Leadership and Organisational Performance. Professor Chris Ham Chief Executive The King s Fund 2 June 2013

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2 Leadership and Organisational Performance Professor Chris Ham Chief Executive The King s Fund 2 June 2013

3 The role of The King s Fund The King s Fund is an independent foundation established in 1897 The Fund has been involved in leadership development since 1951 We work closely with NHS organisations today to support leadership development We are also engaged in research and thought leadership on leadership in the NHS

4 Leadership Commission 2011 Politicians of all parties called for cuts in management costs Massive, complex organisation like the NHS requires top class leadership and management Managers have a critical role supporting doctors, nurses and other clinicians to improve patient care

5 Our findings (1) No more heroes: the NHS needs to move beyond heroic leadership Leadership needs to be shared and collective: a property of teams and not individuals Leadership needs to be distributed and present at all levels, especially in clinical microsystsms Leadership needs to be developed alongside followership

6 Our findings (2) Clinical leadership remains variable and under developed Clinical leaders need to work hand in hand with experienced managers High performing health care organisation around the world exemplify the benefits of clinical leader/manager partnerships

7 Leadership Review 2012 Building on the themes in our first report Leadership and engagement: Within organisations at every level links to distributed leadership Across organisational and system boundaries Aim to understand/clarify the value of engaging leadership in the NHS Provide case studies and recommendations to support the further development of leadership and engagement for improvement in the NHS

8 Leadership and Engagement for Improvement in the NHS Strong evidence that leaders who engage staff deliver: Better patient experience Stronger financial management Higher staff morale Less absenteeism and stress

9 Absenteeism

10 Performance

11 Findings (1) Business case is compelling Strong link also between medical engagement, improved organisational performance and better patient outcomes Strong correlation between levels of staff engagement and hospital mortality rates Happy staff make happy patients

12 Findings (2) Simple changes can make a big difference NHS organisations need to support leadership and engagement for improvement e.g. through effective appraisals, clear job design and a well-structured team environment NHS boards should value patient and staff engagement and pay attention to staff health and wellbeing e.g. by acting on the results of the NHS staff surveys Pace-setting style of leadership needs to be complemented by other approaches

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14 Leadership in microsystems Gill Maben s research on leadership in microsystems is very important This research underlines the critical role of team leaders in creating the right climate for high quality patient care Effective team leaders value staff, create time to care, and provide support and feedback Valuing and developing team leaders needs much more attention

15 Medical engagement and organisational performance Various studies have shown a relationship between medical engagement and organisational performance The Medical Engagement Scale in the UK uses a tool to assess engagement and relates the results to routine performance measures Research in Europe and the US by McKinsey and the LSE found that organisations with clinically qualified managers produced better results Goodall has observed a correlation between hospital performance in the US and whether the CEO is a physician

16 Key Assumptions of Approach Improvement in healthcare needs the positive involvement and engagement of doctors who are highly influential in planning and delivering service change Competence can be thought of as what someone can do but engagement requires a will do attitude Reliable and valid measurement and monitoring of medical engagement is critical since this will inform and shape the effective management of change Many definitions of engagement focus solely on individual aspect of engagement whereas the current approach also incorporates organisational conditions

17 Scales and Definitions MES Scale Scale Definition [The scale is concerned with the extent to which..] Index: Medical Engagement...doctors adopt a broad organisational perspective with respect to their clinical responsibilities and accountability Meta Scale 1: Working in an Open Culture...doctors have opportunities to authentically discuss issues and problems at work with all staff groups in an open and honest way Meta Scale 2: Having Purpose and Direction...Medical Staff share a sense of common purpose and agreed direction with others at work particularly with respect to planning, designing and delivering services Meta Scale 3: Feeling Valued and Empowered...doctors feel that their contribution is properly appreciated and valued by the organisation and not taken for granted Sub Scale 1: [O] Climate for Positive Learning...the working climate for doctors is supportive and in which problems are solved by sharing ideas and joint learning Sub Scale 2: [I] Good Interpersonal Relationships...all staff are friendly towards doctors and are sympathetic to their workload and work priorities. Sub Scale 3: [O] Appraisal and Rewards Effectively Aligned...doctors consider that their work is aligned to the wider organisational goals and mission Sub Scale 4: [I] Participation in Decision-Making and Change...doctors consider that they are able to make a positive impact through decisionmaking about future developments Sub Scale 5: [O] Development Orientation...doctors feel that they are encouraged to develop their skills and progress their career Sub Scale 6: [I] Commitment & Work Satisfaction...doctors feel satisfied with their working conditions and feel a real sense of attachment and reward from belonging to the organisation Applied Research Ltd

18 The MES Scale Hierarchy Medical Engagement Working in an Open & Fair Culture Having Purpose & Direction Being Valued & Empowered O Climate for Positive Learning Appraisal & Rewards Effectively Aligned Development Orientation I Good Interpersonal Relationships Participation in DM & Change Commitment & Work Satisfaction Applied Research Ltd

19 Level of Medical Engagement and the Care Quality Commission NHS Performance Ratings (2008/9) TRUST ID OVERALL MEDICAL ENGAGEMENT SCALE INDEX OVERALL QUALITY SCORE FINANCIAL MANAGEMENT SCORE Good Excellent Good Good Excellent Good Excellent Excellent Good Excellent Excellent Excellent Good Excellent Good Fair Excellent Excellent Excellent Excellent

20 Level of Medical Engagement and the Care Quality Commission NHS Performance Ratings (2008/9) cont d TRUST ID OVERALL MEDICAL ENGAGEMENT SCALE INDEX OVERALL QUALITY SCORE Fair Fair Fair Fair Fair Fair Fair Good FINANCIAL MANAGEMENT SCORE Good Excellent Fair Excellent Fair Fair Good Good Fair Fair Poor Poor

21 Medical Engagement and Organisational Performance Available at

22 Implications Engaging and valuing all staff will bring benefits Engaging doctors is especially important because of their ability to block change as well as make change happen Health care organisations are complex adaptive systems that need leaders at all levels Medical leaders must work within the team and organisational context: No more heroes

23 Where next? The business case is compelling but many obstacles remain Engagement is as much about the development of followership as of leadership Medical leadership roles are not always attractive compared with the alternatives Leadership development needs to go hand in hand with work on valuing medical leadership, developing career structures, and providing financial and nonfinancial incentives

24 Followership Developing leaders without developing followers risks setting up leaders to fail High performing health care organisations like KP and Mayo Clinic focus on developing all staff These organisations develop cultures of engagement and improvement Other examples include Intermountain Healthcare and Jonkoping County Council which invest heavily in leadership for improvement

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26 Finally Let s remember the many other influences on organisational performance Medical engagement and leadership are certainly critical factors but they are not the only ones

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