Leadership and teamwork development

Eastern Region CMHT Forum 14th December 2007

Steve Onyett.

The 2006 NHS National Staff Survey

89% responded positively when asked: Do you work in a team? However this shrunk to 41% when the survey explored whether the team in question fulfilled criteria for a well structured team Findings consistent since 2003!

Steve Onyett.

An auspicious time for leadership and teamwork development

 Performance management that is stronger on outcome while being less centrally controlling is promised.  Stronger local accountability advocated  In a policy context where there is good alignment of policy imperatives with the expressed concerns of users and carers, for example with respect to personalised care, dignity and choice.
Steve Onyett.

Darzi interim review in the wake of Wanless

 Performance is not commensurate with investment.  Darzi stresses effective leadership and the creation of stable contexts for service improvement.  No change unless it is an improvement!
Steve Onyett.

The challenge: How do we achieve team role clarity within a complex local whole system?
Steve Onyett.

Scary graphic coming up on the inter-team relationships described in the Policy Implementation Guides
Steve Onyett.

In-patient services

Continuing care

Early intervention team

Assertive community treatment

Child and Adolescent MH Team

Crisis resolution/Home treatment team

Police Criminal justice system Services for homeless people Psychology Acute medical services

Approved social workers

CMHT/ Primary care liaison team

Inter team relation -ships

KEY Direct referral route Referral may be out of hours
Steve Onyett.

Forensic services

Non-statutory agencies

Primary Health Care Team

Self referral

A solutions focused approach to development

 Developing shared vision of your preferred future  Being clear where you are now and celebrating the strengths that got you there  Taking the first small steps forward  Affirming each other
Steve Onyett.

Boundary spanning: Implications

 Managers may combat ineffective intergroup relations by enhancing employees identification with their organization, while acknowledging groups for their individual performance  Measures for enhancing organizational identification may include
Communication of organizational successes, values, and goals. Rotation of individual boundary spanners Promotion into boundary positions of employees with dual identification Ensuring that intergroup working is on a groups agenda, in order to combat silo working Intergroup social gatherings Frequent intergroup meetings, Steve Onyett. Use of cross-functional teams

The filling in the sandwich

 Middle management the critical layer between corporate management and practitioners.  The most stressed group in the NHS workforce.  Often feel disempowered- so like practitioners exercise what power they have by saying no or taking flight from authority.  Thus need to link their development strongly with neighbouring layers in hosting organisations
From NHS Confederation Report- The challenges of leadership in the NHS. 2007
Steve Onyett.

Middle management survey by NHS Confederation/HSJ

 Who are they?  High levels of stress and a long-hours culture- worst in mental health.  Generally positive about their jobs but least so in mental health

Steve Onyett.

Middle management survey by NHS Confederation/HSJ

 High levels of role ambiguity- especially among the 40% who had not had an appraisal  Appraisal often criticized and link to organisational goals often unclear.  Sometimes the aim of the organisation itself is unclear
Steve Onyett.

That context re Risk..

..Success is the ability to go from one failure to another with no loss of enthusiasm.
Winston S Churchill

Steve Onyett.

Development to make a difference

 Take a longer term view which encompasses the wider system.  Create more time for really important issues- such as improving delivery and staff understanding of the wider strategy [and values of the organisation].  Aim for more stability
From NHS Confederation Report- The challenges of leadership in the NHS. 2007
Steve Onyett.

Development to make a difference

 Context requires a a much wider and more subtle range of influencing and persuasion skills than would be required in some other settings.  Pay attention to the skills required for a much more complex world in which thinking, listening and influencing will become much more important (12).  Develop sophisticated skills to deal with the emotional side of organisational life that are probably even more important [than the need to improve technical skills]
NHS North West chief executive Mike Farrar
From NHS Confederation Report- The challenges of leadership in the NHS. 2007

Steve Onyett.

Some distant reflections from the turn of the century!

 Goodwin (2000) advocated a move away from a focus on individual skill development towards a local leadership mindset.  Leadership development as mandatory, locally focussed, based around action-learning principles, and concentrated on interorganisational and shared leadership between organisations rather than leader-follower relationships within organisations.
Goodwin, N. (2000). The national leadership centre and the national plan. British Journal of Health Care Management. 6(9), 399-401.
Steve Onyett.

Observations underpinning the development of ETL

 Leadership initiatives sometime fail to focus strongly enough on service improvement  Service improvement initiatives often fail to take enough account of the involvement of senior managers.
Hence the need to integrate the two at local level

 Leadership is bound by context, shaped by the task in hand and dispersed  The vast majority of care is delivered by teams and this is where service improvement and effective leadership needs to be enacted.

Steve Onyett.

Observations underpinning the development of ETL

 You cannot assume that the ways teams are currently configured are real teams  In trying to engage clinicians in change in makes sense to use evidence-based models of change that they are familiar with from their clinical work.  We often neglect the mental health of staff in trying to achieve sustainable improvement.
Steve Onyett.

The Thinking
 Leadership is not just the task of a particular individual or discipline.  Effective multidisciplinary teamworking is the platform for evidence-based interventions.  A focus on outcomes for users and staff.  A focus on you and the resources you bring
Steve Onyett.

Aims of the programme

To improve multidisciplinary team working and leadership within and across local teams.
Through applying recent research findings on leadership and teamworking, and working on real issues of concern to you and the people that use your services.

Steve Onyett.

Objectives
To increase your confidence and effectiveness as a leader, manager and/or team member. To increase your ability to develop solutions to complex problems. To support you in achieving meaningful change.
Steve Onyett.

The essence
 Bringing teams together in sets- small groups where learning is achieved through action.  Helping you hone your peer coaching skills so you can better support colleagues through action-learning sets.  Introducing new learning on leadingedge research on leadership and Steve Onyett. teamworking.

The effective teamworking and leadership programme

 7 day action learning based programme  For 21 people dependent on each other to achieve positive outcomes for a defined group of users (including the users and their supports).  Includes whole group work on improving team effectiveness.  Funded by Leadership Centre and rolled out by CSIP Development Centres
Steve Onyett.

Key features
Working across boundaries Leadership linked to improvement and the task in hand An emphasis on clarifying shared objectives and values Developing a shared experience of the users perspective Using tried-and-tested models for improvement + those based on clinical know-how- e.g. solutions focus, motivational interviewing  Can be used in concert with other key developments such as CCTA
    
Steve Onyett.

Steve Onyett.

The learning sets start here!

Steve Onyett.

Steve Onyett.

Steve Onyett.

Reported Benefits
More openness and cohesion Clearer view of objectives. More insight into interpersonal interactions I really do believe the team has benefited. It has made us all aware of issues we avoid, i.e. conflict, and building in innovation More openness in discussion. Better understanding of each other. Development of realisable objectives Enabled the team to deal with uproar in a positive way. Brought team closer together. A peer group now started. Office environment a little better Steve Onyett. From Rees and Shapiro, 2005

Reported Benefits
A high proportion of the membership work together and techniques from the course have been evident in the work place throughout. These include process mapping, problem solving de Bonos hats, understanding complexity etc. In the main, some of the topics were pertinent to the development of the new team and enhanced cohesion. Much of the management exercises have been noted and used within our team, mapping, systems etc. Improved leadership with clearer identified goals A more informed leader From Rees and Shapiro, 2005
Steve Onyett.

Does it work? To quote:

 Overwhelmingly, participants response to the day-byday experience of their development programmes was positive. Throughout the course their comments indicated that they valued the opportunity to interact with other team members away from the work environment, enjoyed both networking and the chance to meet new people, and find out more about them. participants selected action learning sets as being particularly useful. They found these covered real issues and problems, had connections with their practice, and enabled them to come away with definite action plans (Rees and Shapiro, 2005).
Steve Onyett.