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CLINICAL LEADERSHIP What is it, why is it important and how do we learn to lead?

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CLINICAL LEADERSHIP What is it, why is it important and how do we learn to lead?

Professor Tim Swanwick

Dean of Postgraduate Medical Education Health Education North Central and East London

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There is no ‘them’. There’s only ‘us’

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CLINICAL LEADERSHIP What is it, why is it important and how do we learn to lead?

Professor Tim Swanwick

Dean of Postgraduate Medical Education Health Education North Central and East London

www.hee.nhs.uk www.ncel.hee.nhs.uk

process of influence

LEADERSHIP

group context

goal attainment

A process whereby an individual influences a group of individuals to achieve a common goal Northouse, 2004

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for enabling others to achieve shared purpose, in the face of uncertainty.

Marshall Ganz,

Kennedy School of Government Harvard

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SURFACING ASSUMPTIONS

• Leadership is about individuals

• Leadership is about systems

• Leadership and management are different, distinct and tied to positions

• Leadership is for those at the top

• Leadership is at ‘all levels’

• Leadership is about command and control

• Leadership is about collaboration and participation

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There is nothing so practical as a good theory

Kurt Lewin, 1951

Adaptive leadership Engaging leadership

Affective leadership Leader-member-exchange (LMX) theory Authentic leadership Ontological leadership

Charismatic leadership, narcissistic Phenomenological leadership Complex adaptive leadership Relational leadership Collaborative leadership Servant leadership Contingency theories Situational leadership Dialogic leadership Trait or ‘Great Man’ theory Distributed, dispersed (shared) leadership Transactional leadership

Eco-leadership Transformational leadership

Emotional intelligence (EI) Value-led, moral leadership

LEADERSHIP THEORIES, CONCEPTS AND MODELS

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MAKING SENSE OF LEADERSHIP THEORY

1. Theories that focus on the personal qualities or personality of the leader as an individual

2. Theories relating to the interaction of the leader with others 3. Theories which seek to explain leadership behaviours in relation to

the environment or system

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1. Personal qualities/personality

• ‘Great man’ theories - position, heredity, religion - ‘heroic leader’

• Trait theory, emotional intelligence

• Personal qualities of a leader

• Personality

• Authentic, fallible, value-led, affective (emotional labour)

• Wise leader

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2. Interaction of leader with others

• Transactional leadership

• Leadership styles

• Situational leadership

• Transformational leadership

• Relational, dialogical

• Followership

• Power relations, authority and control

• Servant leadership

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3. Leading systems

• Adaptive leadership

• Metaphors or ‘frames’

• Complexity and systems theories

• Leaders as change agents

• Building social capital

• Shared, distributed, dispersed, collaborative

• Eco-leadership

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CLINICAL LEADERSHIP What is it, why is it important and how do we learn to lead?

Professor Tim Swanwick

Dean of Postgraduate Medical Education Health Education North Central and East London

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www.hee.nhs.uk www.ncel.hee.nhs.uk

Employee engagement and NHS performance

Michael A West, Lancaster University and Jeremy F Dawson, University of Sheffield, The King’s Fund 2012

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Overall engagement by Annual Health Check performance

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CLINICAL LEADERSHIP

Greater freedom, enhanced

accountability and empowering staff are necessary but not sufficient in the pursuit of high quality care.

Making change actually happen takes leadership. It is central to our expectations of the healthcare professionals of tomorrow.

High Quality Care for All, 2008

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CLINICAL LEADERSHIP

We will empower health

professionals. Doctors and nurses must to be able to use their professional judgement about what is right for patients. We will support this by giving frontline staff more control. Healthcare will be run from the bottom up, with ownership and decision-making in the hands of professionals and patients.

Equity and Excellence, May 2010

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adopt and demonstrate a shared culture in which the patient is the priority in everything done. This requires: A common set of core values and standards shared throughout the system; leadership at all levels from ward to the top of the Department of Health, committed to and capable of involving all staff with those values and standards…

Recommendation 2 - Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry February 2013

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The health and care system must change. We cannot merely tinker around the edges – we need a radical overhaul with high quality care and compassion at its heart.

Government Response to Francis DH 3rd April 2013

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CLINICAL LEADERSHIP What is it, why is it important and how do we learn to lead?

Professor Tim Swanwick

Dean of Postgraduate Medical Education Health Education North Central and East London

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PREVAILING THEMES

Evolution in thinking about:

• The educational approach – from training to development

• Where learning is situated

– from the classroom to the workplace

• How career development is considered

– balancing organisational and individual needs

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1. From ‘training’ to ‘development’

‘The transformation paradigm…emphasizes co-creation, interpretation, discovery, experimentation and a critical perspective. Rather than learning leadership as it is known by others, learners make sense of their own experiences, discover and nurture leadership in themselves and in each other, not in isolation but in community’

Antonacopoulou EP (2004) Methods of 'learning leadership': Taught and experiential. In: Storey J (ed.) Leadership in organizations:

Current issues and key trends (pp. 82-102). Routledge, Abingdon

.

2. From the classroom to the workplace

Learning about 20%

self from others

Courses 10%

Project work 70%

Learning about self from others 20%

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TRENDS IN LEADERSHIP COURSE DEVELOPMENT

West and Jackson, 2002

Longitudinal programme Theory applied to practice Participation

A group with a purpose Co-designer

One-off event Theoretical course Lectures Individuals Supplier

3. Balancing organisational with individual needs

Who?

What?

Leadership development

targeted at individuals Leadership development offered across the

organisation

Individualized content

High performing individuals are nurtured through tailored programmes

Open opportunities provided for development but left to self-direction of the individual

Consistent content

Planned activities for specific groups are driven by the needs of the organisation

Organisation-wide provision is cascaded down and available to all

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WHAT INTERVENTIONS WORK?

Courses, seminars,

workshops Action learning Multi-source feedback

Simulation Psychometric tools Structured workplace experiences

E-learning Coaching and mentoring Project work

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Enable personal development

Be work and action orientated

Develop practical skills Link theory to

practice Build networks An effective leadership development programme should…

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FMLM provides a professional home for doctors and dentists from all career stages and specialities with an interest in leadership and management. Through this we sustain a vibrant community that supports members in their aspirations to develop and enhance their leadership, management and team working skills and networks. FMLM aims to promote and support excellence in medical leadership and management and influence health policy for the benefit of patients and the population through advocacy; by developing professional standards; and by giving members access to key resources.

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Vision To be a centre of excellence and beacon of best practice on leadership

development, owned by the NHS and working for all those involved in NHS funded care.

Mission To develop outstanding leadership in health in order to improve people’s health and their experience of the NHS.

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1.3M NHS staff

700 000 clinical professionals

146 000 doctors

50 000 doctors in training

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• Healthcare is delivered by teams and systems, not by clinicians working in isolation

• The purpose of clinical leadership is to sustain and improve the quality of patient care

• Doctors have a unique leadership role to play

• Leadership is everyone’s responsibility

• Opportunities for development are everywhere

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