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Leadership and the positive management of change


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Title: Leadership and the positive management of change

Leadership and the positive management of change
  • Steve Onyett
  • Senior Development Consultant- CSIP SW/
  • Visiting Professor- UWE
  • Steve.onyett_at_nimhesw.nhs.uk

Just part of the challenge
  • At the local level, joint action to support
    health and well-being needs to be driven through
    strong effective leadership within PCTs and local
    authorities These changes, .. should facilitate
    better joint working. They need to be backed by
    strong leadership at chief executive and board
    level, and by individuals who have clear
    responsibilities for improving peoples health
    and well-being. (Our health, our care, our say
    2.53, 2.54).

The nature of change required
  • Social care and primary health care services are
    embedded in our communities. They are part of the
    pattern of our daily lives. We will shift the
    whole system towards the active, engaged citizen
    in his or her local community and away from
    monolithic, top-down paternalism (1.39).

From - Plsek, P. Complexity, culture and large
systems change presentation
Source Brenda Zimmerman, PhD
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 its behaviour
  • How do we get to know what other perspectives
    there are on this issue and how do we understand
  • How can we learn what is most effective here for
    ourselves? How would we know?
  • What relationships are key to moving forward and
    how can we nurture them?

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.
  • Leadership should not be determined by position

  • The soft stuff is
  • The hard stuff

Organisational culture is
  • the norms and expectations regarding how people
    behave and how things are done
  • It includes implicit norms, values, shared
    expectations, and assumptions

From Paul Bate. A receptive context for change.
What we know about organisations that provide a
receptive context for change.
Constructive and defensive cultures in mental
health services
  • Constructive cultures are those characterized by
    organizational norms of individualism and
    supportiveness. Constructive cultures encourage
    interactions with people and approaches to tasks
    that will enable staff to meet their higher-order
    satisfaction needs.
  • Defensive cultures are characterized by norms of
    conformity and submissivenessencourage or
    implicitly require interaction with people in
    ways that will not threaten personal security

Organisational climate is
  • a global impression of ones organization and
    personal impact of the work environment, which
    influences the individuals work behaviours and
    job-related attitudes
  • Includes emotional exhaustion, personal
    accomplishment, job satisfaction, organisational


So what?!
  • organizational culture had both direct influence
    on work attitudes job sat and commitment and
    indirect influence through organizational climate
    e.g. emotional exhaustion and depersonalisation.
  • Work attitudes significantly predicted one-year
    staff turnover rates. These findings support the
    contention that both culture and climate impact
    work attitudes and subsequent staff turnover.
  • Aarons and Sawitzky, 2006

Aarons, G. A. and Sawitzky, A. C. (2006)
Organizational Climate Partially Mediates the
Effect of Culture on Work Attitudes and Staff
Turnover in Mental Health Services.
Administration and Policy in Mental Health and
Mental Health Services Research
ToolSpider ChartAssessment of current culture
for innovation
Group 1
Group 2
Group 3
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Trusting Relationships
Shared Vision
Conflicting Needs
Shared Values
Clear Communications
Reliable Information
Complex/Poor Data
Lack of Time / Prior Experience
Distrusting Relationships
Source Richard Lauve, MD (VHA Inc.)
Systems failure- Chapman, 2004
  • A key insight from systems theory is that
    different individuals and organisations within a
    problem domain will have significantly different
    perspectives, based on different histories,
    cultures and goals. These different perspectives
    have to be integrated and accommodated if
    effective action is to be taken by all the
    relevant agents.
  • This insight conflicts directly with the command
    and control culture that dominates government and
    public administration. The use of command and
    control inevitably fails within complex systems
    and alienates people by treating them

In his powerful Critique of Cynical Reason,
Peter 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
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

From An opportunity to learn more about
Appreciative Inquiry Presentation by Anne Radford
We manifest what we focus on and we grow toward
what we persistently ask questions about
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
It should not deny issues of power and inequality
..and is respectful of peoples realities as
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 where this
    is modelled and enacted

The 2004 NHS National Staff Survey
  • 91 of staff (up from 89 in 2003) responded
    positively when asked Do you work in a team?
  • However this shrunk to 43 (compared to 41 in
    2003) when the survey explored whether the team
    in question fulfilled criteria for a well
    structured team

Real teams
  • Less than 10 members
  • Need to work together to achieve their task
  • Have different and defined roles within the team
  • Have a team identity

Effective teams have..
  • The minimum number of team members required to
    get the job done.
  • Clear aims
  • Participation in decision making
  • Norms for excellence
  • Support for innovation

  • When it comes to understanding organisational
    existence from the perspective of human action,
    the is no better clue to a systems overall
    well-being than its guiding image of the future
  • Srivastva and Cooperrider, 1999

Have the right team leading right
  • The most common reason for failure of large
    systems to change is the failure of the senior
    leadership team to function as an effective team
    with the right balance of skills, healthy
    relationships, and deep personal commitment to
    the achievement of the goals
  • (Reinertsen et al, 2004, p.3).

Four Column Matrix
Strategic Goals
System Level Measures
National Targets
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
Establish a system-level vision for improvement
with ambition and commitment.
  • Leaders need to commit personally to these aims.
    This means taking a stand and framing the
    objectives as promises to users and the people
    that support them.

Aims framed as promises to users
Aims framed as promises to users
Jake Chapman on Systems Practice- to quote
  • interventions would be ongoing and based upon
    learning what works, rather than specifying
    targets to be met
  • the priority would be to improve overall system
    performance, as judged by the end-users of the
    system not just by ministers or civil servants

Jake Chapman on Systems Practice- to quote
  • the policy-making process would focus on the
    processes of improvement, rather than the control
    of the agencies involved
  • engagement with agents and stakeholders would be
    based more upon listening and co-researching than
    on telling and instructing responsibility for
    innovation and improvement would be widely
  • implementation would deliberately foster
    innovation and include evaluation and reflection
    as part of the overall design.

  • These days, what managers desperately need is to
    stop and think, to step back and reflect
    thoughtfully on their experience. events or
    happenings, become experience only after they
    have been reflected on thoughtfully
  • Jonathan Gosling.
  • The Five Minds of a Manager. Harvard Business
    Review. 2003

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
  • Funded by Leadership Centre and rolled out by
    CSIP Development Centres

Key features
  • Working across boundaries
  • Leadership linked to improvement and the task in
  • An emphasis on clarifying shared objectives and
  • Developing a shared experience of the users
  • Using tried-and-tested models for improvement
    those based on clinical know-how- e.g. solutions
    focus, motivational interviewing

The effective teamwork and leadership programme
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Does it work? To quote
  • Overwhelmingly, participants response to the
    day-by-day 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).

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