What makes a good manager?

Managers in Partnership Master Class 24th November, 2009

Professor Derek Mowbray.

©Derek Mowbray

derek.mowbray@orghealth.co.uk derek.mowbray@psychologistsdirect.org www.orghealth.co.uk www.derekmowbray.co.uk

‘If you feel well you will work better than if you feel ill’

•78% with poor mental health find it difficult to concentrate at work •57% say it takes longer to do work•46% say they are less patient with customers or clients

•41% say poor mental health interferes with their decision making•26% say their mental health is moderate to very poor•56% of these state the reasons are both home and work related

•CIPD Employee Outlook Survey 2009

Wellbeing and Performance The definitions of wellbeing and performance follow two models shown below.

Wellbeing is a personal sense of wellness. You can feel well and energised whilst being diagnoses

with illness; equally you can feel unwell without any illness for example a hangover. If you feel

well you will be able to concentrate better on your work that when you are thinking of

something else, like your illness or the sensations of feeling unwell. The feeling of feeling unwell

includes psychological distress where your concentration is diverted by the cause of your distress

– often the behaviour of other people towards you, in particular your manager.

The ‘Just a Minute Performance Model’ illustrates the need for concentration. In addition to

being able to conduct your work without deviation, hesitation of repetition, the performance

model includes clarity of purpose and ensuring your work achieves its aims.

Wellbeingfeeling wellbeing well and feeling wellbeing ill but feeling wellbeing alertconcentratingmotivatedengagedhaving energy

Performanceclear aimsappropriate aimsclear timetableefficacious actionno deviationeffective actionno repetitionefficient actionsno hesitation

Wellbeing and Performance

Just a Minute Performance Model

Quality of Care The essential feature of high standards and quality of care is the point of delivery which is

essentially chaotic. This means the ability to respond to events that unfold in front of you and

being sharp enough to react appropriately to the situation. Events may be entirely random, which

suggests that with the appropriate skills, knowledge and experience, combined with the correct

intervention for the task, based on appropriateness, efficacy, effectiveness and efficiency, you

should be a position to respond the chaotic events successfully. Much depends on your ability to

concentrate at the time the chaotic event occurs.

Quality of health care

Appropriate

Efficacy

Effective

Efficient

chaos/dynamic/change/action

KNOWLEDGE

SKILL

experience

What is stress?

Stress is at the wrong end of a continuum that starts with pressure, moves to strain and ends

with stress.

Pressure is energising, and heightens one’s concentration and produces higher levels of

performance. However, we can only tolerate pressure for periods of time dependent on our

levels of resilience. If we cannot see an end to the pressure we can move into a state of strain

where our concentration becomes diverted because of a sense of feeling unwell, which may be

similar to a sense of anxiety and slight panic. If this continues and we feel out of control of the

sensations we move to a state of stress, which can be very serious.

Pressure – Strain - Stress

Stimulant (pressure)

Diversion (strain)

Impairment (stress)

What are the characteristics of stressin individuals?

IrritationAnxietyInsomniaFatigueSmokingOver eatingHeadachesPhysical inactivityExcessive drinking

Glucose intoleranceHypertensionCoronary heart diseaseDiabetesstrokeHeart attackCancer

The are are many signs of the impact of stress. Overtly, levels of stress cause about half the reasons for people going off sick, and more than half the reasons why people leave their jobs for another somewhere else. Leaving jobs is a method of coping with stress. In the following slide, taken from the survey of the Top 100 Companies to Work For the turnover of staff in ‘successful’ organisations is higher than truly successful organisations that are in the range of 1-6% staff turnover annually. In this slide it is seen that about 46% of the apparently good organisations have staff turnover of greater than 16% the costs of this to the organisations and individuals is massive.

5

10

15

20

25

30

0-5 6-10 11-15 16-20 21-25 26-30 Over 35

Numberof

companies

Percentage of all staff turnover pa

7

14

31

22

11

4

8

Turnover of staff 2006, 2007 and 2008

‘Top 100 Companies to Work For’Source: Sunday Times March 2007, 2008 and 2009

5

13

40

14

17

1

7

2006

2007

31-35

2

6

2008

42

9

11

23

30

15

The impact is, also, on compliance with HSE Management Standards, the costs of insurance premiums for staff medical insurance, the costs of manager time and costs of tribunals and litigation, as well as the haemorrhaging costs to the organisation.

The impact of stress at work

Individualmisery

The Law and

Tribunals

Insurance premiums

Sickness absence

staff turnover

money.

HSE Management

Standards

Complexities of the NHS The NHS is a complex organisation largely because of the multi-professionals delivering its prime

product, but, also, because of the extensive background services that are largely in support of

the foreground activities, and in a recent observation, the same size as the foreground

operations. There are different cultural foundations relating to foreground and background

activities – the foreground is highly influenced by professional cultures based on individual

responsibility towards the patient or client. The background cultural foundations are based on

bureaucratic principles of targets, procedures, processes and political accountability.

These cultures can clash at the delivery level of the NHS where there is an existing conflict

between the professional and the bureaucracy – where the professional focuses on the needs of

the individual whilst the bureaucracy focuses on the needs of all individuals. This tension needs to

be managed effectively for both aims to be satisfied together.

Healthcare organisation

foreground background

Threats to quality

Professionals and bureaucracy

Threats to quality

professionals bureaucracy

Typologies of organisations that reflect wellbeing and performance, and,

therefore, quality.

The following slide shows some generalised examples of organisational characteristics that link

wellbeing, performance and output/outcome.

Look at your own organisation to see if parts of it relate in any way to any of the typologies.

High personal wellbeingGood business performance

Average personal wellbeingPoor business performance

Poor personal wellbeingAverage business performance

Poor personal wellbeingPoor business performance

Characteristics:Clear purposeCommitment, Trust, EngagementEffective recruitment practicesGood terms and conditionsTeam working; staff involvementAdaptive leadership and managementCustomer and staff focusLow sickness absenceLow staff turnoverLow costs/high profits

Characteristics:Ambiguous purposePoor recruitment practicesAverage terms and conditionsMismatched skills to jobsLaissez-faire management practicesFew company wellbeing programmesAverage company benefitsAverage sickness absenceHigh staff turnoverHigh costs/ low profits

Characteristics:Clear purposeAverage terms and conditionsLimited alternative employmentTransactional managementIncentive and bonus schemesHigh levels of sickness absenceHigh number of tribunalsLimited wellbeing programmesAverage staff turnoverVery high costs/Minimal profits

Characteristics:Ambiguous purposePoor terms and conditionsLack of Commitment, Trust, EngagementCoercive, competitive and bullying cultureHigh level of presenteeismHigh numbers of tribunalsHigh levels of sickness absenceHigh staff turnoverHigh costs/Low profits

The iceberg effect or presenteeism Many people remain in work whilst feeling unwell and lacking in focus and concentration. They

feel lethargic and unenthusiastic about their work, and essentially go through the motions

without being identified as unfit for work. Such people may under-perform and may be counter-

productive. The overall cost of the iceberg effect and presenteeism is far greater than the costs

of sickness absence and staff turnover.

Costs of the ‘Iceberg Effect’ as a percentage of total costs of psychological distress at work

sickness absence

staff turnover

reduced productivity at work

58%‘Iceberg effect’

32%

10%

Tackling these problems The first step is to listen to your staff. There are many ways of achieving this – open space

discussions, learning sets, workshops and staff surveys. The best approach is for managers to

listen to their staff, and to help with this there are a number of tools that can be used. The one I

would like you to complete now is below. It will take you less than a minute and provide you with

a good idea of how people are feeling at work.

Health and wellbeing at work questionnaire

We want to find out if you are feeling good about your work, and about your working situation. To help us find out we would like you to complete this questionnaire. It focuses on how you feel now and over the recent past (say a couple of weeks). Please try and complete all the questions. Thank you very much for your co-operation. Have you recently: Been unclear about what you are supposed to do at work? Found that others have been taking decisions that prevent you from performing at your peak? Become irritated by the behaviour of your manager? Found yourself idling the time away? Been spoken to by someone you thought was being rude, unhelpful and thoughtless? Found it difficult to get involved in your work? Felt under pressure at work? Spent longer than your normal time at work? Experienced sexual innuendo or verbal abuse at work? Felt you have been unfairly treated? Been feeling energized at work? Taken a decision that has been acknowledged as a major step forward at work?

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

Not at all No more Rather more Much more than usual than usual than usual

If you circle either of the two right hand answers for the first ten questions or the left two

column for the last two questions you are experiencing something that may amount to strain,

and you need to tackle the causes.

Next, you need to establish a framework as a strategic outline for your overall approach to

reducing and eliminating psychological distress at work. The following includes five strategic

purposes:

Prevention – to prevent psychological distress from happening in the first place.

Prevent deterioration – once someone is identified as under strain the purpose here is to stop

that situation from deteriorating further. This requires interventions of various kinds, the most

effective of which is good man management. However, often managers abdicate their

responsibilities and expect HR, Employee Assistance Programmes or Occupational Health to

solve this problem for them.

Restoration – once someone is off work due to psychological distress the purpose here is to

restore the person back to their normal level of independent life and beyond. This requires

sophisticated arrangements for rehabilitating people back into the environment that causes the

problems in the first place.

Palliation – once someone is off sick for 6 weeks or longer it is more difficult to restore them

back to their normal level of independent life. The purpose here is to use sophisticated skills to

bring people into any form of work, voluntary or paid, as this is known to improve their

wellbeing.

The next generation – once you have developed a culture that prevents psychological distress

from occurring the purpose here is to maintain that culture whilst staff change and managers

move elsewhere.

Prevention Prevent

deterioration

Restoration Palliation

Nextgeneration

Strategic purposes

Next: take a look at the influences on wellbeing and implement programmes that address these.

This talk cannot go into these in any detail other than the headlines.

Mental

Social

Spiritual

Emotional Physical

Environmental

Components of wellbeing

Next: is taking the strategic framework above and identifying the kinds of programmes that help

to populate the framework. The following slide provides some ideas, but again, time prevents

any exploration of these in any detail.

Wellbeing and Performancestrategy

PositiveWorking Culture

Derek Mowbray 2009

Getting down to the nitty gritty

We are all actors We all act. We act according to our understanding of the situation we are in, and respond with

the behaviours we believe to be correct under the circumstances. We are not very good at this in

a culture that is hostile, and where the cultural foundations are not based on virtuous intent

towards wellbeing and performance of staff.

We behave according to the meaning we place on specific situations

Threats to wellbeing and performance There are three levels of threat. The most significant is our behaviour and the behaviour of

people towards each other.

Organisations are controlled communities, and the people who control the communities are

normally called managers. A prime threat to wellbeing and performance is often the behaviour of

controllers.

The second level threat are life events that each of us can expect to experience at least once.

These can be, therefore, predicted and managed. They are foreseeable and common. Much

depends on our personalities and levels of personal resilience as to how we cope with these

events. For example, the difference between J’s and P’s on MBTI proves insight into why some

people find change difficult compared to others. J’s like events to be well planned and any

alterations causes anxiety, whilst P’s are more flexible and can adapt to change very quickly.

Other personality influences include ‘conscientiousness’ and ‘extraversion’ which help in

resilience.

The third level threat are most familiar as they are the describable effect of failed interaction at

level 1 threat with events from level 2 and are packaged in HR policy terms and can be presented

for arguments in court or tribunal.

Threats to wellbeing and performance

Coping, resilience and prevention I want to briefly touch on three types of activities that help to tackle the problems of

psychological distress.

Coping strategies:

Coping with your own stress

laugh

The most effective coping strategy is laughing.

Other strategies include self cognitive behaviour therapy, shouting at yourself in the mirror with

positive thoughts and determination to overcome the misery you are experiencing. You’ll feel

great after doing this each morning! It’s more complicated than this sometimes, but doing this

will raise your adrenalin and get you going in the morning.

Others include:

Imagery with deep breathing

Self hypnosis

Meditation

All of which will calm you down and provide th thinking space you need to regain personal

control in stressful situations.

Resilience strategies:

There are eight resilience strategies to adopt. Time prevents me from any detail but there are

exercises to be undertaken within each of these headlines that will strengthen your personal

resilience.

Building resilience

Wellbeingand

Performance

Self-assurance

Flexibleand

adaptable

Problem solving

Socially connected

Personal vision

Organised

Active

Interaction effect

Controlling oneself

Prevention The third activity I wish to introduce is prevention. As part of my efforts to introduce prevention

programmes to the NHS I have been involved, and initiated, the new Code of Conduct for

Healthcare Management that is receiving support from MiP, IHM, HSE, BPS, RCN, BMA, DoH,

Health Foundation. RCGPs, and Welsh Assembly Government.

Code of Conduct for Healthcare Management

The context within which managers are expected to behave

The behaviours they are expected to exhibit

The actions they are expected to take

Wellbeing and performance

Download draft copy from MiP web site

This is about creating a Positive Work Culture based on wellbeing and performance. The overall

aim is to build organisations with the following characteristics:

•a clear, unambiguous purpose, expressed as a simple ‘big idea’, an idea which all the staff relate to closely, and are proud to discuss with friends and colleagues.

•an atmosphere of confidence, where all the staff are interested in each other, support each other, and project this confidence towards clients and customers.

•staff who behave respectfully towards each other, value each other’s views and opinions, work in teams which are places of mutual support, where anything is debated without a hint of humiliation, where the critique of individual and team work is welcomed, discussed and where lessons are learnt and implemented.

•staff who ‘go the extra mile’ by providing unsolicited ideas, thoughts, stimulus to each other, and where their interest in their customers offers something more than is expected, beyond courtesy, and beyond service, offering attentiveness and personal interest.

•challenges for their staff, that provide opportunities for personal development through new experiences, and which treat everyone with fairness and understanding.

•staff who are personally driven towards organisation and personal success - intellectually, financially, socially and emotionally.

Our benchmark for organisations

Psychologically healthy organisations have:

Contact: E: info@orghealth.co.uk T: 0845 833 1597 W: www.orghealth.co.uk

I refer you back to the typographies of organisations and these characteristics are found in the

top right hand typography.

We start by having an Organisation Development framework:

This includes organisation purpose, architecture, rules and how to play the game (behaviour).

Remember that organisations are two or more people acting together to achieve a common

purpose, so this framework applies to each department, team as well as the larger organisation

or envelope for everyone else.

Organisation purpose

Organisationarchitecture

Organisation‘rules’

Organisation‘how to play the game’

Organisationdevelopment

Organisation Development

Derek Mowbray 1994

In order to make progress we have to have an overall cultural aim, which is virtuous intent based

on wellbeing and performance. To achieve this, the organisation, its design , rules and behaviours

need to aim to build commitment, trust and engagement. There are specific activities that

achieve this and they are headlined below:

The ‘Big idea’

Purpose

Architecture

Rules of the game

How to playthe game

Structure

JobRecruitmentPayChallenge Secure

Teamwork InvolvementOpennessCommunication

Work life balanceResponsiveness

Training and development

Career opportunity

Management encouragement Leadership abilityPerformance appraisal

Manager – employeerelationshipEmployee attitudeManager discretionEmployee discretionAttentiveness

Factors that influence trust and commitment

CitizenshipBehaviourProceduresPolicies

Under the new Code we move on to the behaviours managers are expected to show. For the

purposes of this presentation I am focusing on ethical leadership that headlines the behaviours.

The 4S model of ethical leadership

Status– the profile of an ethical person that shines

through into leadership and convinces followers of his or her common sense, wisdom and effectiveness as a leader.

Staff – the behaviours and decisions of leaders that lead

to the engagement, trust and commitment of the workforce in their work and their organisation.

Service – the behaviours and decisions of leaders that

produce the highest quality and standard of service.

Society – the behaviours and decisions of leaders that

demonstrate a concern to prevent harm to, and promote wellbeing in, society at large.

The attributes and behaviours needed to conduct ethical leadership are shown in the following

slide. I can train everyone in both the attributes and behaviours – remember, everyone acts,

therefore we have to train everyone in acting out a different script, and the script is one that aims

to achieve wellbeing and performance by building commitment, trust and engagement.

Personal attributes andbehaviours

PeopleLeaders

Managers

Personal attributes

AttentivenessTrustworthiness

Demonstrate wisdomAssertive

Intelligence with humourPassion

Direction with committed ambition

Address individual needsNurture

Behaviours

AttentivenessPolitenessCourtesy

Personal communicationBody language

Addressing needsEmpathetic

Intellectual flexibilityEmotional intelligence

NegotiationSharing

ReliabilityHonesty

ClarityFairnessHumility

Conflict resolutionEncourage contribution

EngagementCommitment

TrustResilienceTolerance

Under the new Code the behaviours are grouped under headlines as follows:

Attentiveness

Intellectual flexibility

Reliability Resolve conflicts

Encouragement

Behaviours that inspirecommitment, trust

and engagement in others

If you take nothing else away from this session take away the behaviour of attentiveness. If I am

attentive to you, you will be attentive back. This is the starting point of a successful interaction. If

you are not genuinely attentive to others they will break off any sense of commitment to you.

What we don’t want is:

What we do want is:

Followers of Strictly Come Dancing will know that as the weeks go by the remaining contestants

grow in confidence, and strengthen their trust and commitment in each other so much that their

quality of dancing improves, but, also, they try more complex and difficult dance steps. This is a

useful metaphor for managerial behaviour. The ‘rules’ include the basic dance steps, but the

interpretation relies on discretion – managerial discretion that allows freedom of choice within

limits of the rules is what we are after.

If we can achieve this we have a map that is different to the iceberg effect:

Management actions The final aspect of the new Code is management actions. The slide below sets out the categories:

Actions managers are expected to take

Co-ordination

Direction

Control

Strategy

Administrative

Executive

Appropriate

Efficacy

Effective

Efficient

Return on investment Building a Positive Work Culture produces real success on a number of dimensions. For a

relatively modest investment the following benefits can be achieved:

Return on Investment

Costs

Performance

Engagement

Inspiration and Innovation

Trust

Commitment

Quality

Thank you