Steve Onyett.

Leadership and teamwork development

Eastern Region CMHT Forum

14th December 2007

Steve Onyett.

The 2006 NHS National Staff Survey89% responded positively when asked:

“Do you work in a team?” However this shrunk to 41% when the

survey explored whether the team in question fulfilled criteria for a well structured team

Findings consistent since 2003!

Steve Onyett.

An auspicious time for leadership and teamwork development Performance management that is stronger on

outcome while being less centrally controlling is promised.

Stronger local accountability advocated In a policy context where there is good

alignment of policy imperatives with the expressed concerns of users and carers, for example with respect to personalised care, dignity and choice.

Steve Onyett.

Darzi interim review in the wake of WanlessPerformance is not commensurate with

investment. Darzi stresses effective leadership and the

creation of stable contexts for service improvement.

No change unless it is an improvement!

Steve Onyett.

The challenge:

How do we achieve team role clarity within a complex local whole system?

Steve Onyett.

Scary graphic coming up on the inter-team relationships described in the Policy Implementation Guides

Steve Onyett. Primary Health Care

Team

Early intervention

team

Assertive community treatment

In-patient services

Non-statutory agencies

Approved social

workers

Continuing care

Services for homeless people

Psychology

Police

Criminal justice system

Acute medical services

Self referral

CMHT/ Primary care liaison

team

Forensic services

Child and Adolescent MH

Team

Crisis resolution/Home treatment team

KEY

Direct referral route

Referral may be out of hours

Inter team relation-ships

Steve Onyett.

A solutions focused approach to developmentDeveloping shared vision of your

preferred futureBeing clear where you are now and

celebrating the strengths that got you there

Taking the first small steps forwardAffirming each other

Steve Onyett.

Boundary spanning: Implications Managers may combat ineffective intergroup relations by

enhancing employees’ identification with their organization, while acknowledging groups for their individual performance

Measures for enhancing organizational identification may include • Communication of organizational successes, values, and goals. • Rotation of individual boundary spanners• Promotion into boundary positions of employees with dual identification• Ensuring that intergroup working is on a group’s agenda, in order to

combat “silo working”• Intergroup social gatherings• Frequent intergroup meetings,• Use of cross-functional teams

Steve Onyett.

The filling in the sandwich

Middle management the critical layer between corporate management and practitioners.

The most stressed group in the NHS workforce. Often feel disempowered- so like practitioners

exercise what power they have by saying “no” or taking flight from authority.

Thus need to link their development strongly with neighbouring layers in hosting organisations

From NHS Confederation Report- The challenges of leadership in the NHS. 2007

Steve Onyett.

Middle management survey by NHS Confederation/HSJ

Who are they?High levels of stress and a long-hours

culture- worst in mental health.Generally positive about their jobs but

least so in mental health

Steve Onyett.

Middle management survey by NHS Confederation/HSJ

High levels of role ambiguity- especially among the 40% who had not had an appraisal

Appraisal often criticized and link to organisational goals often unclear.

Sometimes the aim of the organisation itself is unclear

Steve Onyett.

That context re Risk..

“..Success is the ability to go from one failure to another

with no loss of enthusiasm”. Winston S Churchill

Steve Onyett.

Development to make a difference

Take a longer term view which encompasses the wider system.

Create more time for really important issues- such as improving delivery and staff understanding of the wider strategy [and values of the organisation].

Aim for more stabilityFrom NHS Confederation Report- The challenges of leadership in the NHS. 2007

Steve Onyett.

Development to make a difference

Context requires a “a much wider and more subtle range of influencing and persuasion skills than would be required in some other settings”.

Pay attention to the skills required for “a much more complex world in which thinking, listening and influencing will become much more important” (12).

Develop “sophisticated skills to deal with the emotional side of organisational life that are probably even more important [than the need to improve technical skills]”

NHS North West chief executive Mike Farrar

From NHS Confederation Report- The challenges of leadership in the NHS. 2007

Steve Onyett.

Some distant reflections from the turn of the century! Goodwin (2000) advocated a move away from a

focus on individual skill development towards a “local leadership mindset”.

Leadership development as mandatory, locally focussed, based around action-learning principles, and concentrated on inter-organisational and shared leadership between organisations rather than leader-follower relationships within organisations.Goodwin, N. (2000). The national leadership centre and the national

plan. British Journal of Health Care Management. 6(9), 399-401.

Steve Onyett.

Observations underpinning the development of ETL Leadership initiatives sometime fail to focus strongly

enough on service improvement Service improvement initiatives often fail to take enough

account of the involvement of senior managers. • Hence the need to integrate the two at local level

Leadership is bound by context, shaped by the task in hand and dispersed

The vast majority of care is delivered by teams and this is where service improvement and effective leadership needs to be enacted.

Steve Onyett.

Observations underpinning the development of ETL You cannot assume that the ways teams are

currently configured are “real” teams In trying to engage clinicians in change in makes

sense to use evidence-based models of change that they are familiar with from their clinical work.

We often neglect the mental health of staff in trying to achieve sustainable improvement.

Steve Onyett.

The ThinkingLeadership is not just the task of a

particular individual or discipline.Effective multidisciplinary teamworking is

the platform for evidence-based interventions.

A focus on outcomes for users and staff.A focus on you and the resources you

bring

Steve Onyett.

Aims of the programmeTo improve multidisciplinary team

working and leadership within and across local teams.

Through applying recent research findings on leadership and teamworking, and working on real issues of concern to you and the people that use your services.

Steve Onyett.

ObjectivesTo increase your confidence and

effectiveness as a leader, manager and/or team member.

To increase your ability to develop solutions to complex problems.

To support you in achieving meaningful change.

Steve Onyett.

The essenceBringing teams together in “sets”- small

groups where learning is achieved through action.

Helping you hone your peer coaching skills so you can better support colleagues through action-learning sets.

Introducing new learning on leading-edge research on leadership and teamworking.

Steve Onyett.

The effective teamworking and leadership programme 7 day action learning based programme For 21 people dependent on each other to

achieve positive outcomes for a defined group of users (including the users and their supports).

Includes whole group work on improving team effectiveness.

Funded by Leadership Centre and rolled out by CSIP Development Centres

Steve Onyett.

Key features Working across boundaries Leadership linked to improvement and the task in hand An emphasis on clarifying shared objectives and values Developing a shared experience of the users perspective Using tried-and-tested models for improvement + those

based on clinical know-how- e.g. solutions focus, motivational interviewing

Can be used in concert with other key developments such as CCTA

Steve Onyett.

Day One

Exploring what’s

important from a

variety of

perspectives, starting

with users

Visualising where we

want to get to.

Day TwoClarifying values underpinning the work

Getting feedback on team workingBeginning to action plan

Steve Onyett.

Day three

Working on

learning/coachin

g together-

Introducing

action learning

Day fourIntroduction to complex systems and thinking about change.

Introduction to service improvement methods

The learning sets start here!

Steve Onyett.

Day five

Building better

communication,

starting with

how to

participate

effectively in

team meetings

Day sixLooking at decision-making, power, accountability and responsibility.

Making better use of information

Steve Onyett.

Day seven

Staying

effective-

including

looking after

ourselves

Steve Onyett.

More openness and cohesion

Clearer view of objectives. More insight into interpersonal interactions

I really do believe the team has benefited. It has made us all aware of issues we avoid, i.e. conflict, and building in innovation

More openness in discussion. Better understanding of each other. Development of realisable objectives

Enabled the team to deal with ‘uproar’ in a positive way. Brought team closer together. A peer group now started. Office environment a little better

Reported Benefits

From Rees and Shapiro, 2005

Steve Onyett.

A high proportion of the membership work together and techniques from the course have been evident in the work place throughout. These include process mapping, problem solving – de Bono’s hats, understanding complexity etc.

In the main, some of the topics were pertinent to the development of the new team and enhanced cohesion. Much of the management exercises have been noted and used within our team, mapping, systems etc.

Improved leadership with clearer identified goals

A more informed “leader”

Reported Benefits

From Rees and Shapiro, 2005

Steve Onyett.

Does it work? To quote: “Overwhelmingly, participants’ response to the day-by-day

experience of their development programmes was positive. Throughout the course their comments indicated that they valued the opportunity to interact with other team members away from the work environment, enjoyed both networking and the chance to meet new people, and find out more about them…. participants selected action learning sets as being particularly useful. They found these covered real issues and problems, had connections with their practice, and enabled them to come away with definite action plans” (Rees and Shapiro, 2005).