1. Leading and Changing School of Management, RMIT Tuesday 9 December 2003 Assoc. Prof. Janet A Secatore Director of Nursing The Alfred

2. Change - a constant - lack of certainty Complexity - always in crisis Leadership - to manage / cope with change

3. Goals §Introduce (re-acquaint) you to ideas and authors §Encourage you to think, reflect, learn

4. Change If change is happenning all the time, why arent we very good at it?

5. Paradigms §establish boundaries §identify behaviours for success Set of Rules & Regulations that

6. Characteristics of Paradigms §Common §Useful §Reverse common sense §More than one §Paradigm Paralysis §Paradigm Flexibility §Can choose to change paradigm

7. Change and Paradigms §Changes in societal paradigms §Changes in healthcare paradigms

8. Complexity

9. Simple Following a Recipe §Recipe is essential §Recipes are tested to assure replicability of later efforts §No particular expertise; knowing how to cook increases success §Recipes produce standard products §Certainty of same results every time Complicated A Moon Rocket §Formulae are critical and necessary §Sending one rocket increases assurance that next will be ok §High level of expertise in many specialised fields & coordination §Rockets similar in critical ways §High degree of certainty of outcome Complex Raising a Child §Formulae have only a limited application §Raising one child gives no assurace of success with the next §Expertise can help but is not sufficient §Every child is unique §Uncertainty of outcome remains Plsek 2003

10. Complex Adaptive System §Collection of parts §Share an environment or space §Parts can act independently §Parts are interconnected §Action by any part affects the whole Examples : immune system, insect colony, flock, stock market, just about any collection of humans Plsek 2003

11. Complex systems can be described by the following elements… §Structure (concrete attributes) §Process (sequence of events) §Pattern (phenomena, behaviours) Plsek 2003

12. Medication Administration System Structure Pharmacy Nursing Units Elevators Committees Info systems Individual roles Etc. Process Ordering Transcribing Entering Dispensing Etc. Pattern Prescribing practices Types of errors Feelings & values Supportive behaviour Blaming Fear # of errors reported Etc. Plsek 2003

13. Organisational Change Efforts §Much change in structure §Classic improvement work focuses on process §Patterns are more difficult and are often left largely untouched §Successful transformation requires integration and change in structure, process, and pattern Plsek 2003

14. Five Key Patterns in Organisational Culture Key patterns that need rethinking in health care organisations include: §the nature of relationships §how decisions are made §how power is defined, acquired, and used §how conflict is handled §how learning is supported Plsek 2003

15. Leadership Change our thinking, not structures (Morgan) Organisations are overmanaged and underled (Kotter)

16. Leadership is influencing others § Neutral

17. Leadership §Positively influencing others §Giving people a reason to follow

18. Vision Precedes Success §Have to know what you want to be, not just want to want to do (De Pree)

19. Management or Leadership Role §Tool §A means to an end §What do you want to achieve?

20. Leadership Capacity to translate intention into reality and sustain it. Influence and organise meaning for members of an organisation (Bennis)

21. Leadership Define mission. Create a human community held together by a work bond for a common purpose. (Drucker)

22. Leadership Capacity to hold a shared picture of the future we seek to create. (Senge)

23. Leadership The first responsibility of a leader is to define reality. The last is to say thank-you. In between the leader is a servant. (De Pree)

24. Leadership Leadership is that influential increment over and above mechanical compliance with the routine directives of the organisation. (Katz and Kahn, 1978)

25. … to make the agony of decision making so intense that one can only escape by thinking. (Fred Friendly, 1993)