Leading for Cultures of Compassion and Inclusiveness in the NHS

Transcription

1 Leading for Cultures of Compassion and Inclusiveness in the NHS ESRC Seminar Series: Embedding EDI in the workplace: Role of Strategy, policies, climate and culture Michael West Lancaster University Management School & The King s Fund 1

2 BME Staff Experiences across NHS Equal opportunities Score lower Diversity training Score lower Discrimination from colleagues Score higher Harassment from colleagues/managers Score higher Violence from colleagues/managers Score higher Discrimination from patients Score higher Violence from patients Score lower Engagement Score higher FFT Score higher Job satisfaction No sig difference Harassment from patients No sig difference Controls: Full time/part time, extra hours, age, disability, patient contact, tenure, occupational group 2

3 BME Representation in London NHS Organisations (Trusts) NHS staff London 41% BME Community 45% BME Trust Board members 8% BME Chief executives and Chairs 2.5% BME Two fifths of Trust Boards have no BME members Likelihood of white staff becoming managers/senior managers three times higher than that for BME staff Kline, R. (2014) Snowy white peaks of the NHS data/assets/pdf_file/0012/59799/the-snowy-whitepeaks-of-the-nhs.pdf.pdf 3

4 Ethnicity in the NHS Representativeness: the extent to which a workforce is representative of its customers (in this case, in terms of ethnicity) Is representativeness linked to patient views of civil treatment, and to hospital performance? Cultural (in)sensitivity, social categorization, may lead to negative interpersonal behaviours King, Dawson, West, Penny, Gilrane & Bastin (2011, Academy of Management Journal)

5 Representativeness Model NHS staff survey Organisational Ethnic Diversity NHS acute inpatient survey Annual Health Check ratings Ethnic Representativeness Civility Organisational Performance Community ethnicity data taken from UK Census Each output area (c people) matched with local hospital Representativeness measured by Kolmogorov-Smirnov effect size

6 Representativeness Results Organisational Ethnic Diversity -0.76** 0.37** Ethnic Representativeness Civility Quality of services Use of resources 0.37** 0.37** 0.15** (indirect) 0.16** (indirect)

7 Achieving real and sustained change 1. Prioritising an inspirational vision and narrative focused on compassion and inclusiveness 2. Clear aligned goals and objectives 3. Good people management and employee engagement 4. Team-working, cooperation and integration 5. Via a values-based, collective leadership strategy

8 1. Vision, values and strategy Vision sets out clear ambition for the future, to guide and inspire the whole organisation 1. It is forward looking 2. Makes clear commitments 3. Is inspiring to and welcomed by stakeholders

9 2. Clear aligned goals at every level Clear objectives linked to quality improvement Aligned, measureable and challenging at every level and feedback on performance

10 3. People management and engagement Positive effects of staff perceiving equal opportunities on employee outcomes (satisfaction, turnover, absenteeism) Negative effects of aggression and discrimination High work pressure impacts on discrimination and inclusiveness Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data 2/issue-50#abstract

11 3. Employee engagement success factors A compelling strategic narrative Inclusive leadership and management styles Putting staff in charge of service change Values and Integrity Successful Trusts develop a clear narrative on their purpose and aims The happiness of all our staff, through their worthwhile, satisfying employment in a successful business Successful Trusts have invested in retraining staff to adopt inclusive management styles For example, Oxleas has introduced a substantial programme to retrain middle managers in facilitative leadership Notts Healthcare NHS FT develops leadership aligned around strategy and values Successful Trusts give staff responsibility for leading service change Wrightington, Wigan and Leigh works with Unipart to support staff-led change Salford s quality directorate supports teams of frontline staff in testing improvements Staff survey evidence highlights importance of values and trust in senior leadership Perceptions of unfairness are best predictor of intention to leave In particular, fairness of procedures, bullying and discrimination.

12 BME Staff Experiences across NHS Equal opportunities Score lower Diversity training Score lower Discrimination from colleagues Score higher Harassment from colleagues/managers Score higher Violence from colleagues/managers Score higher Discrimination from patients Score higher Violence from patients Score lower Engagement Score higher FFT Score higher Job satisfaction No sig difference Harassment from patients No sig difference Controls: Full time/part time, extra hours, age, disability, patient contact, tenure, occupational group 12

13 Leadership, positive emotion and culture Leader positive affect, climate and performance Leader bias (LMX research) Individualised consideration and encouragement

14 4. Team working, cooperation and integration

15 Social categorization versus intergroup bias Clear shared objectives All have task-relevant knowledge and clear roles Positive attitudes to diversity modelled by leader Climates of cooperation, shared leadership Positivity, civility and mutual respect Cultures of listening and learning 15

16 Reflexivity Teams are more effective and innovative to the extent that they routinely take time out to reflect upon their objectives, strategies, processes and environments and make changes accordingly. Schippers, West & Dawson, 2012 Journal of Management

17 Bringing about change Biggest improvements Royal National Orthopaedic Hospital (37% BME) Great Ormond Street (26%) Whittington Hospital (33%) Royal Brompton & Harefield (31%) Barking, Havering and Redbridge (28%) Central London Community Healthcare (37%) Ealing Hospital (58%) King's College Hospital (42%) Croydon Health Services (43%) Luton & Dunstable (34%) 17

18 5. Collective Values-Based Leadership To what extent and how effectively do leaders at every level: Have authentic leadership values and behavioural styles Promote engagement, participation and involvement as their core leadership strategy? Promote appropriate staff autonomy and accountability? Ensure staff voices are encouraged, heard and acted on? Encourage staff to be responsibly proactive and innovative? Avoid domination, command and control except in crisis? Take action to address behavioural problems Deal effectively with intimidating behaviour and poor performance? Model compassion in dealing with patients and staff?

19 Collective Leadership Leadership of all, by all and together with all. Leadership the responsibility of all - anyone with expertise taking responsibility when appropriate Interdependent, collaborative leadership - working together to ensure high quality health and social care Leaders and teams working together across boundaries within and across organisations to ensure system success Requires that leaders prioritise success of patient care across the system/organisation at least equally with their own area of operation In effect, creating a collective values-based leadership culture

20 Leadership Culture Typologies Center for Creative Leadership, Used with permission.

21 The Logic of Leadership Strategy The challenges the NHS is facing require new strategies We are choosing a set of strategies to address these challenges These strategies require new leadership capabilities in the organisation And they require new organisational capabilities (things that leaders can t do alone) Leadership Strategy Delivers These Center for Creative Leadership, Used with permission.

22 Leadership Development Strategy Center for Creative Leadership, Used with permission.

23 5. Collective Leadership Strategy 1. Number of leaders needed in each area of organisation over next five years (minimum) 2. Qualities required of these leaders - skills, competencies, knowledge specific to their level/area to meet challenges, diversity, professions 3. The desired leadership culture, including required skills, values and behaviours needed to achieve the vision such as improving high quality care, compassion, equality, engaging staff, commitment to learning, positivity, openness 4. Collective leadership capabilities and strategies - leaders acting together to implement organisation strategies and nurture cultures (that individual leaders working alone cannot accomplish)

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25 Thank you e.mail