1. CLINICAL LEADERSHIP DEVELOPMENT PROGRAMME Leadership in “Wicked” Times Friday 13 January 2012 Carole Langrick Director of Strategic Development / Deputy Chief Executive

2. Aims of the session Offer you a model for thinking about how you might behave and lead in a change situation Introduce you to the idea of tame and wicked problems Encourage you to think about how you apply your leadership qualities to wicked problems Use Momentum as a backdrop to thinking about how you might behave differently in your leadership role.

3. Successful leadership of a change programme Us & Our Behaviours What Resources How

4. Successful leadership of a change programme Us & Our Behaviours Momentum Leadership Qualities Tame & Wicked Problems & Clumsy Solutions

5. Our Vision “A patient centred and clinically driven local NHS responsive to the needs of local people, delivering the best quality care available in an integrated and efficient way, in first rate facilities as close to home as possible by well trained professionals using state of the art knowledge and equipment.” Three elements to the Programme: Service Transformation and the redesign of care pathways, New community based facilities to deliver care closer to home, New hospital to replace the existing two in Hartlepool and Stockton.

7. Momentum is a massive change management programme: 20% reduction in general & acute beds (124) beds 18% reduction in average length of stay (0.8 days for emergencies) 10% reduction in acute based staff (400 wte) Fewer operating theatres and consultation rooms 40% of A&E attendances in town centre minor injury units (40,000 patients) 40% of all outpatient appointments in community locations (160,000 appointments) 15% of elective procedures in community locations (6,000 procedures)

8. Pre-requisites for successful change management Accepted need to change A vision / alternative state Change agents Sponsorship from above Scale and pace of change An integrated transition programme A symbolic end to the status quo A plan for likely resistance Constant advocacy A locally owned benefits plan (Grint, 2008)

9. Management vs. Leadership Management – deja vu – seen this before – do it – solve it – tried and tested methods. Leadership – vu jade – never seen this before – novel – unique – no experience of this before.

10. Tame vs. Wicked Problems Tame problems Complicated Difficult Usually resolvable through unilinear acts Likely to have occurred before Limited degree of uncertainty There is always an answer Wicked problems Complex Affects the environment in which the problem lies No relationship between cause and effect Often not really solvable Requires leadership

11. Wicked problems in the context of Momentum Funding approval Capacity Planning Managing the transition Local politics and public opinion Policy environment New players on the block Collaboration v competition £40m Challenge

12. Or perhaps? Which services does it just not make sense for us to continue to provide? What is our core business? Do we really believe in integrated care pathways or only when we are the boss of that pathway? Others?

13. Approaches to Problems Increasing uncertainty about solution to problem WICKED TAME CRITICAL COERCION/ PHYSICAL (Hard Power) CALCULATIVE/ RATIONAL NORMATIVE/ EMOTIONAL (Soft Power) COMMAND: Provide Answer MANAGEMENT: Organize Process LEADERSHIP: Ask Questions Increasing requirement for collaborative compliance/ resolution

14. Leadership Qualities Personal Qualities Self belief Self awareness Self management Drive for improvement Personal integrity Seizing the future Intellectual flexibility Broad scanning Drive for results Political astuteness Setting Direction Delivering the Service Collaborative working Effective and strategic influencing Leading change through people Holding to account Empowering others

15. Clumsy Solutions

17. Some Scenarios The availability of neonatal services………………… The integrated provision of musculo-skeletal services……………. An integrated approach to reablement…………………. The increasing usage of (expensive) diagnostic facilities and tests………………… Uneasy relationships with other OOHs providers……………. Building relationships and understanding with the new clinical commissioners……………………. Your directorate CIP……………… A network approach to providing your service across multiple providers………………………. How as a leader might you behave differently to how you may have behaved to date to facilitate a clumsy solution (rather than yours) to the wicked problem of:

18. Tactics for resilient leadership Think options, not solutions Learn to value not knowing Embrace ambiguity Re-connect with your personal anchors Avoid feeling overwhelmed Make conscious and deliberate choices

19. Thank You