1. Michael West Lancaster University and The King’s Fund
Compassionate and Collective Leadership and Strong Teams for High Quality Care
Michael West Lancaster University and The King’s Fund

2. ‘Compassionate leadership for compassionate health services’
Attending: paying attention to staff – ‘listening with fascination’
Understanding: shared understanding of what they face
Empathising
Helping: taking intelligent action to serve or help
Slido:
Which behaviour do you feel that you as a leader most need to develop?
Attending/Listening with fascination
Understanding
Empathising
Helping/Serving
West, M. S., & Chowla, R. (2017). Compassionate leadership for compassionate health care. In P. Gilbert (Ed.).Compassion: concepts, research and applications. London: Routledge,

3. Ensuring the Isle of Wight health and social care system is a best place to work
Inspiring vision & values lived by all leaders
Clear goals and performance management preventing work overload
Enlightened leadership, support & compassion at every level
Effective and supportive team work/cross boundary working
Collective leadership, valuing and respecting all
Belonging: Inclusive and compassionate organisational culture
Inclusive and values-based recruitment, selection and performance management
Evidence-based, inclusive talent management and succession planning
Continuous learning & QI for all
Continuous, evidence-based leadership development
Competence: Fulfilling growth, skill development, and careers
Primary interventions to protect well-being
Flexible, protective work patterns and working conditions
Effective inclusion and diversity culture
Perceived control and autonomy for staff
Perceived justice and fairness
Voice and influence for all
Autonomy and Control: Fair and supportive employee-centred practices

4. Cultures for high quality care
An inspirational vision of high quality care
Clear aligned goals at every level with helpful feedback
Good people management and employee engagement
Continuous learning and quality improvement
Enthusiastic team-working, cooperation and integration
West, Baker, Dawson, Dixon Woods, et al. (2013) "Quality and safety in the NHS." Lancaster, University of Lancaster.

5. Leadership Outcomes Direction: agreement on goals
Alignment: coordination of shared work
Commitment: group trust, motivation, and responsibility

6. Cultures for high quality care
An inspirational vision of high quality care
Clear aligned goals at every level with helpful feedback
Good people management and employee engagement
Continuous learning and quality improvement
Enthusiastic team-working, cooperation and integration
West, Baker, Dawson, Dixon Woods, et al. (2013) "Quality and safety in the NHS." Lancaster, University of Lancaster.

7. 1. Direction: An inspirational vision
Leaders relentlessly focused on inspirational vision, values and narrative about high quality, continually improving and compassionate care
Vision
‘The Isle of Wight as a model for the UK of how to ensure the health, well being and flourishing of all in our community’

8. 1. Direction: Inspirational vision and values
Leaders relentlessly focused on inspirational vision, values and narrative about high quality, continually improving and compassionate care
Compassion
Team working
Improving
Valued

9. North East Ambulance Service Strategy

10. 2. Alignment: Clear goals at every level
A focus on (5 or 6) clear, agreed, challenging and aligned team objectives at every level with helpful and timely feedback on performance
Effectiveness – clinical effectiveness, safety, patient experience
Patient satisfaction and involvement
Staff growth and well being
Innovation and quality improvement
Inter-team working
Productivity and finances
Slido: To what extent is this cultural element (Alignment) strong in your organisation:
Very strong
Strong
Moderate
Weak
Very weak
Don’t know
Dixon-Woods, Baker, Charles, Dawson, Jerzembek, Martin, ... & West,(2013). Culture and behaviour in the English National Health Service. BMJ: Quality and Safety. 23(2),

11. A Feedback Rich Environment ..
highlights what teams and individuals are doing right, helping to build confidence
clarifies progress towards objectives
identifies areas for improvement
helps to build competence
promotes engagement and involvement with the organisation, developing a sense of being valued by their organisation.

12. Characteristics of effective feedback
Timely – soon after; Frequent – regular and continuous
Specific, Verifiable, Consistent, Private
Contextual Consequences of behaviour
Describes first, evaluates second
Sees performance as continuous not simply ‘good’ or ‘bad’
Identifies patterns rather than isolated mistakes
Communicates confidence in the person
Is collaborative inviting ideas from the employee (idea generation).

13. Implications for Leadership
Direction and Alignment: Are these elements present and strong within the Isle of Wight health and care system?
What can you do to ensure presence and sustainability of these elements?

14. 3. Commitment: Leadership that is …
Authentic
Open and honest
Humility and curiosity
Optimistic
Appreciative
Compassionate
Which of these characteristics would you say leaders in your organisation most need to develop?
Authenticity
Openness and honesty
Humility and curiosity
Optimism
Appreciativeness
Compassion
Don’t know

15. People management and engagement
Staff views of leaders → patients’ views of care quality
Staff satisfaction → patient satisfaction
High work pressure → less compassion, privacy, respect.
Poor staff well-being → poorer CQC performance (and £)
Good HRM practices → lower patient mortality

16. 3. Employee engagement success factors
A compelling strategic narrative
Inclusive leadership and management
Staff in charge of service change
Values and Integrity
A clear narrative on their purpose and aims
‘providing the highest quality health and social care to our local communities and staying true to and embodying the organisation’s values’
Retraining leadership to adopt inclusive, compassionate and supportive styles
In house programmes to retrain all managers in compassionate and collaborative leadership
Staff have skills, time, freedom, resources and responsibility for leading service change
Wrightington Wigan & Wigan and Leigh and Unipart
Buckinghamshire and ELFT programmes
Importance of values and trust in senior leadership
Perceptions of unfairness and intention to leave
Fairness of procedures
Bullying and discrimination.
Average nearly 4 times more likely BME staff entering disciplinary process. In some places more than 6 times more likely.
Staff being appointed from shortlisting – white staff 1.5 times more likely – in some places 3 times more likely.
Some places have achieved e.g. Oxford Health making good progress
Stable senior leadership

18. Positive emotion and culture
Leader positivity – optimism, humour, compassion
Caring for staff e.g., Schwartz Rounds
Dealing with aggression and poor performance
To what extent are these cultural elements (Commitment: Engagement, People Management, Enlightened Leadership) strong in your organisation:
Very strong
Strong
Moderate
Weak
Very weak
Don’t know

19. Implications for Leadership
Commitment, Engagement, Positive Emotional Environment: Are these elements present and strong within the Isle of Wight health and care system?
What can you do to ensure presence and sustainability of these elements?

20. 4. Innovation, learning, quality improvement
Reducing waiting time for bone density clinic from 18 weeks to 1 week
Cheshire firefighters – handheld ECG devices with Halton CCG and Innovation Agency, Halton Borough Council - pulse checks on Safe and Well visits to vulnerable residents to help prevent strokes. 27 already identified.
Chassin & Loeb (2013). High reliability health care. Millbank Quarterly, 91, Caring to Change: How compassionate leadership can stimulate innovation in health care

21. Key Elements for Innovation
Compassionate Leadership
Inspiring Vision and Strategy
Autonomy and Support
Positive Inclusion and Participation
Enthusiastic Team and Cross-Boundary Working
Commit-
ment to Innovation
Skills, capabilities, systems and processes

22. Inclusive/Collective Leadership
1. Band 4 administrator who presents their teams quality improvement project to a London conference 
2. Band 6 nurses who run our inpatient units out of hours/weekends, including dealing with emergency admissions, incidents etc. 
3. Tower Hamlets Together - a partnership between ELFT, Barts, the local authority, CCG and GP federation, who come together to improve the health and wellbeing of the local population
West, Armit, Loewenthal, Eckert, West, & Lee (2015) Leadership and Leadership Development in Health Care:
London: FMLM/The King’s Fund.
West, M. A., Lyubovnikova, J., Eckert, R., & Denis, J.L. , (2014),Collective leadership for cultures of high quality health care. Journal of Organizational Effectiveness: People and Performance, 1, 240 –

23. Inclusive/Collective Leadership
Leadership the responsibility of all - anyone with expertise taking responsibility when appropriate
Shared leadership in teams and across teams
Interdependent, collaborative leadership - working together across boundaries prioritising quality, well-being and performance across the system/organisation
Consistent approach to leadership within the leadership community – authenticity, openness, humility, optimism, compassion, appreciation
Which of these four elements is strongest in your organisation?
Leadership the responsibility of all
Shared leadership in teams
Interdependent collaborative leadership prioritising care overall
Consistently supportive and compassionate leadership
Don’t know
Which of these four elements is most in need of development in your organisation?

24. Implications for Leadership
Innovation and Quality Improvement: Are these elements present and strong within the Isle of Wight health and care system?
What can you do to ensure presence and sustainability of these elements?

25. 5. The Dance of Teams: team working, cooperation and integration

26. Team working, cooperation and integration
Care quality and improving care
Patient satisfaction and safety
Multi-disciplinary integration
Fewer errors, lower mortality
Staff well-being, lower turnover & absence
Large financial savings
Lyubovnikova, J. & West, M.A. (2013). Why teamwork matters: Enabling health care team effectiveness. In E. Salas et al. (eds.). Developing and enhancing teamwork in organizations. San Francisco: Jossey Bass.

27. Key elements for effective team working
Clear, agreed vision and challenging objectives
Role clarity
Positivity, optimism, cohesion, compassion
Effective communication and constructive debate
Enthusiastic and supportive inter-team and cross-boundary working
West, M. A. & Markiewicz, L. (2016). Effective team work in health care. In E. Ferlie et al., (eds.). The Oxford handbook of health care management (pp ). Oxford University Press.

28. Patient mortality
5% more staff working in real teams associated with 3.3% drop in mortality rate (p = .006)
For an “average” acute hospital, this represents around 40 deaths per year
Lyubovnikova, J., West, M. A., Dawson, J. F., & Carter, M. R. (2015) 24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations, European Journal of Work and Organizational Psychology, 24:6,

29. Reflexivity
Teams are more productive, effective and innovative to the extent that they routinely take time out to reflect upon their objectives, strategies, processes and environments and make changes accordingly.
Schippers, West & Dawson, 2012, Journal of Management
Tannembaum & Cerasoli, 2013, Human Factors

30. Team leadership Offer an inspiring vision and clear direction
Ensure regular and positive team meetings
Encourage positive, supportive relationships
Resolve and prevent intense conflicts
Positive group attitudes towards diversity
Be attentive and listen carefully to the team
Lead inter-team cooperation
Nurture team learning, improvement
and innovation
Conflict between Acute Medicine and Elderly Care – key leaders sharing office space and quickly resolving conflicts and working well together

31. Partnership Working – Leading Across Boundaries
A compelling shared vision of transforming the health and well-being of communities
Frequent personal contact between leaders who need to work together to build trust and make real progress to deliver for their communities
A shared commitment to work together for the medium and long term (not only short term objectives)
A shared covenant to surface and resolve conflicts quickly, fairly, transparently and collaboratively
An overt commitment to behave altruistically towards each other’s organisations, mutually supporting system success to transform the health and well-being of communities

32. Partnership Working Shared Vision and Values Compassionate Leadership
Long-Term Continuity and Stability
Trust
Frequent Contact
Innovation
Effective Conflict Management
Strong Team-Working
Mutual Support
See also: West, M. A. (2018). The future of teams, In Salas, Rico, & J. Pasmore (eds.). The Wiley Blackwell handbook of the psychology of team working and collaborative processes.

33. Implications for Leadership
Team, Inter-team and Partnership Working: Are these elements present and strong within the Isle of Wight health and care system?
What can you do to ensure presence and sustainability of these elements?

34. How to develop the leadership capabilities to deliver the culture?
The challenges health care 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.

35. Seeking a Better Approach to Change
Designed to be delivered internally
Open-source
Evidence based
Integrated
And … the change team:
Volunteers from across the organisation
Between 15-20
Help deliver and analyse the tools
Most importantly- act as ambassadors for the work

36. We have designed a programme to be delivered in three phases
Reminder of Discovery, Design, Delivery Phases.
Diagnostics to identify the culture of our organisation
Implementation of collective leadership strategies
Development of collective leadership strategies

37. Culture Phase 2: List of evidence-based interventions
Goals and Performance
Leaders role job design
Inclusive recruitment Regular (annual) leadership forecast update
Team goals
Development on providing feedback on goals, behaviour and performance
Compassionate Performance Management
Vision and Values
Values based Recruitment
Values Based Appraisal and Performance Management
Values-focused curricula
Annual talent cycle
Support and Compassion
Recruiting and promoting for compassion
Emotional Intelligence Development
Inclusion - listening with fascination and compassion
Peer coaching
Mentoring
Diversity and Equal opportunities training
Identity-based talent management
Team Work
Strategic recruitment for diverse teams
Selection for team orientation
Selection for team leadership capability
Board/Executive Team development
Team leadership training
Team-based appraisals
Working with shared team-leadership (peer coaching)
After action reviews and team reflexivity
System Leadership
Learning and Innovation
Developing cultures for innovation
Leading for QI
Developmental assignments
Action Learning
Recruit for commitment to innovation & QI
Development for leading innovation and Change

38. Culture and Leadership Trust coverage
Total Trusts 58
Acute 45
Community 1
Integrated 3
Mental Health & LD 7
Specialist
Ambulance
SoF rating 1 6
Sof rating 2 21
Sof rating 3 20
Sof rating 4 10
March 2019 Culture and Leadership programme Trust coverage

39. Belonging
Sleep
Exercise
Being Present
Learning
Giving

40. ‘Compassionate leadership for compassionate health services’
Attending: paying attention to staff – ‘listening with fascination’
Understanding: finding a shared understanding of the situation they face
Empathising
Helping: taking intelligent action to help

41. e.mail m.a.west@lancaster.ac.uk
Thank you!