Engaging with leaders Thursday 8th March 2011 Tim Heywood What gets my back up: “The Board seem focused and work well together, and there many examples of clinical excellence and high quality care delivery, but…. the problem is middle management. I am not here as an expert. I am here as a colleague who has sat where you are sitting and have a sense of respect for what you are dealing with. Want to offer you some perspectives of things I have learnt through my involvement in the 1000 Lives Campaign that I hope might be relevant to you. It is important to do this, because, the Campaign talked a lot explicitly about Board level engagement, and about clinical team engagement, but it talked very little about the critical centre. Engaging with leaders Tim Heywood Insert name of presentation on Master Slide

Are you at this stage? “ We’re starting to see improvements on this ward, but need help to consolidate our progress and spread the changes”. Or… “ We know what we need to do next, but they are things that are not within our control and we aren’t getting the support we need”.

Do you know who the Executive lead is for your programme area? Having an Exec lead for each programme area is a requirement for 1000 L+. This is not a figurehead role, but is about providing active support and challenge to improvement teams. Everyone should know who the exec lead is…. (There is a list of Exec leads that you could get from the programme office in case anyone doesn’t know).

If you are encountering obstacles to progress do you know why If you are encountering obstacles to progress do you know why? Is it problem of: Will Ideas or Execution It is important to think this through carefully – problems of execution ( deciding how to make the changes at a practical level) are the most common, but don’t assume this. If you are struggling with data collection – don’t assume this is a problem of execution and that you need a data clerk – have you thought about whether people really do have the WILL to make changes (i.e. can see the point and don’t regard it as an audit or data collection exercise) and have considered IDEAS for change (e.g. have thought about how to integrate data collection with other activities so that it doesn’t become an additional chore) Also – remember that data collection is not the objective, the objective is to find ways of making new practice easier than reverting to old practices so that it becomes routine. That is why you are collecting data and doing run charts – to see if you are achieving this reliably. Also remember that your are area of INFLUENCE is bigger than your area of CONTROL – you may well be able persuade people to test small scale changes even if they don’t work in your direct team. Don’t always assume you have to go via their line amanager. Don’t expect to engage with your leaders until you have thought these things through carefully and are clear about the support you need.

Always use data to help you communicate. Annotate your run chart to show what changes you have tested and what the impact has been. The advice given to Executive leads about their role says: “Always insist on basing your discussions on data”.

This is what Executive leaders are advised to do when they meet the team.. … Ask the team to describe their purpose to you (check they understand the organisational context of their work). Move straight to the data. Ask about the tests of change and how these link to data run-charts. Check where the team is getting its ideas clarify the obstacles and barriers to progress This is what you should expect when meeting with leaders – are you ready to answer them 6

Complete an SBAR to help you communicate. Keep it specific Include data Make your recommendation clear SBAR should not be an addiitional chore – it is an important communication tool. Exec leads (other other leaders if they have delegated) will be juggling with a large number of issues at once, so you need to make it easy for them. Make sure your recommendation is clearly supported by the precediing information. Expect to be challenged (think about the reasons why others might not agree with your recommendation). It is likey that the Exec lead will be challenged if they recommendation is difficult to achieve so you need to help them by considering pitfalls in advance and making sure your information stacks up.. Don’t try to find a recommendation that will solve everything, or make it too general. It should focus on the most important specific issue you need to be addressed next – this should be the start of a regular communication.