Doing your local leadership differently

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Doing your local leadership differently

• Steve Onyett
• Long Term Neurological Conditions
• 1st May 2009

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• Leadership has been the neglected element of the
  reforms of recent years. That must now change.
• Darzi Review final report (DH, 2008)

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Putting People First

• stated that national and local leadership is
  now essential if we are to achieve system-wide
  transformation
• and lists the first key element of a personalised
  adult social care system as
• Local authority leadership accompanied by
  authentic partnership working with the local NHS,
  other statutory agencies, third non-statutory
  and private sector providers, users and carers
  and the wider local community to create a new,
  high quality care system which is fair,
  accessible and responsive to the individual needs
  of those who use services and their carers.

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Thought for the day. Today Programme. Radio 4.
26th February 2009

• Here is the gift of relationship. It lies at the
  very core of what it is to be human.
• Rev David Wilkinson, principal of St Johns
  College, Durham

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Start with what builds relationship for service
users
The artist is Mel Gittridge, and this image was
exhibited as part of Expressions, a touring
display of art by people who have experienced
mental or emotional problems- this picture
captures the idea of environments where people
can take power, supported by other environments
where people can take power.
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Chris Ham on commissioning

• Failed attempts at the purchaser-provider split
  suffered from lack of time to develop skills,
  relationship and experience
• too much attention appeared to have been paid to
  the legal form of contracts and not enough to the
  development of relationships between purchasers
  and providers (HSMC, 3).

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Make time (somehow!)

• ..recent research into the impact of Local
  Strategic Partnerships .. suggests the need for
  development time to explore the type of
  relationships that local agencies want to have
  and the organizational processes and structures
  that will be needed to deliver this. Making this
  time and space is crucial yet difficult, as the
  pressure to deliver better outcomes for service
  users can often seem in tension with the need to
  develop the capacity of the board and thus the
  partnership.
• Glasby and Peck, 2006 p.16

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Trust and social capital

• .. the greatest loss over the past 50 years may
  have been in squandered social capital. Social
  capital consists of those social networks of
  mutual trust and the associated norms of
  reciprocity that made the NHS ours.
• The NHS is essentially a national partnership
  between the citizens and those who work in it.
  For all partnerships the defining element is
  mutual trust and generalised reciprocitythe
  willingness to contribute, confident that at time
  of need in the future there will be support in
  return.

Welsh, T. Pringle, M. (2001).
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Four underpinning principles in the new DH
approach to change

• CO-PRODUCTION
• To engage people across the system to work
  together to make change happen
• SUBSIDIARITY
• Ensuring that decisions are made at the right
  level, and as close to the user as possible Each
  tier of the system only does what it can only
  do.
• CLINICAL OWNERSHIP AND LEADERSHIP
• Building on the Darzi concept of staff as
  Practitioners, Partners and Leaders.
• SYSTEM ALIGMENT
• Aligning different parts of the system towards
  the same goals as a way of achieving complex
  cultural change

TAKEN TOGETHER THEIR WHOLE IS GREATER THAN THE
SUM OF THEIR PARTS
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CO-PRODUCTION- It is not just about delivering
public services

• If co-production focuses exclusively on the
  types of labour needed to enable public systems
  to work better, it will tend to undervalue the
  significance of the effort invested in giving
  love and comfort, approval and disapproval,
  caring and mentoring and equally the effort
  involved in civic engagement ranging from
  attending meetings to making phone calls to
  mobilising social protest.
• Personalisation needs to be rooted in mutual
  support and recognition that not everything can
  be bought
• Should users use budgets to buy friendship?

Edgar Cahn. Foreword. Co-Production. A manifesto
for growing the core economy. NEF. 2
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New Economics Foundation. Co-Production. A
manifesto for growing the core economy.2008. 2
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It is about deepening and broadening public
service

• The point is not to consult more, or involve
  people more in decisions it is to encourage them
  to use the human skills and experience they have
  to help deliver public or voluntary services

New Economics Foundation. Co-Production. A
manifesto for growing the core economy.2008. 10-11
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Co-production and working from strengths

• people are defined entirely by their needs and
  so those needs become the only asset they have.
  No-one should be surprised when people then
  behave in ways that perpetuate such needs (11).
• When ..assets are deliberately ignored or
  sidelined they atrophy. (11)
• Co-production demands that public service staff
  shift from fixers who focus on problems to
  enablers who focus on abilities. This role is
  not recognised or rewarded within the management
  structures that are currently in place.(13)

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Front-line staff are essential to delivery and
empowerment...

• Their morale is as important as client morale.
  Yet in practice, the participation that they are
  asked to extend to clients is often not extended
  to them.

New Economics Foundation. Co-Production. A
manifesto for growing the core economy.2008. 13
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Trusting Relationships
Shared Vision
Conflicting Needs
Shared Values
Pressures/Stress
Integrity
Change/Uncertainty/Dishonesty
Clear Communications
UnclearCommunications
Reliable Information
Complex/Poor Data
Familiarity
Lack of Time / Prior Experience
Distrusting Relationships
Source Richard Lauve, MD (VHA Inc.)
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The energy of social movements

• Social movement thinking is about connecting
  with peoples core values and motivations and
  mobilising their own internal energies and
  drivers for change
• evidence from change management studies show
  people change what they do less because they are
  given analysis that shifts their thinking than
  because they are shown a truth that influences
  their feelings
• ..rather than a single individual, it is a
  network of leaders at multiple levels who guide
  and mobilise the successful movement
• Helen Bevan of The NHS Institute

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Four Column Matrix
Strategic Goals
System Level Measures
National Targets
Projects
Develop transformational goals that connect with
the values that brought people into healthcare in
the first place
Develop system level measures that track progress
against these goals
Show how externally set targets sit within the
context of the strategic goals to build ownership
to delivery
Align project level goals with the strategic
goals of the system to create a sense of purpose
and channel energy
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Establish a system-level vision for improvement
with ambition and commitment.

• Leaders need to commit personally to the vision.
  This means taking a stand and framing the
  objectives as promises to users and the people
  that support them.

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Aims framed as promises to users
Users needs and wants Promise
I want to be involved in my own care planning Your care planning session will be attended by you and the people you know need to be there. The care plan will be signed by you to indicate your involvement
I want to be seen as a whole person not just an illness Assessments and care plans will cover all the areas of your life that are meaningful and important to you. You will be able to control what is looked at and be given information telling you what you should expect
I want to be confident that I have had the best care and treatment Your care and treatment will be evidence based It will be delivered by enthusiastic and skilled staff
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System alignment

• Allow yourselves with others to be moved by
  delivery stories
• Give wide and shared exposure to the lived
  experience of service users
• Envision the future together and ambitiously
• Dont be coy about the love you put into your work

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Appreciative Inquiry
Is about developing the competence to CHOOSE a
way of thinking

• Appreciative Inquiry is the cooperative search
  for the best in people, their organizations, and
  the world around them.
• It involves systematic discovery of what gives a
  system 'life' when it is most effective and
  capable in economic, ecological and human terms.

From An opportunity to learn more about
Appreciative Inquiry Presentation by Anne Radford
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We manifest what we focus on and we grow toward
what we persistently ask questions about
Solution focus/appreciative inquiry- exploring
what works so that we can do more of it

• orWhat we talk about gets bigger!

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It works to build the positive core of the
organisations involved.

• Organisations need a lot less fixing and a lot
  more affirmation.
• Appreciation builds relationships, collective
  intelligence, and freedom to innovate

From An opportunity to learn more about
Appreciative Inquiry Presentation by Anne Radford
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The Power of Appreciation..

• ..rests with its self-reinforcing and
  self-generative capacity
• Srivastva and Cooperrider, 1999
• This requires inclusion, safety in participation
  and good communication
• Effective teamworking and leadership
• Teams are where this is modelled and enacted

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The 2007 NHS National Staff Survey

• 93 responded positively when asked Do you work
  in a team?
• However this shrunk to 42 when the survey
  explored whether the team in question fulfilled
  criteria for a well structured team
• Findings consistent since 2003!

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Real teams have..

• Clear and shared objectives
• Members who have to work closely together to
  achieve the objectives of the team
• This interdependency includes users and their
  supporters
• Members who have different and clearly defined
  roles within the team
• The minimum number of team members required to
  get the job done

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• Working well with living systems means working
  well with complexity
• See for example
• Bob Hudson. (2006). Whole systems working- a
  Guide and Discussion paper. CSIP-ICN
• Jake Chapman. (2004). Systems failure. Why
  governments must learn to think differently.
  London Demos

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Or just

• Recognising how the universe works and just
  getting on with it
• .. theory

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Are your issues wicked?

• Dont be surprised of they are the easy
  problems have been solved!
• They involve many stakeholders with different
  values and priorities
• When confronting frustrating problems, an
  enterprise would do well to recognise that they
  may be wicked. Moving from denial to acceptance
  is important otherwise companies will continue
  to use conventional processes and never
  effectively address their strategy issues

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
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Wicked problems

• Involve issues with roots that are complex and
  entangled.
• Are difficult to get to grips with and change
  with every attempt to address them.
• Have no precedent
• So .. nothing to indicate the right answer

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
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Properties of Wicked problems

• There is no definitive formulation
• It is not obvious when you have reached a
  solution (no stopping rule)
• There is no immediate and no ultimate test of a
  solution- the solutions have their own
  consequences
• Every attempt at solution counts significantly

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
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Properties of Wicked problems

• Each problem can be seen as a symptom of another
  problem
• Discrepancies can be explained in numerous ways-
  because people have different definitions of the
  problem
• You have no right to be wrong- there is too much
  at stake!
• Solutions are not true or false but good or bad-
  its all down to judgement
• there is only better

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
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So its a bit swampy!

• Swamps were generally seen as useless and even
  dangerous.
• Swamps are characterised by rich biodiversity
  and specialized organisms..
• .. such as frogs.
• . swamp draining is nowadays seen as a
  destruction of a very valuable ecological habitat
  type
• Wikipedia

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Complicated
Complex
Simple
From - Plsek, P. Complexity, culture and large
systems change presentation
Source Brenda Zimmerman, PhD
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Questions? (after Chapman, 2004)

• Are we spending too much time trying to apply
  complicated solutions to complex problems?
• What approach would we adopt if we accepted that
  systems cannot be controlled nor their behaviour
  predicted?
• What might we need to do differently?

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The problem of Big Planning

• Long term planning and the rigid structures,
  precise task definitions and elaborate rules that
  often accompany it, may be positively dangerous,
  fixing an organisation in pursuit of a
  particular vision when an uncertain world
  requires flexible responses.
• Hudson, 2006
• May need holding frameworks for relevant
  subsystems to keep direction and coherence

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Build collective understanding of what working in
complex systems really means

• Small changes can have big effects
• ..and big changes very little effect
• Emergence- the whole is greater than the sum of
  the parts
• Tolerance of uncertainty and flexibility
• Recognising the futility of control

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The pointlessness of controlfrom Jenny Rogers
Influencing Skills

• You cant force people to work effectively on
  something they disagree with.
• Organisations are so complex and subject to so
  many diverse influences that it is pointless
  trying to control them.
• Distance from most senior to most junior makes it
  unlikely that control can be exercised over that
  stretch
• Much control is unnecessary -where there is
  openess and willingness to give feedback
• Control reduces risk taking- a necessary
  precondition for the innovation on which
  organisations depend
• Its exhausting and your time can be better spent!

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What implications of more ecological thinking?

• Push and exhortation (nor even resources!) from
  leaders and policy makers can be
  counter-productive.

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• Peoples ability to stay the same will always be
  greater than our ability to make them different

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Working with your stakeholders- what is their

• Readiness to change?
• Confidence to change?
• Judgement of the importance of change?

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Respectfully consider these cells and provide
information to inform
Advantages Disadvantages
Change -
No change -
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What are their natural attractors?

• Patient/carer benefit
• Feeling effective
• Getting to know people better
• Autonomy
• Choice
• Self image (e.g. as a scientist)
• Reduced paperwork and boredom
• Geewhizz gadgets
• Feeling part of something important
• Lifestyle enhancement
• Good stories to tell
• CV brownie points
• Etc., etc., etc., etc.

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What implications of more ecological thinking?

• Change needs to happen bottom-up but the right
  conditions need to be created.
• like gardening, or throwing a party?

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Working with complexity values

• Allowing solutions to emerge by
• encouraging rich interaction, removing barriers
  and oppressive controls
• giving space and time,
• not overspecifying means

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Working with complexity values

• Valuing multiple perspectives
• Using multiple approaches that make effective use
  of experience, experimentation, freedom to
  innovate and working at the edge of knowledge and
  experience.

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Working with complexity as surfing the edge of
chaos, Pascale, et al (2000)
.. In systems as in life, when threatened, it
move towards the edge of chaos. At this edge
experimentation and mutation occur from which
creative solutions can emerge. When this occurs
living systems self organise and new forms or
patterns emerge. The challenge for leaders is to
disturb or disrupt the movement at the edge to
provoke the desired outcome sometimes referred
to as perturbing the edge. McKimm et al, (2008)
Panic Zone
Discomfort Zone
Comfort Zone
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• ..Success is the ability to go from one failure
  to another with no loss of enthusiasm.
• Winston S Churchill

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Leadership? Two broad approaches

• Some view leadership as a set of traits or
  competencies possessed by certain individuals
• others view leadership as an emergent social
  phenomena, a social process shaped by
  relationship within groups.
• Bolden, 2004

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Competencies

• . can be likened to Brighton Pier,
• very fine in their own way, ..
• but not a good way of getting to France
• John Alban-Metcalfe quoting Neil Kinnock
  describing the 1981 Special Education Act.

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Law of the Situation

• Leadership is transient and contextual
• Where knowledge and experience are needed the
  person who can is the right person to do it.
• Not all leadership should be determined by
  position power yet people with authority should
  be prepared to exercise it.

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Subsidiarity

• Decision making should be located as closely as
  possible to the place where actions are taken.
• This means addressing the flight from authority
• .. and helping people love their monkeys!

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• If you do not fill your leadership space, voids
  appear, and in voids bad things happen
• Hugh Martyn and Robert Scurr quoting William
  Calley on his lack of leadership in the Mai Lay
  massacre in Vietnam, 1968

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The essence of leadership and management

• is the creation of environments in which people
  can be creative.. Where they can exercise power
  to achieve outcomes valued by patients/users,
  their supports, and other key stakeholders.
• This is usually a team

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New paradigm approach to leadership

• More soft stuff emphasis on working through
  others
• Leaders with more faith in other people than they
  have in themselves (and they have a lot of faith
  in themselves!)
• More concerned with connectedness and
  inclusiveness

With acknowledgement to Bev Alimo-Metcalfe of
www.realworld-group.com
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New paradigm approach to leadership

• More concerned with vision
• More concerned with improvement
• Less concerned with Great man models of
  leadership
• Striving for excellence through optimism,
  openness and personal humility

With acknowledgement to Bev Alimo-Metcalfe of
www.realworld-group.com
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Transformational leadership- roots

• James MacGregor Burns transformation as that
  which turns followers into leaders and leaders
  into moral agents.
• Transformational leadership occurs when people
  elevate each other into a higher level of
  motivation and morality.
• Thus inextricably linked with the social meaning
  that people attach to their work.

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Leadership as an ethical endeavour

• Positive Emotional Climate an environment
  where managers take into account the emotional
  needs and personal growth of employees and
  encourage the sharing of positive emotions
• Leadership practices that promote positive
  emotional climate associated with company gains
  in revenue, growth and outcome. Ozcelik et al,
  2008
• Contrasted with charismatic (sometimes referred
  to as transformational) leaders who use their
  skills manipulatively in pursuit of
  organisational goals.

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The importance of authenticity

• Leaders lead most effectively when they are being
  themselves and being true to themselves.
• Authentic leadership is about, being yourself-
  more with skill
• Goffee and Jones, 2006

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Leadership as an ethical endeavour

• PEC associated with less cynicism and more
  engagement

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.. Sloterdijk (1987) observes that the whole of
postmodern society is living within an internal
dialogue or cognitive environment of a universal,
diffuse, cynicism. As a predominant mindset of
the post-1960s era, Sloterdijk takes the cynic
not as an exception but rather as the average
social character. It is argued that at both the
personal and institutional levels, throughout our
society there is a widespread disturbance of
vitality, a bleakening of the life feeling, a
farewell to defeated idealisms, and a sense of
paralyzing resentment. DAVID COOPERRIDER, 1999
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Research using the Team Leadership Questionnaire

• Showing genuine concern has the biggest impact
  on motivation.
• Being interested in your needs and aspirations
  and how things feel for you.

With acknowledgement to Bev Alimo-Metcalfe of
www.realworld-group.com
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Highlights from Host Leadership Towards a new
yet ancient metaphor by Mark McKergow PhD
MBADirector, sfwork - The Centre for Solutions
Focus at Workmark_at_sfwork.com, www.sfwork.com
Forthcoming in the International Journal of
Leadership in Public Services
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Shortcomings of the hero metaphor

• The hero leader is seen as all-knowing and the
  followers all-dependent
• The illusion of control
• The homogeneous imagery of the followers - are we
  subjects or sheep!
• The willingness of the hero (warrior, king, even
  shepherd) to die in the act of saving the flock

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Shortcomings of the servant metaphor

• The richness of the metaphor is not obvious. Your
  waiter or Jeeves?
• The image of servant is not a compelling one to
  those (for example women and ethnic minorities)
  who are traditionally cast in such a role
• The leader as servant has similar hierarchical
  issues to the hero, but from the other end- who
  are really the masters and mistresses?

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Leader as Host, Host as Leader
Host
Hero
Servant
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Warren Bennis on Gladstone and Disraeli

• If you had dinner with William Gladstone, you
  were left thinking That Gladstone is the
  wittiest, the most intelligent, the most charming
  person around.
• But when you had dinner with Benjamin Disraeli,
  you were left thinking, Im the wittiest, the
  most intelligent, the most charming person
  around!
• Gladstone shone but Disraeli created an
  environment where others could shine. The latter
  is the more powerful form of leadership, an
  adventure in which the leader is privileged to
  find treasure within others and put it to good
  use.
• From introduction to Parks 2005 p xi-xii).

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Advantages of the host metaphor

• Its an everyday image
• Host and Guest are co-defining
• Hosting is an activity, rather than a defining
  characteristic of a person
• Hosting gives a definite feel of some
  responsibility for the success of the event
• The role of host can involve behaving as total
  hero or absolute servant

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Elements of host leadership

• The four balances 1

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Principle of Response-ability

• Defining the event

• Responding to what happens

And
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Principle of Co-participation

• Engage and provide

• Join in along with everyone else

And
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Principle of Gate-opener

• Protect boundaries

• Encourage new connections

And
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Principle of Alpha and Omega

• Be the last

• Be the first

And
The host is both the first and the last Arabic
proverb
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The 5th principle?

• Front stage work.

• Back-stage work.

And
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Parting comments on rethinking leadership

• Focus on what counts rather than what is easily
  countable
• ..and then measure with reports to the highest
  levels of governance
• Remember to plot the bloody dots! but that..
• Crude measures of the right thing are better
  than precise measures of the wrong things
• Davis Balestracci, 2008

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Parting comments on rethinking leadership

• Focus on releasing capacity for effective hosting
  of important relationship building based on trust
  - rather than just talent spotting high fliers
• Notice and celebrate the good to build the
  confidence for effective subsidiarity
• Develop networks and teams based upon levels of
  interdependency required among people to deliver
  the task at hand

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Parting comments on rethinking leadership

• Build in incentives and support for giving back
  at all levels, for example
• By service users in contributing to the support
  of others
• By staff in managing their own managers
• By all in the planning, design and delivery of
  service
• Create an environment where innovation is
  possible- it is OK to celebrate failure as long
  as there is learning
• Create the infrastructure for learning
• Start!- Use Rapid Cycle Thinking with small,
  short PDSA cycles where data is collected, shared
  and learned from

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Parting comments on rethinking leadership

• Consciously address sustainability
• Maintain attention
• Celebrate and communicate
• Take away that which supports the bad old ways
• Create and support the new roles and ways of
  being
• Model from above
• Keep moving forward

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Parting comments on rethinking leadership

• Ask yourself

Paul E. Plsek, 2008
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Its all about well-being
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• If you think you are too small to be effective
• you have never been in bed with a mosquito
• Betty-Reese

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Thank you!- steve.onyett_at_gmail.com
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Sources

• Iles, P. Macaulay, M. (2007) Putting principles
  into practice developing ethical leadership in
  local government. International Journal of
  Leadership in Public Services, 3(3), 15-28.
• Ozcelik, H., Langton, N., Aldrich. (2008).
  Doing well and doing good. Journal of Managerial
  Psychology, 23(3), 186-203.
• Ham. C. (2008) Health Care Commissioning in the
  International Context Lessons from experience
  and evidence. 2008.HSMC
• Ham, C. (2008)Competition and integration in the
  English NHS. BMJ. 2008. 336. 805-807
• Welsh, T. Pringle, M. (2001). Social capital.
  Trusts need to recreate trust BMJ. 2001 July 28
  323(7306) 177178.
• New Economics Foundation. Co-Production. A
  manifesto for growing the core economy.2008
• www.icn.csip.org.uk/leadership
• www.leadershipnet-icn.org.uk for people
  involved in leadership and teamwork development
• www.steveonyett.co.uk see page on solution
  focus for links to a range of other resources of
  solution focussed working.
• Steve.onyett_at_gmail.com