leadership cpd uws v2 · 2. understand the principles of change management 3. appraise the...

Welcome back!HEALTH VISITOR CPD: 2015/2016

FACILITATOR: CLARE MCGUIRE

Leadership

HEALTH VISITOR CPD: 2015/2016

Housekeeping

10.30am 12.45pm

No test planned today

Learning Outcomes1. Critically reflect on your own leadership styles

2. Understand the principles of change management

3. Appraise the leadership skills required to effectively chair meetings and lead multi‐professional teams

4. Explore leadership skills required to manage and resolve conflict and dispute

5. Have an increased awareness of motivational interviewing strategies

http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4060058/learning%20contract.pdf

What does the word ‘leadership’ mean to you?

Everyday LeadershipDrew Dudley – TEDx Toronto

https://www.youtube.com/watch?v=uAy6EawKKME

Context

LeadershipTheories

Leadership Theories•‘Great Man’ theory

•‘Trait’ theory

•‘Situational’ theories: democratic, autocratic styles

•‘Management’ theories: transactional styles

•‘Behavioural’ theories: participative and distributed styles

•‘Relationship’ theories: transformational and authentic styles

http://changingminds.org/disciplines/leadership/theories/leadership_theories.htm

http://www.mindtools.com/pages/article/leadership-theories.htm

Great Man theory (1840s)Early research studied people who were already great leaders (often from aristocracy). Some

notion that leadership was to do with ‘breeding’Leaders are born and not made

Gender issues were not at the forefront when this theory was proposed

Trait theory (1930s‐1940s)People are born with inherited traits with some

traits more suited to leadershipGood leaders = right combination of traits

Behavioural theories (1940s‐1950s)

Focus on behaviours of leaders rather than their mental, physical or social

characteristicsLeaders are made not born…

Contingency theories(1960s)

No single way but leadership based on certain situations

Could be viewed as an extension to the ‘trait’ theory

Leaders more likely to express their leadership skills if people are responsive

Leadership Theories

Leadership Theories‘Trait’ theory

(1930s‐1940s)

Traits Skills

• Adaptable to situations• Alert to social environment

• Clever (intelligent)• Conceptually skilled

• Ambitious and achievement orientated

• Assertive

• Creative• Diplomatic and tactful

• Co‐operative• Decisive

• Fluent in speaking• Knowledgeable about group task

• Dependable• Dominant (desire to influence

others)

• Organised (administrative ability)• Persuasive

• Energetic (high activity level)• Persistent

• Socially skilled

• Self confident• Tolerant of stress

• Willing to assume responsibility

Skogdill (1974)

Leadership TheoriesTransactional theories

(1970s)

Transaction between leader and follower – mutually beneficial and reinforcing

Task orientated (effective when meeting deadlines or responding to an emergency)

Leadership TheoriesTransformational theories

(1970s)

Interaction with others which establishes trust and increases motivation (of both leader and follower)

Transformational leaders guide through their inspirational and charismatic qualities

Often inspire others to go above and beyond

Leadership theories recap…Ten leadership theories in five minutes…

https://www.youtube.com/watch?v=XKUPDUDOBVo

Storey and Holti (2013 p27)

What is your leadership style?http://www.lboro.ac.uk/service/std/ilm/Becoming_an_effective_leader/89527_03q.pdf

A questionnaire like this can help you reflect on your individual approaches and styles – building self‐awareness and encouraging a reflective approach.

The questionnaire relates to 3 leadership styles identified by Kurt Lewin (a social psychologist)

AuthoritarianLeadershipAlso referred to as autocratic leaders

Can be viewed as domineering

Task assignment

Problem solving

Good in a work environment with lots of new employees

Effective when quick decisions are required and with large scale organisation

Not always receptive to others participating in decision making processes

DemocraticLeadershipAlso referred to as participative leadership

Collective decision making

Camaraderie

Praise and restrained criticism

Gain authority through accountability, participation and delegation

Leadership style often not useful in groups or organisations with unchanging guidelines, roles and practices

With democratic leadership, there may be multiple leaders – everyone leading at some point in different situations

Laissez‐FaireLeadershipUninvolved

An absence of leadership style

Leaders of this style make no group related decisions

Have very little or no authority

Functions include trusting group members to make appropriate decisions

Most successful in environments with highly trained and self‐directed individuals

Leadership stylesIs the same style of leadership appropriate in all contexts?

When are different styles needed?

Authentic Leadership

‘To become a more effective leader, you must be yourself – more – with skill.’

(Goffee and Jones 2006)

To be as authentic as possible leaders need to:

1. Acquire self‐knowledge – reflective, realistic, clear about values and traits

2. Understand others – know what makes people in your team tick

3. Do what you say – practice what you preach

4. Admit you are not perfect

5. Provide reassurance and direction – particularly in times of difficulty

Authentic LeadershipAuthentic leadership self‐assessment questionnaire:

http://studysites.sagepub.com/northouse6e/study/materials/Questionnaires/03409_11lq.pdf Self‐

awareness

Internalised moral

perspective

Balanced processing

Relational transparency

Authentic LeadershipcomponentsSelf awareness◦ Means being conscious of, and trusting in, our motives, desires, feelings and self‐concepts

Balanced processing◦ Describes remaining objective when receiving information

Internalised moral perspective◦ Refers to regulating our behaviour according to our internal standards and values, not according to what others say

Relational transparency◦ Is presenting the authentic self to others, openly expressing true thoughts and feelings appropriate for the situation

Emotional Intelligence

What is emotional intelligence?

10 minutes – discuss in groups

Emotional IntelligenceThe ability to recognise and manage the effect of emotions on relationship with others (Walton, 2012)

It is thought that effective leaders possess emotional intelligence (Goleman, 1998)

Research around emotional intelligence (particularly relating to links with leadership) is emerging. Emotional intelligence can be difficult to measure.

Recognising your own feelings and emotions in order to identify others (Feather, 2009)◦ Emotionally intelligent leaders will not rush to ‘fix’◦ Are empathetic to others concerns and allow expression of feelings without judgement◦ Recognise that emotions can change from one situation to another

Developing emotional intelligence◦ Self awareness, self management, social awareness and social skills (Feather, 2009)

Giltinane (2013)

Leadership Vs ManagementLeadership = providing direction in relation to a vision

Management = organisation of systems and processes required to achieve/deliver the vision

Adams (2010)

Effective Clinical Leadership

What makes an effective clinical leader?

10 minutes – discuss in groups

What makes an effective clinical leader?

Effective clinical leader…

Communicate, negotiate, listen

Build relationships

Provision of support and mentoring

Credibility

Ability to delegate

Understand accountability

Adapted from Adams (2010)

What would you add in terms of leadership skills / qualities in health visiting?

Leadership and health visiting

Autonomy

Resilience

Assessment and Analysis

Strengths‐basedListening

Partnership working

Decision making

Effective Teamwork

Shared goals and objectives

Effective Communication

Mutual Trust and Respect

Managing challenges and

conflict

Reflection and Self Assessment

Effective Leadership

Sharing information and

expertise

CoachingDeveloping an individuals capabilities to facilitate success –organisational success in the NHS context.

Benefits – increased self awareness, motivation and enthusiasm, improved confidence, better team management and work prioritisation

http://www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadership-LeadershipFramework-OrganisationalToolkit-Coaching.pdf

Using Coaching in LeadershipIndicative objectives

•To step up into a new much larger strategic role

•To feel respected in that role

•To have more self‐belief

•To be “quietly confident”

•To build on strengths – bigger picture

•Mission, adventure and optimism – not just at work but in a wider life context

•Being confident in putting myself forward and verbalising my strengths

•Have the courage to do things that I previously wouldn’t have done – be “unlocked”

How will we know?

•I would feel in control without being overbearing;

•I would be a support that people came to,

•I would be able to step back and know I’m doing enough

•Being able to say: “I did that!” “I made a difference

•Being more laid back

•Instilling confidence in others

Change Management

Change ManagementKotter’s 8‐step change model

https://www.youtube.com/watch?v=9QA7Mvu2QDE

Leadership for change• Concept of change is to make things better

• Complex Process ‐ No right or wrong

• Internal and external influences• Change can be instigated by organisational initiative or own initiative• Drivers for change: Politics

• Economic influences

• Sociological trends

• Technical innovation

• External influences can have significant impact

• People central to process, lack of understanding means no change

Effectively managing change1. Establishing the case for change2. Visualising how the new world will be better3. Establishing a set of shared values4. Resourcing the change initiative appropriately5. Leading by example6. Assessing capability7. Engaging the team in the change process8. Communicating the change itself and the process timeously and sensitively

Leadership for change• Change is inevitable

• It’s how we approach, manage and learn which makes the difference

• Vital to lead and communicate change

• Establishing and communicating a shared vision is key

• Your role in change is often in providing support and motivation

http://www.effectivepractitioner.nes.scot.nhs.uk/

Resistance to changeFear of the unknown

Uncertainty about the long term impact

Reluctance to abandon existing working practices

Competing commitments – beliefs/assumptions that are at odds with someone’s role in a change process

Spotting the signs…◦ Defensive attitude or withdrawn◦ Identifying problems with no solutions◦ Negative body language when talking about the change◦ Continually complaining to colleagues about the change◦ Fixating on small details◦ Lowering standards/productivity when working on anything related to the change

SOURCE: https://app-goodpractice-net.proxy.knowledgeservices.org/#/nhs-develop/s/47e18943

Responding to

resistance

Effective communication

Give people time

Support healthy scepticism

Tune in to the reactions to change

Be positive, active and motivated

Provide practical support

Reflect on the process as a

team

SOURCE, adapted from: https://app-goodpractice-net.proxy.knowledgeservices.org/#/nhs-develop/s/47e18943

ManagingConflict

Managing Conflict• Think of a conflict situation in work which you need to address…

• How has the conflict arisen?

• Taking any differences in how you and others deal with conflict, identify what you need to do and say that may help resolve the conflict

• Reflect on what went well and what could have been done better when trying to resolve the conflict

• 10 minutes in pairs


Managing conflictin a team situation

• Conflict has cost implications in time and money

• Impact on individual and team happiness

• Individuals less effective in their work

1. Don’t ignore it

2. Demonstrate positive behaviours such as active listening

3. Set clear boundaries

4. Hold regular discussions

5. Provide clarity over what is expected

6. Establish clear consequences

Managing Conflict:top tips1. Create a positive working environment

2. Learn to spot the signs of conflict

3. Deal with conflict as soon as it occurs

4. Set some ground rules for discussing conflict

5. Don’t take sides

6. Seek advice and guidance

7. Develop your team’s conflict management skills

8. Evaluate your conflict management skills

Reflection


Strengths‐basedpractice

Adapted from Pattoni (2012)

Strengths‐based

Capacity

Skills

Knowledge

Connections

Potential

Collaboration

Co‐producers

Supportive

Strengths‐based practiceRecap…

Strengths‐based practiceAn alternative to deficit‐based models

Collaborative process (co‐producers rather than consumers)

Working together = determining an outcome which draws on strengths and assets

Relationship building

Less the ‘fixer’ of problems and more the co‐facilitator of solutions

Strengths‐based practice ‐Different perspectivesMental health often use the term ‘recovery’

Community development refer to ‘asset‐based’

‘Resilience’ is also a term which could be closely linked

The variation in terms can be confusing!

Strengths‐based practice should be person centred – strengths will vary

Rapp, Saleebey and Sullivan (2008) offer standards for judging what constitutes a strengths‐based approach. Practitioners may like to use the following list to consider their own practice. The standards include:

► Goal orientation ► Strengths assessment ► Resources from the environment ► Explicit methods are used for identifying client and

environmental strengths for goal attainment ►Meaningful choice

How to use strengths‐based approach

Consider a difficult / challenging parent/carer or practitioner that you work with. Do not name them.

Think about 1 characteristic that you know about them that is difficult and reframe this aspect of their behaviour.Those who feel comfortable share with the rest of the group the behaviour and your reframed thinking around their behaviour.

MotivationalInterviewing

Motivational InterviewingMotivational Interviewing is a collaborative conversation style for strengthening a person’s own motivation and commitment to change. (Miller and Rollnick, 2012)

Originated in the field of client‐centred counselling – therefore transfers quite well in terms of person‐centredness in the NHS

Increasingly used in relation to lifestyle / behaviour change

Motivational InterviewingMotivational interviewing relies on identifying clients’ intrinsic values and goals and using them as a basis to stimulate behaviour change.

Motivation to change is elicited from clients, not imposed on them.

It is designed to elicit, clarify and resolve ambivalence.

Resistance and denial is often a signal to modify motivational strategies.

Eliciting and reinforcing clients’ ability to carry out and succeed in achieving a specific goal is essential.

The therapeutic relationship is a partnership that respects client autonomy.

It is both a set of techniques and counselling style.

Rubak et al (2005)

In what situations do you currently utilise motivational interviewing strategies?

Motivational Interviewing

OARS skills Open ended questions

Affirmations

Reflections Summaries

Watch the following clip and identify which skills were evident:

https://www.youtube.com/watch?v=‐4EDhdAHrOg

Chairing Meetings

Discuss the key skills /qualities / characteristics of an effective Chairperson – identify 5 key points to share

10 minutes

Wider group feedback

•Good listeners

•Active listeners • limit distractions, positive encouragement, feedback your understanding

•Adaptable

•Reflective

•Demonstrates sensitivity

•Approachable

•Knowledgeable

•Show interest

•Be welcoming

•Tactful

•Decisive

•Diplomatic

• Inclusive

•Attentive

•Concise

•Calm and Confident

Skills and qualities of a good Chairhttps://www.youtube.com/watch?v=iuv‐DuScQAU&feature=youtu.be

https://www.argyll-bute.gov.uk/social-care-and-health/chairing-childs-plan-meetings

Consider the key aspects which contribute to ‘effective’ meetings?

10 minutes – discuss in pairs

Group feedback

Where should the meeting take

place?

Is this a formal or informal meeting?

Consider the agenda – assign

items appropriately

Is the meeting required?

Don’t leave important agenda items to the end

What do you want or hope to achieve?

Who needs to be at the meeting?

Effective Meetings:PLAN

Planning a Child’s Plan meetingPlanning your meeting

https://www.youtube.com/watch?v=s1LYmnEWVfU&feature=youtu.be

Considering potential risks to the child

https://www.youtube.com/watch?v=OGd5sVkiRIs&feature=youtu.be


Consider the

venue

Have you completed actions from previous

meeting?

Limit distractions

Why are you attending the meeting?

Make sure everyone can see

and hear

What will your contribution be?

Do you need to read anything in

advance?

Effective Meetings:PREPARE

Child’s Plan meetingEstablishing ground rules and expectations

https://www.youtube.com/watch?v=n3Ty5dp3teI&feature=youtu.be


Be open and respectful to

ideas from others

Support the role of the Chair (if it’s not

you)

Share your thoughts and

ideas

Know why you are there

Be clear of responsibilities for actions agreed

Be there on time

Stay on subject

Effective Meetings:PARTICIPATE

Making your meeting solution focusedhttps://www.youtube.com/watch?v=AhoIFlpb1DU&feature=youtu.be


Summing up and closing the meetinghttps://www.youtube.com/watch?v=jtkfsq_tsg4


After the meetinghttps://www.youtube.com/watch?v=DFBcJQ6w4‐4


Context

Managing conflictDiscussion…During a Child’s Plan meeting, it becomes clear the parents are unhappy about the detail relating to an identified wellbeing need and resulting targeted intervention.

What key steps would you take to manage this situation?

10 minutes – discuss in groups of 4Wider group feedback

Managing conflicthttps://www.youtube.com/watch?v=xA40XICTilc


Top tips / recapChairing meetings☑ Review known information, ensuring that you have noted all the relevant issues that you think needs to be discussed

☑ Speak to the parents when they arrive to remind them about the purpose of the meeting and what to expect.

☑ Prepare to take notes of the meeting, or ask another participant to do this.

☑ Welcome everyone to the meeting, making any relevant introductions to ensure that everyone knows each other, the reason they are at the meeting and the contribution that is expected of them.

☑ Ask those attending the meeting to share their information about the child or young person.

☑ Share any information that has been forwarded to you by an absentee.

Information source: NHS Grampian ‐ http://www.aberdeengettingitright.org.uk/OperationalGuidance.html

Top tips / recapChairing meetings

☑ Facilitate discussion, exploring relevant issues, looking specifically at what is getting in the way of the child or young person’s wellbeing and come to a shared understanding about this.

☑ Facilitate discussion about what need to happen next to make a difference to the child or young person’s wellbeing. Ensure that the parent and child or young person are fully involved in the discussion.

☑ Agree priority areas for action.

☑ Agree the priority actions that need to be taken, and complete the action plan template, identifying the relevant SHANARRI indicators.

☑ Discuss and agree if there are any areas of risks and if there are any, what they are.

☑ Discuss and agree if there are Child Protection concerns.

☑ Discuss and agree whether a referral to the Reporter is necessary.


☑ Agree the appointment of a lead professional if one is required.

☑ Make sure that any contingency plans are clear, particularly where risk is involved.

☑ Write up the Child’s Plan (which now becomes the record of the meeting) and distribute to everyone who was invited.

NOTE: These points are a guide and overview only, you should familiarise yourself with local policies and procedures


Top tips / recapChairing meetings

Outcome focusedrecapChild’s Plan should be outcome focused and linked to wellbeing indicators

Outcomes are not actions or resources

An outcome is something that matters to an individual

They are specific changes, benefits, learning and effects that actually happen or are expected to happen as a result of our activities and interventions

Think SMART

Partnership Working

What are the greatest challenges to partnership working and how can these challenges be addressed?

10 minutes

Post activity discussionUnderstanding and appreciation for each other’s roles

Communicating effectively with each other

Different priorities / work pressures

Varied understanding of what partnership working is

Parents/children/young people receiving different messages from key partners

Spend time with colleagues – discuss and gain an insight

Develop good communication across agencies and at all levels. Establish what you expect from each other in relation to communicationEstablish what the priorities are from the beginning and read the first one again!

Engage in a common language and clarify expectations

Effective partnership working = parents as partners. Ensure there is a consistent and shared vision

How can we work together to ensure better outcomes for the child or young person than if we were working

individually?

Partnership workingChild at the centre

Parents as partners = effective partnership working

Joint planning at earliest opportunity

Respect, mutual understanding, communication, understanding of roles

How can we work together to ensure better outcomes for the child or young person than if we were working individually?

Parents as partnersHow confident are you that roles are clear to parents, children and young people?

“parents may be more realistically identified as participants in care rather than partners” (Fowler et al, 2012 p3307)

How do you know how effective your relationships are with parents and how do you gather information on their views?

What do you do to support and encourage all parents to be informed and involved in their child’s health?

NHS Scotland Leadership Qualities Framework

http://www.knowledge.scot.nhs.uk/media/9566973/scottish%20leadership%20qualities%20framework%20‐%20guidance%20notes%20july%202014.pdf

NHS Scotland Knowledge network leadership and management portal

http://www.knowledge.scot.nhs.uk/home/portals‐and‐topics/leadership‐‐management/about.aspx

Health management online, leadership topic room

http://www.healthmanagementonline.scot.nhs.uk/topic‐rooms/leadership.aspx

Leadership toolkit on the Knowledge network:

http://www.knowledge.scot.nhs.uk/home/portals‐and‐topics/goodpractice/leadership‐toolkit/leadership‐and‐strategy.aspx

Additional information

Moving forward…• What particular skills or strengths would you like to focus on developing?

• Make a plan of how and when you might approach this development

Summary• Developing leadership across the NHS in Scotland involves developing our ways of being as well as our ways of doing

• In this session we have begun to think about our ways of doing at work – our ‘leadership styles’ – how we can adapt them to different situations and what particular skills we feel we need to further develop

• We have also focussed on our ways of being at work – so identifying our core values and what authentic leadership means on a day to day basis

• We choose the kind of leader we are going to be – every day all through the day

Adams, C. (2010) What leadership skills will community nurses need to improve outcomes in the new NHS? [Online] Available: http://www.nursingtimes.net/nursing‐practice/specialisms/district‐and‐community‐nursing/what‐leadership‐skills‐will‐community‐nurses‐need‐to‐improve‐outcomes‐in‐the‐new‐nhs/5022727.article [Accessed 13 November 2015].

Feather, R (2009) Emotional intelligence in relation to nursing leadership: does it matter? Journal of Nursing Management. Vol.17(3), pp.376‐382.

Fowler, C., Rossiter, C., Bigsby, M., Hopwood, N., Lee, A and Dunston, R. (2012) Working in partnership with parents: the experience and challenge of practice innovation in child and family health nursing. Journal of Clinical Nursing. Vol.21, pp.3306–3314.

Giltinane, C.L. (2013) Leadership styles and theories. Nursing Standard. Vol.27(41), pp.35‐39.

Goffee, R. and Jones, G. (2006) Why should anyone be led by you? What it takes to be an authentic leader. Boston: Havard Business School Press.

Goleman, D (1998) What makes a leader? Harvard Business Review. Vol76(6), pp.93‐102

Miller, W.R. and Rollnick, S. (2012) Motivational Interviewing (3rd ed.). New York, NY: The Guilford Press.

Pattoni, L. (2012) Strengths‐based approaches for working with individuals. [Online] Available: http://www.iriss.org.uk/resources/strengths‐based‐approaches‐working‐individuals [Accessed: 20 October 2015].

References

ReferencesRapp, C., Saleebey, D and Sullivan, P.W (2006) The future of strengths‐based social work practice, in Saleebey, D (ed) The strengths perspective in social work practice, (4th Ed) Boston: Pearson Education.

Rubak, S., Sandboek, A., Lauritzen, T. and Christensen, B. (2005) Motivational Interviewing: a systematic review and meta‐analysis. British Journal of General Practice. Vol.55, pp.305‐312.

Stogdill, R.M. (1974) Handbook of leadership: A survey of the literature New York: Free Press

Storey, J. and Holti, R. (2013) Towards a New Model of Leadership for the NHS. Leadership Academy: The Open University Business School.

Walton D (2012) Introducing Emotional Intelligence: A Practical Guide. London: Icon Books Ltd.

West, M., Armit, K., Loewenthal, L., Eckert, R., West, T. and Lee, A. (2015) Leadership and Leadership Development in Healthcare: The Evidence Base. London, Faculty of Medical Leadership and Management

leadership cpd uws v2 · 2. understand the principles of change management 3. appraise the...

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