‘Good leadership doesn’t mean top down’
Vijaya Nath
Assistant Director, The King’s Fund
@VijayaNath1
www.hqip.org.uk
‘Good leadership doesn’t mean top down’
• Introductions
• Leadership for QI
• Measurement from
descriptive to
prescriptive
• Creating Cultures for QI
The King’s Fund 2014
•
Research & Analysis to generate,
develop and evaluate ideas in the
UK and across the world
•
Develop Individuals, Teams &
Organisations through building
Leadership capability to improve
healthcare
•
Promote Understanding of
healthcare & health policy
•
Bring people together who work in
and around Health & Care –
clinicians, politicians, academics,
patients-to learn, share knowledge
& debate
‘Good leadership doesn’t mean top down’
• Measurement,
standardisation,
precision and
inspection can be
traced back to the
Stone Age, to
Babylonian civilisations
and to the Roman
Empire.
‘Good leadership doesn’t mean top down’
‘Good leadership doesn’t mean top down’
• The Edwin Smith
Papyrus
• Ancient Egyptian
Medical Text
• Movement from
descriptive to
prescriptive
‘Good leadership doesn’t mean top down’
• PDCA Plan , Do, Check,
Action.
• Quality ‘ fitness for purpose’
‘internal customer
• Total Quality Management
(TQM)
• Cause and Effect
• ‘Zero defects’
• Worker responsibility.
• Demming
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Juran
Feigenbaum
Ishikawa
Shigeo Shingo
• Crosby
‘Good leadership doesn’t mean top down’
• ‘Four Habits of High
Value Health Care
Organisations’
• Professor Richard
Bohmer , visiting fellow
The King’s Fund
• N.ENGL J Med 365:22
NEJM. Org Dec 1 2011
‘Good leadership doesn’t mean top down’
• Specification & Planning
• Infrastructure design
attention to
microsystem
• Measurement &
Oversight
• Self Study
‘Good leadership doesn’t mean top down’
• Measurement & Oversightfor many driven by external
regulation for these it is
their internal DNA
• Collect more & more
detailed data than what's
required above
• E.g. Intermountain 200 plus
measures 2/3 internally
developed or refined.
‘Good leadership doesn’t mean top down’
• Leadership is the most important
influence on culture
• In 2011 we published ‘No More
Heroes’ - distributed leadership
• Staff engagement is one of the
most important influencers of
patient outcomes and
experiences of being cared for
(‘Rediscovering our purpose’,
2012)
‘Good leadership doesn’t mean top down’
‘All staff take responsibility for the success of
the organisation in delivering continually
improving,
high quality and compassionate care ‘
Developing Collective Leadership for
Healthcare, The King’s Fund, 2014
‘Good leadership doesn’t mean top down’
Previous philosophies/ norms need
revisiting
• Role of ‘the Dr’
• Micro System/delivery
team – Aviation
• Team working over
individual performer
• Informed
patient/patient leader
• QI
• Gender & full Diversity
of workforce (AI)
Cultural change
(Bate et al (2000, Organisation Science)
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Fragmentation
Tribal
Internally focused
Factionalism
Control
Domination
Imposition
Resentment
I, them and us
Disparaging others
Lid on secrecy
Conflict avoidance
Division
Integration
Team
External focus
Federation
Collaboration
Accommodation
Negotiation
Tolerance
We, us and us
Valuing self and others
Lid off and open
Working through
Partnership and networked
How will the board oversee the
creation of leadership capabilities?
A Leadership Strategy
The challenges
the NHS is facing
require new
strategies
New strategies
imply new
leadership
capabilities
These are both
individual and
collective
leadership
capabilities
This requires new
and collective
leadership
cultures
A Leadership Strategy Must Deliver These
© Center for Creative Leadership, 2014. Used with permission.
‘Good leadership doesn’t mean top down’
• What is your organisation’s Quality
Improvement Strategy ?
• How does Clinical Audit get valued ?
‘Good leadership doesn’t mean top down’
• Set goals &values from
bottom up not top down
• Focused standardisation
• Establish transparency in
methods & data(local
measure &target creation
&open data sharing
‘Good leadership doesn’t mean top down’
• Support autonomous
professionalism within bounds
(internal peer to peer comparison
,peer to peer control)
• Treat routine care as research
enterprise –Feedback systems at
all levels . Continuous
Improvement never there
‘Good leadership doesn’t mean top down’
• Clinical Audit &Quality
Improvement requires Leadership
• Wrapping Leadership around QI
achieves extraordinary results
• It is a journey not an event , it will
deliver patient centred care
‘Good leadership doesn’t mean top down’
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Thank you
Questions
Stay in touch
Be Brilliant because you are!