Title: Positive leadership, true team work and values in action for effective patient care
1Positive leadership, true team work and values in
action for effective patient care Michael
West Aston Business School Clinical Leaders
Network NHS LondonĀ Tuesday 21st March
2Three areas of research
- HRM patient mortality
- Nature of team working
- Team working links to outcomes
- Leadership
- Leadership links to patient other outcomes
3HRM 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
4Patient 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
5Control 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
6Results
- 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)
7Causal 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
8Effect 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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10Real 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?
11Working 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?
12Team working in Primary Care Trusts
13Working in Teams and Job Satisfaction(170 acute
trusts, 120,000 respondents)
www.nhsstaffsurveys.com
14Working in Team and Errors, Stress and Injury
www.nhsstaffsurveys.com
15Working in Teams, Harassment and Violence
16Data 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
17Team functioning and patient satisfaction
3.3
3.2
3.1
Clarity of objectives
3
Reflexivity
Patient experiences
Support for innovation
2.9
2.8
2.7
Low
Moderate
High
Team functioning
18Teams and organisational performance
- Annual Health Check 2007 extent of team
working
19Team processes
- Participation
- Support for innovation
- Clarity of objectives
- Emphasis on quality
- Reflexivity
20Team processes
- Participation
- Support for innovation
- Clarity of objectives
- Emphasis on quality
- Reflexivity
21Our 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
22ABS 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
23Three 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
24Three 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
25Organisational 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
26Leadership
- 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
27Results
- Leadership ratings related significantly to all
four outcomes
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29Summary
- 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
30A 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
31Positive 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.
32Positive 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)
33Positive 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.
34Positive 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
35Positive vs negative aspects of relationships
- Expressions of affection (especially by husbands)
predict marital satisfaction - Role of positive feedback in organisations
36The Psychology of Human Strengths
- Wisdom and Knowledge
- Courage
- Humanity
- Justice
- Temperance
- Spirituality and Transcendence