‘Good leadership doesn’t mean top down’ Vijaya Nath Assistant Director, The King’s

‘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’

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 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

‘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 & Oversight- for 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) FragmentationIntegration TribalTeam Internally focusedExternal focus FactionalismFederation ControlCollaboration DominationAccommodation ImpositionNegotiation ResentmentTolerance I, them and usWe, us and us Disparaging othersValuing self and others Lid on secrecyLid off and open Conflict avoidanceWorking through DivisionPartnership and networked

How will the board oversee the creation of leadership capabilities? 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, Used with permission. A Leadership Strategy

‘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’ Thank you Questions Stay in touch Be Brilliant because you are!