Download - Mr presentation to rcpch oct 2011
Managing and motivatingColleagues in a shrinkingWorld
Dr Mike Roddis 21 October 2011 1
Topics to cover today
Leadership styles and motivation
Clinical engagement – what the NHS says
What leaders do vs. how leaders do it
Motivating people and how to do it (or not)
The shrinking world and what it means
Case studies
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Leadership styles and motivation: one approach
Question:
Can you motivate others or can you only produce a climate in which they motivate themselves?
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Leadership styles and motivation: one approachDaniel Goleman. Leadership that gets results. HBR March 2000
Style:
Coercive
Authoritative
Affiliative
Democratic
Pace-setting
Coaching
Climate:
Negative
Most strongly positive
Positive
Positive
Negative
Positive
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Leadership styles and motivation: one approach
Native style
Innate preference
Adaptability
Changing circumstances
Different individuals
Effect on outcomes
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Clinical engagement: an NHS buzz-phrase
Engaging Doctors: Can doctors influence organisational performance? Hamilton et al. AOMRC and DH 2008
“The essence of clinical leadership is to motivate, to inspire, to promote the values of the NHS, to empower and to create a consistent focus on the needs of the patients being served. Leadership is necessary not just to maintain high standards of care but to transform services to achieve even higher levels of excellence.”
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Clinical engagement: Where are you now?
The Medical Engagement Scale
Organisational opportunity scales which reflect the cultural conditions that facilitate doctors to become more actively involved in leadership and management activities
Individual capacity scales reflecting perceptions of enhanced personal empowerment, confidence to tackle new challenges and heightened self-efficacy.
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What leaders do vs. how they do it
What you do: competencies
The Medical Leadership Competency
Framework
How you do it
Transformational leadership questionnaire
(Prof Beverly Alimo-Metcalfe)
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Engaging transformational leadership(Real World Group)
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Motivating people and how to do it – some tips
Motivate yourself
Align your goals with that of your people
Try to understand what motivates themTalk to themListen to themObserve themDon’t make assumptions about them
Adapt your systems to support the process
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Motivating people and how to do it – some tips
Hold 121 meetings
Develop skills in delegation
Praise good performance and affirm positive contributions
Focus on behaviours not personalities
Reward what you see rather than focusing on what you feel
Use appraisal and performance management systems actively
Explain how behaviours contribute to success.11
The Shrinking World
Service restrictions
Service reconfigurations
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Service restrictions
Absolute budget cuts
Efficiency gains
New ways of working
Changed balance between the professions
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Service reconfigurations
Networks
Rationalisation/centralisation
Public sector mergers and takeovers
Private sector involvement
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Case study – 1
The problem: A Partnership Trust with a 20% decrease in income from
commisssioners
Chief Executive removes £3M from the medical staffing budget and suggests traditional cuts with ward closures, recruitment freeze etc
The Trust has 90 consultants, 70 SAS staff
60 – 70 trainees
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Case study – 1
The solution:
Agree trainees remain untouched
Shed 50 SAS posts
Reduce medical support to one post per consultant
Establish consultant-delivered service
No reduction in workload
Savings achieved
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Case study – 2
The problem:Two merged DGHs with duplicate services
Enormous cash deficit
No history of joint clinical working
No culture of clinical engagement or medical involvement in management
Possible forced implementation of service reconfiguration
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Case study – 2
The current position:
No service changes
On-going conflict and disputes across the sites
Multiple internal workshops and reviews
External facilitation and mediation failed to bring about change
Future of all clinical services remains in doubt
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Why were the results so different?
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In conclusion
Factors associated with high levels of motivation:
Clinical engagementPositive leadership climateMedical staff and board goals alignedExtensive internal consultation on plansEffective communicationStaff opinions and expertise actively soughtEffective delegation and empowerment
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With other end of the spectrum:
Disengagement
Poor morale
Cynicism
Bitterness
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Chronic embitterment:(taken from paper by Dr Janet Ballard to the European Association of Public Health Medicine 2010)
Embitterment:
“An emotion encompassing persistent feelings of being let down, insulted or being a loser, and of being revengeful but helpless.”
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Chronic embitterment:
Features: History• Manifests itself in the context of a relationship
that has ‘gone wrong’.
• Events cited as evidence of having been let down or badly treated by superiors or by the organisation as a whole
• Lack of resolution of event(s)
• Present distress attributed directly to event(s)
• Strong convictions about fairness, justice or anticipated support
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Chronic embitterment:Contributory factors
Personal:• Strong personal aspirations (especially strong
principles and
sense of justice)
• Perceived breach of the psychological work contract
Organisational:• Nature of precipitating event(s)
• Attempts to resolve the precipitating events and their aftermath
• Lack of adequate attention to organisational justice24
Chronic embitterment:Management of the organisation
Increase awareness of the condition (including causes and consequences)
Reduce collusion with rumination (balancing need not to be perceived as dismissive)
Encourage open and responsive communications
Prompt response to investigations/grievances
Attention to procedural justice
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Chronic embitterment:Management of the individual
Coaching to:
• Acknowledge the problem (including behaviours)
• Reduce unhelpful behaviours
• Develop strategies to reduce rumination
• Review personal goals
• Reduce likelihood of escalation
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Thank you