Transcript Building Teams and Cultures of High Quality

Building Teams and Cultures of
High Quality Safe Care
Michael A. West
Lancaster University &
The King’s Fund
Leadership Involves:
Concentration and Inquiry
What kinds of NHS Cultures do we want?
• Quality of care is the top priority
• Patients come first - respect and dignity, everyone
counts
• Fully involving patients in decision making as appropriate
• Compassionate
• Efficient, effective, professional and productive
• Enlightened and effective people management
• Positive, appreciative, supportive, optimistic
• Team, inter-team and cross-boundary working
• Learning organisations
• Transparency and openness
Appreciative Inquiry as Cultural
Orientation for Teamwork
• Identifying and appreciating areas of good
practice/strong and appropriate values
• Identifying the learning from this and diffusing
• Identifying areas where improvement,
strengthening is needed
• Drawing out the implications from areas of
strength to apply (where relevant) to areas
where improvement is needed
• Offering helpful suggestions for improvement
Leading Teams and Nurturing Cultures
for High Quality and Safe Care
1. Prioritising an inspirational vision
2. Clear team and individual objectives
focused on improving quality and safety of
care
3. Good people management
4. Promoting employee engagement
5. Good team and inter-team working
6. Values-based compassionate team
leadership
Team Vision
• Vision sets out clear ambition for the
future, to guide and inspire the whole
team
• e.g., Service users working with this team will
have greater control of their health and their
wellbeing, supported to live better quality
lives by high quality care services that are
compassionate, inclusive and constantly
improving
Team Objectives
•
•
•
•
•
Clear team objectives
Five (or six at a push)
Focused on improving quality/performance
Measureable
Challenging
Good People Management: Leadership
• Prioritise high quality, compassionate patient care
• Supportive, available, empathic, motivating, fair,
respectful, compassionate
• Agree clear, challenging, measureable objectives
focused on improving performance
• Appraisals
• Appreciative orientation – do not use blame as a tool
• Commitment to learning
• Prioritise staff growth, learning and well-being
• Building effective team and inter-team working
• Intervene to solve systems problems and resource
issues
Patient Satisfaction
• Patient satisfaction highest in organisations with
clear goals at every level – patients say good
communication with staff and they feel involved in
care decisions
• Staff views of their leaders are strongly related to
patients’ perceptions of the quality of care
• Staff satisfaction and commitment
predict patient satisfaction
• Supportiveness of immediate
managers
• Staff positive feelings at work
http://www.dh.gov.uk/health/2011/08/nhs-staff-management/
Patient Satisfaction
• High work pressure - patients report too
few nurses, insufficient support, privacy
and respect
• Poor staff health and well-being, high injury ratespatients less satisfied, poorer care and financial
performance of hospitals is worse
• Good HRM practices - low and decreasing levels of
patient mortality
• A well structured appraisal leads to high staff
engagement, better health and well-being - poorly
structured appraisals have no effect
http://www.dh.gov.uk/health/2011/08/nhs-staff-management/
Patient Mortality
• One of the best predictors of patient mortality is percentage
of staff working in well structured teams
• Those working in teams have better health and well being
• Lower mortality in trusts whose staff have opportunities to
influence and contribute to improvements at work
• A positive organisational climate
is associated with low and
declining levels of patient mortality
http://www.dh.gov.uk/health/2011/08/nhs-staff-management/
Patient and Carer Involvement
• Information sharing and feedback from patients and
carers
• How patients/carers are talked about and to
• Compassion towards patients – attention, empathy,
intelligent action
• Innovations to improve patient experience and
involvement
• Involvement of patients and carers in schemes to elicit
ideas for new and improved ways of providing care
• Case studies every month of patient and carer
experience leading to system learning
Employee Engagement in the UK
National Health Service
Leadership
Supervisors’
Support
Team Working
Job Design
Work Pressure
Having an
interesting job
Feeling valued by
colleagues
Overall
Engagement
•Advocacy
•Intrinsic Engagement
•Involvement
Employee
Reactions
Health and Well-being
Stress
Hospital
Performance
Quality of Services
Financial Performance
Absenteeism
Patient Mortality Rate
Patient Satisfaction
http://www.kingsfund.org.uk/publications/leadership_review_1
2.html
Positivity Builds Compassion
> Barbara Fredrickson www.positiveemotions.org
> (... and negativity is necessary)
Team Engagement and Proactivity
• Climate of positivity, staff satisfaction, celebration and
optimism – mutual respect and support
• Team engagement scores improving
• Team members’ ‘voice’ and throughout the organisation
– all ‘speak up’
• Team member proactivity is high and increasing
• Team members’ engagement with quality/safety
improvement as core to their work
• Team members’ commitment to team working and interteam cooperation to continuously improve safety and
quality
• High level of trust in leaders and low levels of stress, fear
and work overload
Positive Affect and Team Working
• Team leaders dealing with disruptive
behavior and poor performance
• Team leaders enabling negatives to be
sources of learning and growth
Team Learning, Innovation and Proactivity
• Everyone focused on continual learning and improvement of patient
care, ‘top to bottom and end to end’
• Staff intervene to solve problems and ensure quality of care e.g.,
brusqueness/rudeness from others
• Effective schemes to promote innovation and proactivity
• Celebrations of innovations introduced at every level and in every
department/team/function
• Visits by staff at all levels to learn about best practice in other health
service orgs (nationally, internationally) and in other sectors plus
peer review with other organisations
• Learning from good practice is diffused across the organisation
• Reflexivity is endemic
Learning, Innovation and Proactivity:
Complaints, Errors and Incidents
• Complaints welcomed, explored, treated as opportunities for
organisational system as well as organisational symptom
learning?
• Evidence of a ‘what can we learn from this?’ culture
• No evidence of blame culture
• Staff openness about errors, near misses and incidents
• Staff approach to learning from errors, near misses and
incidents
• Embedded in ways of working – i.e., discuss and learn
Team Working in Health Care Promotes
Productivity, Care Quality, Innovation
and Staff Well Being
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
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 reflexivity and regular
self-coaching
Reflexivity
Teams are more effective and
innovative to the extent that they
routinely take time out to reflect upon
their objectives, strategies, processes
and environments and make changes
accordingly.
Schippers, West & Dawson, 2012 Journal of
Management
Team Working Review
•
•
•
•
•
•
•
•
Team identity
Team objectives
Roles
Decision making
Constructive debates
Effective communication
Other teams
Team positivity
Dream Team Leadership
• Offer an inspiring vision
• Ensure regular and positive team meetings
• Encourage positive, supportive relationships in teams
• Resolve and prevent intense conflicts
• Be attentive and listen carefully to the team
• Inquiry plus advocacy
• Lead inter-team cooperation and model organisational
loyalty
Leadership
• Leaders ensure clarity of direction, alignment
and commitment in the trust
– Direction: agreement and pride among people on
what the trust is trying to achieve together, consistent
with vision, values and strategy
– Alignment refers to leaders’ effective coordination and
integration of the work
– Leaders ensure commitment such that everyone in
the trust takes responsibility and makes it a personal
priority to ensure the success of the trust as a whole,
rather than focusing only on their individual or
immediate team’s success in isolation
6. Values Based Leadership
e.mail [email protected]
Twitter @westm61