shift local cultures Frances Wiseman, Assistant Director, - - PowerPoint PPT Presentation

The power of clinical leaders to shift local cultures

Frances Wiseman, Assistant Director, Improvement, the Health Foundation Dr Liz Wiggins, Associate Professor Change and Leadership, Ashridge Business School

Our intentions for this session

• Encourage you to rethink some of your assumptions about culture,
• rganisations and leadership
• Explore why culture matters and how leaders can shift local cultures
• Share examples of how fellow leaders have shifted their local cultures
• Encourage you to consider what gestures you might make to shift the

culture where you work

GenerationQ

Leadership Development Fellowship Programme commissioned since 2011 The Health Foundation & Ashridge / Hult Business School Network of 126 senior leaders across health and healthcare skilled in leadership of improvement

Talk to your neighbour

And have a few minutes conversation about something that went well at work last week….

Why should culture matter to you as leaders?

• Impacts mood and atmosphere
• Impacts performance and explains why some organizations, and parts of
• rganizations, perform better than others
• Shapes behaviour through beliefs about what we can and can’t do
• Impacts discretionary effort and energy employees are willing to offer
• Contributes to ‘stuck’ patterns of working and unhelpful rituals, processes

and routines to continue unless there is a shift

What is culture?

• Not a thing that can be managed
• Patterns of behaviour between people that have been established over time
• Patterns reinforced and amplified by visible artefacts
• People experience and interpret the meaning of patterns and artefacts

differently

Local cultures

• Easy to get tripped up by the way we talk: ‘generalised other’
• We talk about the culture of the NHS or the culture of the organisation – just

because we have one word for it doesn’t mean it exists as a single thing

• Cultures will differ across wards, teams, different professional groups, sites

and departments

• Local cultures matter and can be fluid and shifted

Re-thinking organisations and leadership

• Machine thinking influences how we understand organisations
• It’s the dominant discourse in the NHS
• Emphasis on standard procedures, hierarchy, job specifications,

positional power and directive approach from the top

• Through this lens, change can be ‘managed’
• Leaders are supposed to be heroes who are in control and responsible for

everything.

A clinician reflects on machine thinking..

‘’Everyone has a 'line manager', we have 'theatre production control' meetings and have to meet monthly 'productivity targets' whilst producing 'performance and efficiency' savings. Our business is the care and treatment of patients and their families, yet we try to fit them into boxes and give 'standard care' according to 'protocols’. We try to squash them in to a production line, which is linear. There often seems to be abrogation of responsibility once anything but this is in keeping with the dehumanisation of individuals when considered as a machine part, and encouraged by the mentality that orders come from above and they are just there to do what they are told.’ GenQ Fellow

Machine thinking and managing change

Machine thinking common for clinicians

‘It seems to me that the machine way of thinking is ingrained into clinicians during their training…and clinical leaders may therefore transfer this mode

• f thinking and acting into their leading.

I was trained as a diagnostician: I would gather the evidence (symptoms), decide what was the cause (diagnose) and implement a change as a remedy (prescribe). Therefore as the medical leader, I assumed that I could identify mechanistically the fault with the system and put in a fix ’. GenerationQ Fellow

01.01. 17 Title of Presentation

Shadow side of machine thinking

“If you treat others as the audience for your performance, then they will applaud from time to time – or throw rotten eggs – but they are unlikely to get up on stage and help you.” Binney (2012)

• In terms of leadership:
• Everything falls on the leader
• Others are passive
• Stress and pressure
• Imposter syndrome

And best laid plans…

Complexity thinking

• Derived from complexity sciences and idea of non linear relationships

that cannot be predicted

• Organizations are communities of people interreacting and relating in

non linear ways

• We can’t predict what people will do or how they will interpret our gesture
• Small gestures can create tipping points
• Leaders are in charge but not in control

Change more akin to starling murmurations

Initially discombobulating

‘I felt disturbed by the idea of complexity thinking. It seemed to beg the question “why bother?” If the organisation only exists within the personal interactions of individuals, what is the role of the leader and what is the purpose of leadership? What had I been doing with my life so far?’ GenQ Fellow

Patterns you might see in your local culture

• Deficit versus appreciative
• Leaders are responsible and everyone else is passive
• Debate rather than dialogue
• Parent – Child versus Adult - Adult
• Competition versus collaboration
• Them and us

Over to you….

• What resonates or intrigues you

about the ideas we have shared?

Implications for you as leaders

• You as a leader are in charge but not in control
• You have a choice about what you do and say which shapes your local

culture

• Your gestures will lead to a response in others – and you cannot control

their response

• Small shifts can have significant impact in creating new patterns than

are more conducive to patient safety and person centred care

• All of us are leaders and all of us have the ability to shift our local

culture

Interested in exploring these ideas more?

• Relational Change published 2017
• May 2018: two books being published

containing clinical leaders’ stories

• Beyond the Toolkit: Stories of leading QI
• Hope Behind the Headlines. Stories of

local leaders shifting cultures in the NHS

GenerationQ Cohort 8 starting May 2018 Open for applications 27 November 2017 Please visit the Health Foundation stand to find out more or visit www.health.org.uk/generationq

Stay in contact…

Frances Wiseman Frances.wiseman@health.org.uk @frances_wiseman Liz Wiggins Liz.Wiggins@ashridge.hult.edu @lizwigginsBM

Thank you