Transcript Welcome [www.patientsafetyfederation.nhs.uk]

Team Work for Patient Safety and Care
Michael West
Aston Business School
Patient Safety Federation Conference
10th February 2011
The Ark, Basingstoke
Leading culture change for safety
• Searching for new ways to meet clients’ needs and
ensure quality and safety
• Leadership is upbeat and self confident. There’s no
problem that can’t be solved, no status quo that
can’t be bettered
• Listening to clients/patients .....
• Leadership is about doing the difficult not managing
the inevitable
Results
The HR system variable explains 16.9% of the variance in subsequent mortality
(p < .01)
Mortality
105
100
95
90
85
80
Below average
Average
Above average
Even taking prior mortality into account, the HR systems variable explains a
further 7.8% on top of this (p < .01)
Implications
> 25% more appraisers trained, associated with a reduction of
12.3% of the number of deaths after hip fracture
> 25% more staff working in teams associated with 275 fewer
deaths per 100,000 following emergency surgery or 7.1% of the
total number of deaths following emergency surgery
West et al,2001 International Journal of HRM
West, Guthrie, Dawson, 2006 Journal of Organizational Behavior
The Dance of Teams
Employee Involvement Programme*
> The extent of team working in hospitals predicts:
> job satisfaction
> organisational commitment
> adherence to organisational
rules and procedures
> individual and organisational
innovation
> cooperation with co-workers
> patient mortality
West et al., 2005. Working together: Staff involvement and Organizational
Performance in the NHS. Final Report
Four conditions for effective teams:
• Having a real team - bounded, stable, interdependent
with a real team task
• Having a clear team purpose, challenging and
consequential with clear objectives
• Making the right choices about who should be on the
team - skills and roles, enablers not derailers
• Developing through regular coaching and self-coaching
Real Teams
Having a real team - bounded, stable, interdependent with
a real team task
• Bounded?
•Team A CEO: 11; Members 7-84;
•Team B CEO 5; Members 5-9.
•Only 11/120 agreed on the size of the team
• Team size?
• Team stability?
Wageman et al, Senior Leadership Teams, Harvard University Press
Working in Teams in the NHS
‘Do you work in a team?’
If yes (91%) …
> Does your team have clear objectives?
> Do you have to work closely together to achieve these objectives?
> Do you meet regularly to review your team effectiveness and how it could
be improved?
> 38% of 1.4 million employees
Team working in Primary Care
300 PCTs
50,000 respondents
% working in
real teams
% working
in pseudo
teams
Organizational health and safety overall
.41
-.43
% staff suffering injury at work in previous year
-.30
.36
% staff witnessing potentially harmful errors/near
misses in previous month
-.32
.30
% staff experiencing physical violence in previous
year
-.36
.34
% staff experiencing bullying, harassment or abuse in
previous year
-.29
.30
Odds Ratio
Working in Team and Errors, Stress and Injury
(170 acute trusts, 120,000 respondents)
1.90
1.91
1.88
1.70
1.70
1.69
1.57
1.50
1.61
1.50
1.31
1.26
1.30
Errors
Stress
Injury
1.10
1.00
0.91
0.90
0.87
0.90
0.70
Not Working in
Team
Pseudo III
Pseudo II
Pseudo I
Types of Team Working Patterns
Real team
www.nhsstaffsurveys.com
Staff absenteeism
5% more staff working in real teams associated with 0.27% in overall
absenteeism rate (p < .001)
For an “average” acute hospital, this represents a potential estimated
saving of over £1 million per year in direct salary alone
5.00
4.80
4.60
Absenteeism (%)
4.40
4.20
4.00
3.80
3.60
3.40
3.20
3.00
Low (< 35%)
Moderate (35-40%)
Extent of real team working
High (> 40%)
Patient mortality
5% more staff working in real teams associated with 3.3% drop in
mortality rate (p = .006)
For an “average” acute hospital, this represents around 40 deaths per
year
110
108
106
Mortality ratio
104
102
100
98
96
94
92
90
Low (< 35%)
Moderate (35-40%)
Extent of real team working
High (> 40%)
Mortality
Failures of team-based working
Clear roles
Cooperation
across
teams
Team vision &
Reflexivity
objectives
Four conditions for effective teams:
• Having a real team - bounded, stable, interdependent
with a real team task
• Having a clear team purpose, challenging and
consequential with clear objectives
• Making the right choices about who should be on the
team - skills and roles, enablers not derailers
• Developing through regular coaching and self-coaching
ABS Management Team Objectives
1.
Increase staff and student satisfaction
2.
Improve student staff ratio
3.
Improve collaboration with central services and the three
other schools and manage university initiatives effectively
4.
Balance the budget and ensure strategic investment
ambitions are met (4%)
5.
Successfully implement DLMBA and associated changes in
processes of learning and teaching
6.
Ensure improvements in employability of students by
building links with employers and student skills
7.
Achieve accreditations
Three things we must always do
1. Provide leadership by focusing on what is difficult
and important rather than inevitable or unimportant
2. Encourage and reward risk and innovation to create
a climate of engagement and excitement
3. Share responsibility for management team
decisions and support each other
Three things we must never do
1. Lose sight of our common purpose
2. Intentionally mislead each other or staff
3. Neglect promoting, learning from and
supporting the whole organization
Four conditions for effective teams:
• Having a real team - bounded, stable, interdependent
with a real team task
• Having a clear team purpose, challenging and
consequential with clear objectives
• Making the right choices about who should be on the
team - skills and roles, enablers not derailers
• Developing through regular coaching and self-coaching
Four conditions for effective teams:
• Having a real team - bounded, stable, interdependent
with a real team task
• Having a clear team purpose, challenging and
consequential with clear objectives
• Making the right choices about who should be on the
team - skills and roles, enablers not derailers
• Developing through regular coaching and self-coaching
Regular honest review and feedback
Developing through regularly taking time out to review
performance and how to improve
Coaching the team
Reflexivity
How to lead dream teams
Team Leadership - Managing
• Team members enabled to work interdependently
• A high degree of autonomy in achieving
objectives
• Accurate and timely feedback on team
performance
• Sufficient forming time to build rapport
• Encourage, model and reward positive group
attitudes towards diversity
Positivity Opens Us
Barbara Fredrickson www.positiveemotions.org
Positivity ratio > 3:1; Maximum 11>1
Fredrickson & Losada, American Psychologist (2005) 60, 678686
(... and negativity is necessary)
Team Leadership - Coaching
• Encourage positive, supportive relationships in
teams
• Resolve and prevent intense conflicts
• Inquiry plus advocacy
• Ensure regular and positive team meetings
• Encourage optimism in teams by modelling
The Value of Team Diversity
“Where do good new ideas come from? That’s
simple! From differences. Creativity comes from
unlikely juxtapositions. The best way to maximize
differences is to mix ages, cultures and
disciplines.”
Nicholas Negroponte
Team Leadership - Leading
• Offer an inspiring vision
• Ensure that team leadership is clear
• Be attentive and listen carefully to the team
• Lead inter-team cooperation and effectiveness
• Model organisational loyalty
Where does team working fit in?
> Patient focus
> Clear aligned goals and objectives at every level
> Good people management
> Positive emotional environments and relationships
> Employee engagement
> Real team working
> Values based leadership
LEADERSHIP VALUES - How can you promote these values and virtues in the organization?
The Dance of Teams