Pilot Training Programme Delivered To Mental Health NHS Trusts. MAY 2014 Report Number: NHSE007 PSYCHOLOGY WITH BUSINESS IN MIND

Transcription

1 REPORT 01 Supportive Leadership & Management Behaviour Training Pilot Training Programme Delivered To Mental Health NHS Trusts MAY 2014 Report Number: NHSE007 PSYCHOLOGY WITH BUSINESS IN MIND

2 CONTENTS CONTENTS EXECUTIVE SUMMARY 3 A training intervention to develop supportive leadership behaviour 3 The positive impact of this training on leaders 3 BACKGROUND: THE IMPORTANCE OF LEADERSHIP WITHIN THE NHS 3 A training intervention to assist with leadership development 6 Programme evaluation 9 The evaluation criteria 10 EVALUATION RESULTS: THE IMPACT OF THE SBT LEADERSHIP TRAINING PROGRAMME 12 Leadership capability (Confidence) 12 Changes in behavioural awareness 13 Post training reactions (Quantitative) 15 Post training reactions (Qualitative) 16 Positive impact of the supportive leadership training 17 4 CLOSE SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

3 1 - EXECUTIVE SUMMARY Leaders play a critical role in the determining the success of the NHS. Research conducted within the NHS has demonstrated that supportive leadership is critical for promoting individual and organisational health, performance and effectiveness. Considering the benefits, what does supportive leadership look like and how can this be developed and promoted within trusts? These questions formed the main objectives of this project. A TRAINING INTERVENTION TO DEVELOP SUPPORTIVE LEADERSHIP BEHAVIOUR Commissioned by the NHS Employers and delivered by Zeal Solutions, this project set out to develop a training intervention that would help to cultivate and raise awareness of the importance of supportive leadership behaviour. Working closely with five Mental Health NHS trusts, a pilot train the trainer programme was designed and provided each participating trust with: A one day training programme to be delivered to local leaders/managers A resource pack to support trainers in their delivery of the training Access to an online system to enable trainers to administer the training Access to an online 360 developmental tool to assess supportive leadership Access to articles and other resources to support trainers and leaders/managers SUMMARY The training intervention was evaluated so that the impact and effectiveness of the training could be determined. Each pilot site agreed to train a minimum of 50 delegates to enable an adequate level of evaluation data to be collected. THE POSITIVE IMPACT OF THIS TRAINING ON LEADERS In total, 272 delegates were trained from across the five participating Mental Health Trusts. Following their attendance at the training, leaders/managers were found to have: Significantly higher levels of confidence in their own ability to deal with a range of work-based situations or scenarios Significantly higher levels of awareness of range of supportive and unsupportive behaviours and increased awareness as to how these can be applied to various work-based situations support@zealsolutions.co.uk Telephone:

4 SUMMARY Significantly higher levels of understanding of the impact supportive and unsupportive behaviours and increased understanding as to how these can influence the outcomes of various work-based situations In addition, the leaders/managers attending reacted very positively to the training with the majority of the delegates reporting the training as: Highly relevant to their jobs (88%) Realistic and in line with their work contexts (85%) Qualitative comments received from leaders were equally positive highlighting the realism and necessity of this type of training for NHS trusts. The beneficial impact of the training, and the overwhelmingly positive responses to it, has resulted in the decision to make this training available to all Mental Health trusts from June SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

5 2 - BACKGROUND THE IMPORTANCE OF LEADERSHIP WITHIN THE NHS What makes leadership 1 in organisations effective? This is a fundamental and practical question that continues to challenge those who are interested in leadership. Our own and more general research has shown that to be effective, leaders must be able to motivate and direct followers towards group or organisational goals and be able to maintain stability and group harmony. Across the NHS, leadership is a very topical issue at the moment. A quick search on the internet will bring up a number of news articles, blogs and papers that relate specifically to leadership in the NHS. Recent reports published such as the Kings Fund, Francis Report and Keogh report have revealed the devastating implications of poor leadership within the NHS and have provided evidence of the need for developing effective leaders. The recent changes within the NHS mean that it is a particularly crucial time for the NHS to review its current leaders and to recognise the value of effective leadership. Research has shown that effective leaders are those who: Are resilient Handle stress well Promote and translate vision Help to solve problems Set high goals and work hard Are self-confident but not arrogant Work at building relationships Work hard to build teams Follow through on commitments Treat people fairly Plan and organise work BACKGROUND While the list above does not provide a guarantee of success, these elements do help to improve the odds of building high performing teams that achieve results. Now, the key for many NHS organisations is to help their leaders to develop a better understanding of what effective looks like and to help them to achieve performance outcomes in a tangible, practical and immediately beneficial way. There are important lessons to be learnt about leadership within the NHS. From the recent reviews and reports, it is evident that the role that leaders play is critical for the success of the NHS as a 05 1 In this report the term leaders and managers are used interchangeably. Although we acknowledge the very active debate regarding the similarities and differences between leaders and managers, in our view the similarities outweigh the differences. It is for this reason that the intervention that has been designed applies equally to leaders as it does to managers. support@zealsolutions.co.uk Telephone:

6 BACKGROUND whole, as well as having significant and diverse impacts on staff and patient well-being, patient care and performance outcomes. Having an understanding and awareness of the current evidence and research can allow us to reflect upon our own organisation and explore where there are local lessons to be identified. For example, Dame Ruth Carnall DBE, former Chief Executive of NHS London, commented on the qualities that are important for leaders based on her 37 years experience within the NHS. Amongst other things, she cites resilience as playing an important role as well as being open to new ideas and being able to say sorry and thank you. Although these qualities may seem obvious, there is growing recognition that the behaviour of a leader can be a crucial factor in determining the well-being and performance of staff and the organisation. A training intervention to assist with leadership development Our research has established that when leaders are considered to be, among other things, more supportive, they a) are also considered to be more effective by their staff, b) have staff that are happier and more engaged, and c) are also considered to be fair. As a direct result of this and more general research, it was concluded that there is a clear need to enhance supportive leadership behaviour across the NHS more generally. The NHS Employers commissioned Zeal Solutions to pilot a supportive manager and leader behaviour training programme within five Mental Health trusts. This training targeted Mental Health trusts specifically due to the their increased levels of sickness absence. Further information about the programme and the approach is outlined below. The training intervention The training that was delivered to the pilot sites was in the form of a train the trainer programme that enabled each Trust to deliver the training within their local environments. The aim of the training MoU was as follows: 1. NHSE and Zeal Solutions Limited will jointly train 2 representatives from each trust The Train the Trainer will be a two day programme. Trainers will receive training on (1) how to deliver the SBT management training;(2) how to use the SBT system to support the training; (3) how to use, interpret and provide feedback to managers using the integrated management behaviour assessment tool; (4) how to support the evaluation of the pilot SBT management behaviour training programme; and (5) how to access support from SBT specialists should this be required. 3. Zeal solutions will be responsible for the evaluation of all trusts before and after the training is delivered to ensure robust evaluation of the pilot. SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

7 4. Each trust will then be required to deliver a minimum of four, one day training sessions (one day per session) within an agreed period for the pilot. 5. Each trust will be supported throughout the process by NHS Employers. As shown below, there were three broad objectives of the training. These objectives were met by trainers delivering a series of activities and exercises using scenario based videos and other types of exercises as part of a one day training programme. 1. Increase awareness and importance of everyday manager/leader behaviour. 2. Reflect on your own potential leadership/manager behaviour. 3. Develop a plan to action supportive behaviour in your own work situation. An integrated model of leadership Although the programme itself was designed to increase supportive leadership behaviour, helping leaders to become more aware of their own performance and the factors that can influence their performance was integral to the success of this training intervention. Leaders were therefore introduced to the model of human performance that is shown below in Figure 1. Figure 1 The interactive nature of personal, environmental and behavioural factors PERSONAL BACKGROUND MANAGEMENT/ LEADERSHIP EFFECTIVENESS 07 ENVIRONMENTAL BEHAVIOURAL support@zealsolutions.co.uk Telephone:

8 BACKGROUND The supportive leader behaviour module is built upon the principle that human performance in any given situation is the culmination of three components that interact with and influence each other. These components are what we call 1) Personal Factors; 2) Behavioural Factors; and 3) Environmental Factors. The use of this model helps leaders to understand that no one component can be isolated from the other, and knowledge of all three is crucial to understanding human behaviour, learning and performance. As shown above, these three components/factors act in a constant cyclical pattern, interacting with each other and dictating human behaviour. It also helps leaders to realise that the performance of their staff is similarly influenced by these factors. By developing a greater understanding and appreciation of these factors, leaders can begin to target any specific areas for personal development and also apply the model to develop those they lead using a common framework and language. In addition, and to enable leaders to develop a greater understanding of their own personal, behavioural and environmental factors, the training programme was also offered with a 360 assessment called the SMBI. The SMBI enables leaders to seek feedback on their own approach from their staff, their peers and their managers. This process results in a personal feedback report that can be used to plan their personal development. Supported with resources The leadership training is not a standalone programme. Each site is provided with additional resources and/support to increase the probability of the success of the programme. For trainers Trainers who attend the train the trainer programme also received the following benefits: High quality trainer resource pack to support knowledge development Pre-delivery coaching User support Evaluation support 08 Administration access to an online system to support the delivery of the training intervention including a 360 assessment Access to resources (articles, action learning sets, and other resources) associated with the domain/topic Attendance at user design groups A certificate for completing the training SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

9 For managers Managers who attend the training also receive the following benefits: Access to resources (articles, action learning sets, and other resources) associated with the domain/topic Access to a 360 development tool User support Programme Evaluation Evaluating the impact and effectiveness of the programme was an important part of this project. As shown below, the SBT is being evaluated in multiple ways: 1. Reviewing the responses that have been recorded on the evaluation questionnaires completed before and after training (and in a transfer survey that will be issued to a sample of managers). 2. Reviewing the responses that managers record against pre and post scenarios assessed through the SBT system 3. Reviewing any change in the responses recorded through the SMBI (360 behaviour assessment) 4. Reviewing any impact of the SBT management development training on measured organisational outcomes This report summarises the results from reviewing and where possible - comparing pre and post evaluation questionnaires (Figure 2) with the elements that are measured before and after training listed in Table 1. BACKGROUND BEFORE (PRE) TRAINING QUESTIONNAIRE TIME 1 SBT MANAGEMENT DEVELOPMENT TRAINING IMMEDIATELY AFTER (POST) TRAINING QUESTIONNAIRE TIME 1 09 Figure 2 Illustrating the evaluation process for the SBT management development programme support@zealsolutions.co.uk Telephone:

10 BACKGROUND The Evaluation Criteria One of the most important questions for any training intervention is how to assess the impact or effectiveness of any programme? This is also known as the criterion question. Although there are many possible criteria to assess when evaluating training interventions, this report focuses on three kinds of criteria that were measured and assessed using the pre and post training questionnaires. Perceptions of leadership capability Considering the aim of most training programmes is to enhance awareness and skill, improving the sense of confidence (or perceived capability) that managers and leaders have in dealing with their staff should be an important aim of any manager or leadership training intervention. In short, individuals who report higher levels of capability perceptions to deal with specific situations also report, amongst other things: Increased levels of motivation Higher levels of job satisfaction Higher levels of organisational commitment Higher levels of optimism about their job role Increased levels of work engagement Reduced levels of work-related stress Lower levels of quitting intentions It is for these reasons that leadership capability is used as one of the key criterion against which to evaluate the SBT supportive leader and management behaviour training. These findings highlight the importance of perceptions of capability both in general and also for dealing with specific situations (e.g. management / leadership situations). It is for this reason that capability is included as one of the key criterion against which to evaluate the SBT supportive manager and leadership behaviour training module. 10 SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

11 Perceptions of manager/leadership behaviour A key aspect of this training is to enhance awareness and to increase understanding of what constitutes supportive and unsupportive behaviour among leaders. In addition, this training is to be used to help leaders to understand the impact of their behaviour and how behaviour can be changed to improve employee health and performance. Our research has highlighted a number of behaviours that are indicators of supportive and unsupportive behaviour. Therefore, it is important to assess if and how leadership perceptions of behaviour change over time and as a direct result of attending this particular training programme. Delegate/Trainee perceptions of the leader behaviour were assessed before and after the training. General reactions towards the training Finally, the delegate s experience of the training is also important to monitor. While these indicators do not indicate whether and how the training has influenced the delegates (this is covered by the previous criteria), trainee reactions about the training provide insight into the overall quality of the training as well as the impact of the trainer. Trainee reactions to the training were assessed in the post-training questionnaire. BACKGROUND support@zealsolutions.co.uk Telephone:

12 3 - EVALUATION RESULTS RESULTS THE IMPACT OF THE SBT LEADERSHIP TRAINING PROGRAMME This section provides a summary of key results measured before and after training. In total, we received 272 matched evaluation forms from across the five NHS pilot sites. This number exceeded the target of 250 matched cases that was required for this project. Below is a summary of the key results from the analysis of the evaluation data that was collected. Leadership capability (confidence) Leadership capability is assessed using a five item scale. Each item assesses the confidence with which leaders believe they can deal with various scenarios. As shown below the scale range is from 0 (no confidence) to 10 (complete confidence). Leaders are asked to assess their confidence to deal with specific workplace situations/scenarios. Each scenario is described in detail in the evaluation survey, for the purpose of this report a summary of the scenario domain is provided below in Table 1. Scenario Domain Before Training After Training Significant Difference Dealing with team conflict YES P<.001 Dealing with staff sickness absence YES P<.001 Dealing with organisational change YES P<.001 Dealing with violence and aggression YES P<.001 Dealing with poor communications YES P< Information: Scale range: Minimum = 0 (not at all confident) and Maximum = 10 (completely confident) P< there is less than a 1 in 1000 probability of such an increase in perceived capability happening by chance Table 1 Summary of scores on leader/manager capability perceptions before and after training As shown in Table 2, scores on all scenario domains improved by the end of the training. In addition, when assessed statistically, the improvements in scores were statistically significant indicating a real effect of the training on leader/manager perceptions of their ability to deal with SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

13 the various situations. The five leader capability survey items can be aggregated to enable an overall leader capability score to be calculated. Using the data from across all pilot sites, Figure 3 below depicts the trend line in leadership capability from before to after training. Impact of training on: Leadership capability perceptions Leadership Capability Before Training Time of measurement Figure 3 Change in capability perceptions over time (N=272 Scale Range 0-50) After Training Significant p<0.001 RESULTS These results demonstrate that the training is significantly increasing the level of capability that managers believe they have to deal with the various situations that they face in both a supportive and effective manner. It remains to be seen whether or not the benefits from the training are maintained over time. This can only be determined through a follow-up assessment with the delegates. A follow-up assessment is being planned with all pilot sites. Changes in behavioural awareness A key aspect of this training is to also help managers/leaders become more aware of supportive and unsupportive behaviour as well as to develop a more informed understanding about the impact that certain behaviours can have on employee health, well-being, motivation and performance. To assess any change in awareness and understanding, delegates were asked to rate 17 behaviours in terms of how supportive or unsupportive they considered each behaviour to be. Assessments of behaviour were provided both before and immediately after the training. The 17 behaviours can be grouped into three main categories as shown overleaf in Figure 4. An example behaviour is also provided for information support@zealsolutions.co.uk Telephone:

14 RESULTS Positive or supportive behaviour Encourages staff to share their views Figure 4 Behavioural categories assessed before and after training. The before and after training scores on the three behavioural categories are shown below in Table 2. Behavioural Category Positive or Supportive Behaviour Performance and Target Management Negative or Unsupportive Behaviour Information: Performance and target management Sets demanding expectations for their staff Before Training Negative or unsupportive behaviour Encourages staff to share their views After Training Significant Difference YES P<.001 NO YES P<.001 Scale range: Minimum =1 (Very Unsupportive) and Maximum = 7 (Very Supportive) P< there is less than a 1 in 1000 probability of such a change happening by chance Table 2 Scores on the behaviour categories before and after training It can be seen from Table 2 that: 1. At the end of the training, delegates perceive the positive behaviours as being more supportive than they perceived them to be at the start of the training. This change in awareness and understanding of the impact of the supportive behaviours was found to be statistically significant At the end of the training, delegates perceive the negative behaviours to be more unsupportive than they perceived them to be at the start of the training. This change in awareness and understanding of the impact of the negative behaviours was also found to be statistically significant. 3. Scores on the behaviours that were associated with performance management and target setting did not change as a result of the training and remained neutral (i.e. at the scale mid-point). SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

15 These results offer a great deal of promise in that they demonstrate the approach to the training assists leaders and managers to appreciate, with greater understanding, both the positive and the negative impact of supportive and unsupportive behaviours. Post training reactions (Quantitative) A series of trainee reactions are also measured as part of the evaluation process. Although, and on their own, trainee reactions do not provide a rigorous assessment of any training programme, they are useful indicators of training quality. Reactions which are of importance for this training are associated with: 1. How useful delegates found the training? 2. How relevant did they consider the training to be? 3. How realistic was the training for their needs? 4. Do delegate s feel motivated to apply their learning on the job? 5. Did delegates feel they had ample opportunity to share experiences with colleagues? 6. Were the trainers considered confident? RESULTS Table 4 below provides a summary of the scores on these indicators for all the pilot sites combined. Reaction Indicator Strongly Disagree Disagree Neutral Agree Strongly Agree I really enjoyed this training I found the training of relevance to my job I am keen to apply the learning from this training I found the training realistic There was adequate opportunity to share experiences The trainer/s were confident in their delivery Table 3 Percentage distribution of scores on 6 reaction indicators (N=272) support@zealsolutions.co.uk Telephone:

16 RESULTS 16 As shown in Table 3, a majority of delegates have reacted positively to the training. In summary, 88% of delegates enjoyed the training 88% of delegates found the training to be of relevance to their jobs 86% of delegates reported they are keen to apply the learning from the training 85% of delegates found the training to be realistic 86% of delegates indicated that there was ample opportunity to share experiences 91% of delegates indicated that the trainers were confident in their delivery These reactions are indicators of the commitment of the trainers who participated in this project and worked hard to make this project a success. The fact that 91% of delegates rated the trainers as confident also suggests the approach used for training trainers was a success. These reactions are validated by the qualitative comments that were offered by delegates after the training a sample of which have been summarised below. Post training reactions (Qualitative) A sample of the qualitative feedback from managers is also provided below: Scenarios very realistic and helpful in framing discussion. Good flow in relation to reflecting on other people s behaviours/experiences and impact on role before evaluating Really enjoyed the videos clear and very realistic Very inspiring at present time. Having the opportunity to reflect upon personal strengths and weaknesses has been very refreshing. I was uncertain as to what this training would involve but have found it very thought provoking and challenging. Excellent. Well delivered. Met expectation. Clear goals + expectations. Follow up support offered. Enjoyed the training, looking forward to complete 360 assessment to see how I can develop my leadership skills. Range of activities makes the learning experience more enjoyable, felt these were well incorporated into the day. Thank you. Would be useful to include all grades of staff as a target audience as some of the best leaders are not always in a management role. Need to be supported by all for it to work and applied in practice. Very good training. It has given me lots of ideas. Really enjoyed training. Very useful. Keen to do further training in same style/trainers/format. Many thanks, this should have been done a long time ago. It is important to note that evidence is still being gathered from both pilot and existing NHS sites which will help with a 'fuller' evaluation in the future. SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

17 LEADERSHIP AND MANAGEMENT BEHAVIOUR Positive impact of the supportive leadership training These results indicate that delegates consider the training to be relevant to their job role and they report an increased level of motivation to transfer their learning to the job. In addition, delegates found the training to be enjoyable and report it to be of a high quality. In addition, it can also be seen that the training programme itself is both valuable and valued by trainees. This conclusion is based on the fact that the SBT management development training is having a significant and positive impact on trainee perceptions of their own confidence (capability) to deal with various leadership situations. Furthermore, the training is also having a positive effect on leader awareness, perceptions and understanding of the impact of both supportive and unsupportive behaviour. The results reported here are broadly in line with findings in contemporary leadership research regarding the importance of the leader being someone who 'thinks things through using the input of those in her / his team' and who 'establishes a positive relationship with people in their team'. RESULTS support@zealsolutions.co.uk Telephone:

18 4 - CLOSE CLOSE In closing this report, we must return to the notion of leadership and the role that training interventions have to play in helping to achieve effective leaders. Through their behaviour, leaders help to shape attitudes, feelings and the behaviours of those around them. When leaders are considered to be supportive, they are also seen as more likeable and trustworthy. This finding alone makes it easy for us to explain why it seems to be the case that more supportive leaders also claim to find leading others more enjoyable and less challenging than leaders that are perceived to be less supportive. In this situation, social psychology has taught us that people are more likely to agree with people they like, and to comply with requests and suggestions from people they like. It has also been found that leadership effectiveness is also dependent on the extent to which the leader is seen to have a committed attitude towards the group. In our view, this attitude is derived and demonstrated through supportive behaviours such as those which are explored and developed through the training (e.g. openness, fairness, availability). In essence, the more that a leader is considered/perceived to be supportive, the more they are seen to be operating on behalf of the group. In this situation, leaders are not only seen as being more effective, they also achieve a greater level of the commitment from those who they lead. It is for this reason that the focus of this training intervention is on highlighting the importance of supportive behaviours, helping them to become more aware of the impact of their own behaviour and providing them with the skills and tools to enhance their own behaviour. Finally, it is also important to remind everyone that training is only one way to promote and develop effective leadership. While training is necessary to effect change in leadership, on its own training is not sufficient. Organisations must ensure that they support the implementation of training interventions with a more integrated approach whereby leadership behaviours are integrated (e.g. assessed, developed, and promoted) into appropriate systems, practices and procedures (e.g. selection, appraisal, training) that exist within most organisations. It is only when leadership training is integrated within such systems that organisations are more likely to see the positive impact of their approach and realise a valuable return on their investment. 18 SUPPORTIVE LEADERSHIP AND MANAGEMENT BEHAVIOUR - EVALUATION REPORT 2014

19 Telephone: Zeal Solutions Ltd 15 Beck Street Nottingham NG1 1EQ. PSYCHOLOGY WITH BUSINESS IN MIND Evaluation is a tool that can support learning. Zeal Solutions Ltd Ref.SLMBM ER.