Leading through curriculum
development and change
Professor Judy McKimm
Manchester Medical Education Conference
15 April 2013
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Context
Leadership – what is it? What do leaders do?
A little bit of theory
Curriculum development and change
Issues and challenges – strategies and
solutions
Changing leadership is needed for changing
healthcare and educational contexts
What is leadership*?
* Google search 115,000,000 hits ….
“Leadership is like the abominable
snowman, whose footsteps
are everywhere, but is
nowhere to be seen”
Bennis and Nanus, 1985
“if your actions inspire people to
dream more, learn more, do more
and become more, you are a leader”
John Quincy Adams
Leadership in Health Professions
Educational leadership
Leadership and management of organisations, departments,
resources, research, projects, curricula, assessment, innovations
Clinical leadership
Leadership and management in the clinical setting, of teams,
departments, units and of specific clinical situations
Different contexts, ‘subject expertise’, content?
But common themes
•Leadership at ‘all levels’ - distributed, shared, dispersed
•Leading professionals with high expertise
•Leadership often invested in positional or professional power
“Making change actually happen takes
leadership. It is central to our
expectations of the healthcare
professionals of tomorrow “
Darzi, ‘Next Stage Review’,DoH, 2008
What is a leader?
• ‘Someone with followers’
• Someone with vision, drive (‘energy, enthusiasm
and hope’)
• Guides/motivates groups, teams, organisations
towards common goals
• Is a good communicator, inspirational
• Has perseverance, determination
• Has integrity, can be trusted
• Takes action, takes responsibility
• Gives credit, gives praise
How can theory inform practice?
Leadership theories
Adaptive leadership
Engaging leadership
Affective leadership
Followership
Authentic leadership
Leader-member-exchange (LMX) theory
Charismatic leadership, narcissistic
Ontological leadership
Phenomenological leadership
Complex adaptive leadership
Relational leadership
Collaborative leadership
Servant leadership
Contingency theories
Situational leadership
Dialogic leadership
Trait theory, ‘Great man’ theory
Distributed, dispersed (shared) leadership
Transactional leadership
Eco leadership
Transformational leadership
Emotional intelligence (EI)
Value led, Moral leadership
Making sense of theories ...
1. Theories that focus on the personal qualities
or personality of the leader as an individual
2. Theories relating to the interaction of the
leader with others
3. Theories which seek to explain leadership
behaviours in relation to the environment
or system
How does this help us?
Building leadership capacity
Bolden (2004) distinguishes between:
• developing individual leaders (‘individual
capital’)
• developing ‘social capital’
through system wide approaches
and capacity building
Structured, programmatic development is
most effective, workplace based, clearly
aligned with curriculum or organisational
goals and health needs
What capacities are we building?
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Political ‘savvy’
Understanding the terrain
Curriculum and educational expertise
Leadership skills
Change management
Management skills
Followership
Team working
Curriculum leadership and
management
Leadership – vision, ‘big picture’, strategies,
non-technical/people skills, educational and
organisational expertise, innovation/change
Development of ‘phronesis’ (practical
wisdom) in self and others
Management – technical competencies and
know how, operationalising vision/strategy,
stability, standards, processes, procedures
Leadership and followership
“Innovation distinguishes between a leader and a
follower”
(Steve Jobs)
No-one leads all the time
Followers are very rarely passive, especially professionals.
Kelley (1992) suggests four roles:
– Passive followership
– Active followership
– ‘Little l’ leadership (leading in small ways, at all levels)
– ‘Big L’ leadership
present
state
unfreeze
transition
state
refreeze
Kurt Lewin (1951)
desired
future state
Curriculum cycle
Needs assessment
Professional, organisational,
individual
Monitoring and evaluation
Curriculum design
Against stated learning outcomes
and professional
standards/competencies
Approach, models, resources,
teaching/learning/assessment
methods
Implementation
Pilot, pre-test
blog.rsc-wales.ac.uk
The curriculum – 4 perspectives
1. Curriculum as a body of knowledge to
be transmitted
2. Curriculum as an attempt to achieve certain ends
in students - product
3. Curriculum as process
4. Curriculum as praxis
Smith, M. K. (1996, 2000) 'Curriculum theory and practice' the encyclopaedia
of informal education, www.infed.org/biblio/b-curric.htm.
Shadow (hidden) curriculum
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Covert culture(s)
Idiosyncrasies of individuals/groups/disciplines
Hidden/informal organization
Effects of social processes (internal and external)
Impact of institutional politics/policies
History, myths, beliefs, stories, rituals and routines
adapted from Egan, G (1994)
Working the Shadow Side:
A Guide to Positive Behind-the-Scenes Management.
New York: Wiley.
The curriculum
• ‘a politicised arena’
• ‘tribes and territories’ (Becher and Trowler,
2001) or a ‘jungle’ (Bolman and Gallos, 2011)
• A vehicle for change
Multi-frame perspective
Bolman and Deal’s ‘Four frames’ (1997)
Frame
Metaphor
Central
concepts
Structural
Factory or
machine
Jungle
Rules, roles, goals,
policies, technology
Family
Needs, skills,
relationships
Temple or
theatre
Culture, meaning,
ritual, ceremony,
stories, heroes
Political
Human
resource
Symbolic
Power, conflict,
competition
The political frame
Curriculum as the place and space where
different people and groups compete for power
and resources
Key leadership skills for the political frame
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Agenda setting
Mapping the political terrain
Networking and forming coalitions
Bargaining and negotiation skills
Identifying common external enemies (and
friends)
A new health and education
workforce?
‘Tempered radicals’
(Meyerson, 2004)
‘Broker, mediator and negotiator’
(Hartle et al, 2008; Tennyson and Wilde, 2000)
‘Boundary spanners’
(Bradshaw, 1999)
Issues and challenges
• Constant changes in education and health
services
• Working at the interface of health and
education
• Accreditation, professional standards, quality
assurance, clinical governance
• Structures, systems and funding often
misaligned to curriculum innovation
Strategies and solutions
• Change is the only constant – leaders need to be
comfortable with managing and leading change
• Need for expertise in health and education
systems – funding, structures, cultures
• Understand and work within quality systems
• Design agile, flexible curricula, in line with
educational best practice and society’s needs
Carnall C (1995)
OLD CULTURE
Hierarchical
Paternalistic
Bureaucratic
Fixed boundaries
Control
Risk averse
Managing change in
organizations
Prentice Hall
NEW CULTURE
Teamwork
Connectivity
Empowerment
Trust
Risk taking
Innovation
Support for action
Why people resist change
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Parochial self-interest
Misunderstanding
Low tolerance of change
Different assessments of the situation
Kotter, JP and Schlesinger, LA (1979). Choosing strategies for change, Harvard
Business Review, 106-114
Leaders as change agents
Bennis (1984) identifies 4 competencies of leadership:
• Management of attention (ability to communicate
clear objectives and direction)
• Management of meaning (creating and communicating
meaning so that it is understood and people’s
awareness is raised)
• Trust (the ability to be consistent and clear in complex
circumstances so that leaders are seen as dependable)
• Self-awareness and the ability to work with one’s
strengths and weaknesses
Crises of followership
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Over-managing and bureaucracy
A belief that only senior managers know best
Isolating mavericks
A belief that only a selected few factors in the
external environment need to be addressed
(missing complexity)
Brown and Weiner (1984)
Issues and challenges
• Siloed working (professions, specialities,
teams, organisations, gender)
• Involves working with professionals, patients
and students with different needs and
demands
• Top level leaders sometimes out of touch
with educational change and innovation
• Need to build up leadership/management
capacity
Strategies and solutions
• Communication and networking between
groups, professions, organisations –
translational (‘sense making’) role
• Work with stakeholders to meet and manage
expectations and needs
• Take time to keep up to date and inform
others about innovation and change
Leadership Theories in practice
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Great Man/Trait – personality is important
Behaviourist – styles are important
Transactional – links to reward, management
Contingency, Situational – responding flexibly
Distributive, shared – leadership at all levels
Servant, value led – leaders as stewards
Transformational - leaders as raising moral purpose
Turnaround - leaders as change agents
Collaborative – leaders as connectors
Complex adaptive – leaders as change agents
Congruent - relationships are important
Holistic / Blended – all of the above!
The servant-leader is servant first. It begins with the natural
feeling that one wants to serve, to serve first. Then conscious
choice brings one to aspire to lead (Greenleaf, 1970)
Listening
Awareness and sensitivity
Stewardship
Building a community
Conceptualisation
Healing
Facilitation
Foresight
Persuasion not coercion
Commitment to the growth of people
Empathy
The wise leader (Nonaka and
Takeuchi, 2011)
• Needs more than knowledge alone
• Can practise moral discernment
• Can sum up complex situations quickly and grasp key
essence of problems
• Creates the context for organisational learning
• Communicates effectively
• Exercises political power judiciously
• Fosters development of practical wisdom in others
Leaders are sense makers, expected to identify
and articulate emerging themes and patterns
not necessarily to have to have all the answers
BUT
be able to ask the right questions
In summary
• Leadership needs to be evidence based, theory informed, practice
driven
• Provide opportunities for active followership, “little ‘l’ leaders”,
project champions – enable people to work to their strengths
• Work collaboratively – share resources, actively succession plan,
keep on top of current educational practice
• Look outside medical education - make and develop
cognitive/theoretical connections
• Create flexible, agile curricula, use adaptive solutions to narrow the
gap between aspiration and reality
• Be willing to have fierce and hard conversations – ask ‘wicked’
questions
• Find the balance between transformative change and maintaining
stability through good management
Thank you!
Any questions?
j.mckimm@swansea.ac.uk
Developing teams and individuals
“Leadership is not an esoteric topic
relevant to a select few, but a
ubiquitous feature of daily life for
every physician”
Gunderman, R, Leadership in healthcare, London:
Springer-Verlag, 2009