Part 4 of…

CHANGE, LEADERSHIP AND THE INTERDISCIPLINARY TEAM

CORK

JUNE 10TH 2009

Malcolm Rae, OBE, F.R.C.N.,

Mobile: 07969895710Email:malcolmrae@blueyonder.co.uk

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WHAT ARE YOUR ATTRIBUTES AND WHAT ARE YOUR ATTRIBUTES AND CHARACTERISTICS?CHARACTERISTICS?

Are you an ostrich – that denies and refuses Are you an ostrich – that denies and refuses to change?to change?

Are you a turtle that withdraws?Are you a turtle that withdraws?

Are you a poodle – that gives in, rolls over, or Are you a poodle – that gives in, rolls over, or sticks its leg in the air to be tickled?sticks its leg in the air to be tickled?

Are you a lemming – that waits and sees and Are you a lemming – that waits and sees and then follows?then follows?

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WHAT ARE YOUR ATTRIBUTES AND WHAT ARE YOUR ATTRIBUTES AND CHARACTERISTICS?CHARACTERISTICS?

Are you a gorilla – that repeatedly bullies, Are you a gorilla – that repeatedly bullies, overpowers and forcefully achieves?overpowers and forcefully achieves?

Are you an owl – intellectualises and then Are you an owl – intellectualises and then decides who is inadequate?decides who is inadequate?

Are you a cunning fox who constantly looks Are you a cunning fox who constantly looks for prey, but is eventually hunted itself?for prey, but is eventually hunted itself?

Are you an elegant swan who calmly glides Are you an elegant swan who calmly glides around, or are you a sheep, timid who finds around, or are you a sheep, timid who finds any disagreement unpleasant?any disagreement unpleasant?

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TO BE SELF AWARE, BE YOURSELF, BUILD ON

PERSONAL STRENGTHS, BUT DON’T IGNORE WEAKNESSES AND

PROJECT YOURSELF.

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““What are your strengths and weaknesses”?What are your strengths and weaknesses”?

““Do you sympathise, empathise and organise, Do you sympathise, empathise and organise, or do you hypnotise or terrorise”?or do you hypnotise or terrorise”?

““If you were a fly on the wall and your If you were a fly on the wall and your colleagues were discussing you, what do you colleagues were discussing you, what do you think they would be saying”?think they would be saying”?

‘‘Lean forward to be noticed’.Lean forward to be noticed’.

““A shy man never produces any children”.A shy man never produces any children”.

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INVOLVEMENT IS THE KEYINVOLVEMENT IS THE KEY

Staying focused, don’t be distracted, be Staying focused, don’t be distracted, be consistent.consistent.

Being astute, leading with knowledge, passion Being astute, leading with knowledge, passion and enthusiasm, and having a zest for what and enthusiasm, and having a zest for what you do.you do.

Bringing others with you, pulling as you push.Bringing others with you, pulling as you push.

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RESUME OF VALUESRESUME OF VALUES

Having a positive outlook and enthusiasm.Having a positive outlook and enthusiasm. Respect for self and others.Respect for self and others. Being accountable.Being accountable. Collaborating and co-operative.Collaborating and co-operative. Courtesy.Courtesy. Integrity.Integrity. Modesty.Modesty. Warmth, sensitivity, and empathy.Warmth, sensitivity, and empathy. Courage.Courage. Loyalty.Loyalty. Work ethic.Work ethic.

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LORD DARZI’S REPORT

Must do more to develop clinical

leadership

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Expectations of patients and staff Expectations of patients and staff

and informationand information

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““Trying to influence an organisational Trying to influence an organisational

culture without realistically dealing with culture without realistically dealing with

clinical leadership, is like trying to take a clinical leadership, is like trying to take a

core from an apple without breaking the core from an apple without breaking the

skin”skin”

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CULTURECULTURE

DICTIONARY DEFINITIONDICTIONARY DEFINITION

““THE CUSTOMS AND ACHIEVEMENTS OF AN THE CUSTOMS AND ACHIEVEMENTS OF AN ORGANISATION”ORGANISATION”

““CONDITIONS SUITABLE FOR GROWTH”CONDITIONS SUITABLE FOR GROWTH”

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Must have willingness amongst those who Must have willingness amongst those who

deliver the service to move to new ways of deliver the service to move to new ways of

workingworking

Willingness needs to be enabled and Willingness needs to be enabled and

empoweredempowered

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People will not be persuaded by command People will not be persuaded by command

and controland control

Give them insightGive them insight

Clinical leadership is the tool that can give Clinical leadership is the tool that can give

these insights and influence behaviourthese insights and influence behaviour

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Clinical leadership requires renewalClinical leadership requires renewal

Biggest obstacle is the lack of clinical Biggest obstacle is the lack of clinical

leadership, in transforming culture, leadership, in transforming culture,

overcoming custom, practice, tradition and overcoming custom, practice, tradition and

convention sometimes power struggles and convention sometimes power struggles and

conflict, along with anxiety re change.conflict, along with anxiety re change.

““CULTURE EATS STRATEGY FOR BREAKFAST”CULTURE EATS STRATEGY FOR BREAKFAST”

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Clinicians as navigatorsClinicians as navigators

Services need people with real clinical Services need people with real clinical

credibility and authority more than evercredibility and authority more than ever

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Clinical leaders should be more concerned Clinical leaders should be more concerned

with augmenting professional standards than with augmenting professional standards than

with protecting professional status and old with protecting professional status and old

ways of working.ways of working.

If clinical leadership is strengthened, morale, If clinical leadership is strengthened, morale,

motivation and patient outcomes are likely to motivation and patient outcomes are likely to

be improved.be improved.

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Also,Also,

A culture of innovation, team working and A culture of innovation, team working and

ability to manage the unexpected.ability to manage the unexpected.

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CULTURE CONCERNS – INQUIRY REPORTSCULTURE CONCERNS – INQUIRY REPORTS

Underlying themes of :Underlying themes of :• Poor leadershipPoor leadership• Professional isolationProfessional isolation• Poor partnership workingPoor partnership working• Ineffective systems and processesIneffective systems and processes• Tribalism between profession / cliniciansTribalism between profession / clinicians• DisempowermentDisempowerment• Excessive managerialismExcessive managerialism• Poor communicationPoor communication• Power strugglesPower struggles• Skills, qualifications, attitudes, experiences being Skills, qualifications, attitudes, experiences being

incongruent with delivering best clinical and evidence based incongruent with delivering best clinical and evidence based practice.practice.

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Team issues :Team issues :• ““Everyone knows, but nobody says” cultureEveryone knows, but nobody says” culture

• Active covering upActive covering up

• IndecisionIndecision

• CliquesCliques

A disconnect between managers and cliniciansA disconnect between managers and clinicians

A culture of blame or/and fearA culture of blame or/and fear

A denial of the need for effective clinical A denial of the need for effective clinical

leadershipleadership

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Evidence of relapse fostering of Evidence of relapse fostering of

dependency and other patient care dependency and other patient care

concernsconcerns

Morale, motivation and communication are Morale, motivation and communication are

the lifeblood of an organisationthe lifeblood of an organisation

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Assumptions, beliefs and principles are Assumptions, beliefs and principles are

informed by clinical leaders.informed by clinical leaders.

There is no shortage of leadership talent if There is no shortage of leadership talent if

you look for it and enable it to develop.you look for it and enable it to develop.

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Clinicians are a great power for good, there Clinicians are a great power for good, there

are many impressive and good values are many impressive and good values

clinicians.clinicians.

Leaders need to have courage and lose Leaders need to have courage and lose

their fear of being unpopular.their fear of being unpopular.

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CULTURAL CHANGE WILL INEVITABLY CULTURAL CHANGE WILL INEVITABLY HAPPENHAPPEN

Challenge is – HOW SOON?Challenge is – HOW SOON?

THERE IS NO CHOICETHERE IS NO CHOICE

Martin Luther King Jnr said :Martin Luther King Jnr said :““OUR LIVES BEGIN TO END THE DAY WE BECOME OUR LIVES BEGIN TO END THE DAY WE BECOME SILENT ABOUT THINGS THAT MATTER”SILENT ABOUT THINGS THAT MATTER”

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CHALLENGES FOR THE FUTURECHALLENGES FOR THE FUTURE

• How can we develop and nurture the How can we develop and nurture the

leadership skills, knowledge and awareness of leadership skills, knowledge and awareness of

our clinicians?our clinicians?

• How can we better support, provide How can we better support, provide

information and back clinicians in shaping information and back clinicians in shaping

their own environments?their own environments?

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• How can we unleash the talent of clinical staff to How can we unleash the talent of clinical staff to

lead and shape the culture and positively lead and shape the culture and positively

influence the quality of care?influence the quality of care?

• How better can clinicians time and resources be How better can clinicians time and resources be

used?used?

• How better can we get people to work together How better can we get people to work together

cooperatively?cooperatively?

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““A TEAM SHOULD LOVE WINNINGA TEAM SHOULD LOVE WINNING MORE THAN IT HATES LOSING”MORE THAN IT HATES LOSING”