been stupid.

John PrescottDeputy Prime Minister (1997-2007)

May 2006

Cultural Intelligence

Cultural Intelligence (CI) is concerned with understanding the impact of an individual’s cultural background.

[First described by Earley & Mosakowski in Harvard Business Review, October 2004]

CI in practice

Our inability to receive and reciprocate gestures that are culturally characteristic reflects a low level of cultural intelligence

Cultural intelligence is developed through the

following means…

• Cognitive – learning about cultural diversity

• Physical – using senses and body language

• Motivational – gaining strength through acceptance and success

EQ & CI The link between EQ and CI is a

propensity to suspend judgement, to think before acting.

Only when conduct you have observed begins to settle into patterns can you safely begin to anticipate how these people will react in the next situation.

The inferences you draw in this manner will be free of the hazards of stereotyping.

‘ …on the whole, although I have in a sense failed in everything I set out to achieve, I do not believe that history will blame me for that and I don’t regard my public life as a failure.’

Neville ChamberlainPrime Minister (1937-1940)

October 1940

Success is the ability to go from one failure to another with no loss of enthusiasm.

Winston S Churchill

Businesses fail not because they don’t know what to do. They fail because they don’t know what to give up.

Peter Drucker

Failure: why we fail1. Technical incompetence2. Managing upwards to the exclusion of

managing local relationships3. Inability to handle interpersonal

problems4. Poor team leadership, especially at

times of challenge, difficulty or conflict5. Inability to adapt to change or elicit

trust from others such as staff, partners and stakeholders

Llanelli inquiry: extract from recommendations

• Chairs and CEOs need to exercise leadership

• Trust and commissioner need to establish a more effective working relationship

• Commissioner should develop its external leadership role

• Trust and commissioner need to develop a compelling vision for acute hospital services

Compelling and motivating visions

‘I will build a motor car for the great multitude’

‘To deliver all packages within 24 hours’

‘Destroy Yamaha!’‘To make people happy’

Subjects(of strategy)

Players(stakeholders)

‘Crowd’(unimportant)

Leaders (context setters)

bystanders actors

Perceived power

Inte

rest

Categorising stakeholders for collaboration

[From Huxham C et al. 1996. Creating Collaborative Advantage. Sage]

Why CEOs fail

1. Arrogance: you’re right and everyone else is wrong

2. Melodrama: always grab the centre of attention

3. Volatility: your mood shifts are sudden and unpredictable

4. Excessive caution: the next decision you make may be your first

5. Habitual distrust: you focus on the negatives6. Aloofness: you disengage and disconnect

[Dotlich DL, Cairo PC. 2003. Why CEOs Fail. San Francisco: Jossey-Bass]

7. Mischievousness: you know that rules are only suggestions

8. Eccentricity: it’s fun to be different just for the sake of it

9. Passive resistance: your silence is misinterpreted as agreement

10.Perfectionism: you get the little things right while the big things go wrong

11.Eagerness to please: you want to win any popularity contest

[Dotlich DL, Cairo PC. 2003. Why CEOs Fail. San Francisco: Jossey-Bass]

Learning from failure

•Be reflective and self-aware•Find meaning in negative

events•Bounce back quickly•Consider a mentor or coach

Developing leadership

1. Develop a clear and understood vision supported by consistency between words and actions.

2. Motivate people to share your vision 3. Manage your working environment or context

and make sense of it to those around you.3. Empower individuals to take decision and to

be allowed to make occasional mistakes.4. Develop lateral and vertical open

communication

Leadership…is learning to do four simple and easily understood things consistently

West Midlands Leadership Programme

• Aimed at corporate-level executive leadership for director-level managers of all disciplines

• Developmental – not training – focusing on: Intellectual: the range of theories and

concepts available to the leader Emotional: the depth of understanding

that the leader has of her/his responses and relationships with others

Performative: the breadth of behaviours that the leader can call upon to enact leadership in the system

WM Leadership Programme: built on six core competences

1. The basics (vision, delivery, control and decision-making)

2. Understanding and managing context

3. Emotional intelligence4. Relationship building5. Team and people development6. Tackling difficult issues

Assessment

Residential

Module 1

Residential

Module 2

Residential

Module 3

Action Learning Sets, Coaching, Mentoring and Individual Projects

• Theory and practice of management and leadership

• Organisational theory, strategy and development

• Key aspects of the service system: policy, performance and partnership

• Personal and psychological resources

• Leadership and Performance

West Midlands Leadership Programme Design

Residential

Module 4

Development Centre

Post P

rogra

mm

eA

ssessm

ent

WM leadership programme: early evaluation findings

• More able to articulate expectations about assessing their suitability for CE role

• Feel more influential and energised • Outlook more active than passive• Have greater appreciation of the need to

reflect and think things through before acting

• All have reported feeling more confident in their roles

National Leadership Framework

• Aimed at achieving a national common standard

• Based on the six competences• Seven consortia/organisations chosen

from 24 bids• Universities & personal development

practitioners• Performance management approach• Simplified procurement process for SHAs• Framework to be refreshed regularly

Leading significant change

The story of four chief executives

Chief executive #1

•Distant, decisive•Network builder •Team player•Strategic compromiser•Self-effacing, insightful

Chief executive #2

•Value driven, visionary•Visible, respected•Poor team builder•Poor inter-organisational

relationship builder •Indecisive

Chief executive #3

•Neither visionary nor strategic•Controlling, hierarchical•Poor team builder •Not trusted

Chief executive #4

•Visionary, visible•Organisational insight•Good team and relationship builder •Strategic compromiser

Chief executives #2 & #3

1. Inability to develop effective and respected executive teams

2. Inability to develop effective and sustainable interpersonal and inter-organisational relationships

3. Inability to work with other local leaders by sharing power and decision-making

Chief executives #1 & #4

1. Aligned the historical culture, relationships and decision-making of their health systems with future challenges

2. Successfully tackled big, local issues3. Approach based on interpersonal

relationships and inter-organisational networking, supported by competent and respected executive teams

4. Created a paradox of stability from change

Do not be afraid of strengths in your organisation. This is the besetting sin of people who run organisations.

Peter Drucker

Model for leadership*

Leadership is about developing five interconnected variables…

1. Competent and respected executive team

2. Good interpersonal relationships3. Effective inter-organisational working4. Alliances and partnerships5. Sharing power and decision-making

[*See: Goodwin N (2006) Leadership in Healthcare. Abingdon: Routledge]

Leadership – to summarise

• Preparation, preparation, preparation• Have a good, risk assessed, sensible

plan• Think plan B; and win/win, not win/lose• Really know your partners and

stakeholders • Subsume your ego and think EQ and CI• Be prepared to trade and compromise• Be prepared for failure from time to time• Remember, life goes on afterwards

Don't be afraid to take a big step if one is indicated. You can't cross a chasm in two small jumps.

David Lloyd GeorgePrime Minster 1916-22

The greatest fear known to man is a new idea. If you have strong reasons to believe in your ideas, have confidence, face the brickbats and go ahead.

Sir Harold Ridley FRS (1906-2001)

Father of the modern cataract operation