Positive leadership, true team work and values in action for effective patient care

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Positive leadership, true team work and values in
action for effective patient care Michael
West Aston Business School Clinical Leaders
Network NHS London  Tuesday 21st March
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Three areas of research

• HRM patient mortality
• Nature of team working
• Team working links to outcomes
• Leadership
• Leadership links to patient other outcomes

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HRM systems measure

• Appraisal
• Frequency, extent, training, use of PDPs
• Training
• Assessment of training needs
• Sophistication of training policy
• Extent of team working
• Staff involvement
• Priority of involvement in decision making
• Contribution of staff views
• Decentralisation
• Employment security
• Investor in People (IiP) status

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Patient mortality measure

• We use the Standardised Mortality Ratio (SMR)
  (Jarman et al., 1999)
• Data on all inpatient admissions coded for
• Age
• Sex
• Length of stay
• Primary diagnosis
• Planned or emergency admission
• Number of bodily systems affected by disease
• Ratio of Actual number of deaths to Expected
  number of deaths (based on above coding)
  calculated for each NHS year

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Control variables

• Doctors per 100 beds
• NHS facilities per 100,000 population
• GPs per 100,000 population
• (all found to be significant predictors by Jarman
  et al., 1999)
• Prior mortality (measured for the three years
  prior to HRM data collection)
• We also checked for other control variables (such
  as trust size, region, type), but as expected due
  to the standardisation process, none had any
  effect on mortality

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Results

• The HR system variable explains 16.9 of the
  variance in subsequent mortality (p lt .01)
• Even taking prior mortality into account, the HR
  systems variable explains a further 7.8 on top
  of this (p lt .01)

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Causal relationship?

• HR systems is significantly more highly
  correlated with subsequent mortality (r -.45)
  than with prior mortality (r -.25) (p .036)
• Although this does not prove a causal effect of
  HRM on mortality, it effectively rules out a
  reverse causality argument

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Effect sizes

• If everything else held constant at the mean
  value, a change in the HR systems from 1 sd below
  the mean to 1 sd above the mean is associated
  with
• decrease patient mortality from 104.0 to 96.0
• a 7.7 decrease in the number of deaths
• If prior mortality is also held constant at its
  mean value
• this decrease is from 102.8 to 97.2 a 5.4
  decrease in the number of deaths
• In an average hospital, this means 71 fewer
  people dying in a year!

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Real teams or pseudo teams?

• When we talk about teams, what is it we mean?
• Do employees who work in close proximity to each
  other constitute a team?
• What are the criteria that define a team?

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Working in Teams in the NHS

• Do you work in a team?
• If yes
• Does your team have clear objectives?
• Do you have to work closely together to achieve
  these objectives?
• Do you meet regularly to review your team
  effectiveness and how it could be improved?

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Team working in Primary Care Trusts
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Working in Teams and Job Satisfaction(170 acute
trusts, 120,000 respondents)
www.nhsstaffsurveys.com
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Working in Team and Errors, Stress and Injury
www.nhsstaffsurveys.com
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Working in Teams, Harassment and Violence
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Data from NHS staff survey

• Teams as opposed to pseudo teams
• Data from employees themselves
• A 10 increase in real teams is associated with
  a 3.1 drop in patient mortality
• In an average hospital, this is over 40 deaths
  per year

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Team functioning and patient satisfaction
3.3
3.2
3.1
Clarity of objectives
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Reflexivity
Patient experiences
Support for innovation
2.9
2.8
2.7
Low
Moderate
High
Team functioning
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Teams and organisational performance

• Annual Health Check 2007 extent of team
  working

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Team processes

• Participation
• Support for innovation
• Clarity of objectives
• Emphasis on quality
• Reflexivity

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Team processes

• Participation
• Support for innovation
• Clarity of objectives
• Emphasis on quality
• Reflexivity

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Our Vision To be a world class research-based
business school and the best in Europe for
employability and global mobility To be the most
inspiring and innovative business school in Europe
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ABS Management Team Objectives 08-09

• Improve intake quality and student staff ratio
• Improve collaboration with central services and
  the three other schools
• Balance the budget and ensure strategic
  investment ambitions are met (4)
• Executive Education net contributor and well led
• Increase staff and student satisfaction
• Successfully implement changes to MBA and design
  an innovative Executive MBA for introduction in
  January 2010
• Take steps to promote a culture of innovation in
  ABS

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Three things we must always do

• Provide leadership by focusing on what is
  difficult and important rather than inevitable or
  unimportant
• Encourage and reward risk and innovation to
  create a climate of engagement and excitement
• Share responsibility for management team
  decisions and support each other

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Three things we must never do

• Lose sight of our common purpose
• Intentionally mislead each other or staff within
  the School
• Neglect promoting, learning from and supporting
  the whole university

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Organisational Leadership

• How does non-clinical leadership affect
  organisational outcomes?
• Study based on two data sets one collected as
  part of staff involvement study, the other as
  part of CHI clinical governance reviews
• In total, nearly 18,000 employees in 86 acute
  trusts are included

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Leadership

• Six questions relating to employees views of
  senior management leadership in their
  organisations
• Also measured Climate for quality of care
• Outcome measures
• Complaints per 1,000 patients
• DH Star ratings
• Clinical Governance Review ratings

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Results

• Leadership ratings related significantly to all
  four outcomes

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Summary

• HRM associated with patient mortality other
  outcomes
• Team working (as opposed to pseudo team working)
  associated with many outcomes including
• Reduced error rates
• Lower patient mortality
• Enhanced patient satisfaction
• Increased staff motivation and mental well-being
• Leadership associated with several organisational
  outcomes
• HR Leadership obviously make a difference

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A key role of leaders is to create effective work
communities that enable the organisation to
achieve its aims and to foster the well being,
development and vitality of those who
work within them these go together
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Positive Emotion

• When leaders of service departments are positive
  stronger customer satisfaction positive
  affective tone of workforce
• Optimistic life insurance agents sell more
• Correlation with income (.13-.24)
• Negotiation and conflict resolution
• Work groups less conflict more cooperation
• Salespeople more customer helping and
  extra-role behaviours
• Humour and reframing in difficult times
• Lyubomirsky, S., King, L., Diener, E. (2005).
  The benefits of frequent positive affect Does
  happiness lead to success? Psychological
  Bulletin, 131, 803-855.

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Positive affect

• Job satisfaction is associated with better
  performance in organizations
• CEO positive affect, climate and company
  performance
• Patterson, M., Warr, P. B. W., West, M. A.
  (2004) JOOP
• Foster, Hebl, West Dawson (Submitted)

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Positive emotion and relationships at work

• Positive emotion is a source of human strength
  encourages flexible, open-minded cognitive
  processing that enables people to do what needs
  to be done, and make the most of the situations
  they are in.

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Positive vs negative aspects of relationships

• Relationships are one of the most potent sources
  of human misery (eg death of a spouse)
• Troubled relationships the most common presenting
  problem in psychotherapy
• Chrnoic conflict and hostility damage the immune
  system
• We must sustain positive relationships in
  organisations
• Reis and Gable, 2003

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Positive vs negative aspects of relationships

• Expressions of affection (especially by husbands)
  predict marital satisfaction
• Role of positive feedback in organisations

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The Psychology of Human Strengths

• Wisdom and Knowledge
• Courage
• Humanity
• Justice
• Temperance
• Spirituality and Transcendence