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22/03/2023 Service Improvement - Capacity & Demand - Staff Resilience  

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22/03/2023 Service Improvement - Capacity & Demand - Staff Resilience  

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Impacts of demand on service  consider using control charts and tools to improve capacity.
Demands on our service - referrals, requests coming from external sources, resource requirements (equipment, time, staff).
Demand can also mean expectations from others such as other agencies that are also stretched so by default refer in to CAMHS.
Reporting/outcomes - demands from stakeholders.
Giving choice of what the service offers - can impact on capacity - help at the point of need rather than at the point of availability.
Clear significant increase in demand on mental health services post Covid.
Capacity within our service - resource availability.
What is a control chart?
The control chart is a graph used to study how a process changes over time. Data are plotted in time order. A control chart always has a central line for the average, an upper line for the upper control limit, and a lower line for the lower control limit. These lines are determined from historical data.
Stress Management -
persistence/resilience
Components to help resilience;
optimism
humour
sense of purpose
social supports
altruism
moral compass
facing fear
role models
faith/spirituality

What small changes can I do to help me feel more resilient?
Reframe problems as challenges
Time - don't panic under pressure - find time in the day to reflect, try not to be reactive and be more responsive
Continue to work on self-awareness

Consider others perspective, context of situations.

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22/02/23 Service Improvement & Systems Methodology 

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22/02/23 Service Improvement & Systems Methodology 

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Data driven decision making.
@problem solving is a lot like being lost. It's not until you find out where you are that you figure out where you need to go'. (Dr. Walter Stewhart)
Essential - Voice of the Customer (VOC) -
External - service users, stakeholders, partner agencies and end customers.
Internal - management, employees and other functional departments.
Consider - expectations, preferences, comments and feedback about a product and/or service.
Customers will have separate needs and wants - use surveys, social media, focus groups, testing products, questionnaires and complaints procedure to determine final product/service offer.
VOC - 4 distinct categories;
Voice of associate (employees)
Voice of investor (management)
Voice of customer (clients, service users, end customer)
Consider working LEAN - NHS have heavily invested in this concept.
Specify value (customer defined)
Identify the value (patient journey)
Make the process and value flow (align healthcare processes to facilitate smooth flow of patients and information)
Let the customer pull (pull the products or service as needed - deliver care on demand with the correct resources required
Pursue perfection (develop and amend processes continuously working towards the ideal

What is WASTE in Healthcare?
Waiting - wait times
Inventory - materials/resources
Defects - usually caused due to procedural mistakes, miscommunications, or wrong diagnoses
Extra processing - admin, duplication
Transportation - unnecessary or excessive movement of the product’s
delivery process
Motion - unnecessary movements of the employees
Overproduction - unnecessary scheduled follow-up was recommended, which can be termed as overproduction waste
Human Potential -
Six stigma;
Define - Measure - Analyse - Improve - Control
What is a problem statement?
A problem statement is a short, clear explanation of an issue or challenge that sums up what you want to change. It helps you, team members, and other stakeholders to focus on the problem, why it's important, and who it impacts. A good problem statement should create awareness and stimulate creative thinking.

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Leadership challenges - explored the current situation I am in and my decision to end my secondment as CAMHS Project Lead due to there not being a clear mandate or resources in place to assist in implementing any of the project work I am leading on.
Consider S.C.A.R.E Model - can use this as reference in my final project assignment - identifying triggers/value.
Responsibility with limited authority creates challenges and blockages.
Issues around being micro-managed and the impact this has on my confidence as a leader.
Lack of robust support initially - To thrive in any new role, it is essential to have robust support in place from the start which helps formulate a sense of purpose and value.
Working across two systems, two providers, two services has at times been difficult when trying to implement project work, whilst I have done my best to engage other departments and colleagues with the projects, it is challenging due to colleagues having their own priorities and agenda.

I think my expectations of this role where very different to what the position has offered, however it has been a learning experience. As a relational, transformational leader, this experience has re-enforced that my skills set is best suited to team leadership, working within a team and focusing on team development and individual/team needs.

‘Everything you do in life is based on your brain’s determination to minimise danger and maximise reward’. (Gordon 2008).

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Stretch Collaboration - Adam Kahane
Embraces discord, experimentation and co-creation.
This approach requires stakeholders to embrace conflict, experiment a way forward and change themselves, rather than focus on changing others.
Consider;

You don’t have to agree on the problem or a solution, but you need to commit to experimenting forward

You can’t be part of the solution if you don’t recognize you are part of the problem

You can’t change what other people are doing, but you need to step into the collaboration process

Attend to psychological flexibility and safety.

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Emotional Regulation - Dan Siegal

The Window of Tolerance - Dan Siegal
A model founded in Neuroscience (the scientific study of the nervous system), which helps develop good practice for improving and maintaining mental health and wellbeing. It offers a way of thinking about how we function optimally, in our various roles, and how to manage when heightened emotions begin to have a negative impact.
describes the best state of ‘arousal’ or stimulation in which we are able to function and thrive in everyday life. When we exist within this window, we are able to learn effectively, play, and relate well to ourselves and others.
Explore way to widen my own comfort zone using the window of tolerance.

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Exploring Collaboration.
Sam Kaner - Collaboration Challenge - The Groan Zone -  is that space where groups experience confusion and frustration as part of their decision-making process.
Groan zone includes misunderstanding, blocking each others ideas, confusion, being impatient this can have an impact on moving forward.
'When problem solving - slow down to go fast'.
Disagreement is a divergent state — we differ on how to resolve a conflict or solve a problem. Agreement is a convergent state — we come together on a resolution or solution.

The Diamond of Participation -
Identifies several phases a group goes through on the way to creating participatory decisions. As groups engage with complex decisions there is a very common journey that goes through emotional and creative phases.

Sarah White distinguishes four forms of participation: nominal, instrumental, representative and transformative.

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Presentation by Midlands Young Minds;
Create a culture of participation - involve everyone  (co-production).
Work with young people not on them!

NHS Involvement https://www.england.nhs.uk/futurenhs-platform/

- Personalised
- Inclusive in membership and approach
- Committed to addressing equality/diversity
- Flexible
- Supported by infrastructure
- People/community drivers
- Prioritised/vlaued
- Strength-based
- Collaborative across stakeholders
- Results orientated

Participation covers;
- consultation
- representations
- discussion/sharing
- implementation
- initiating

Peer support workers should be equitable and supported - offer development and progression.

Whole system approach.

Reflection;
For me, this session was extremely valuable because in my current role as CAMHS Project Lead, one of my projects is very much focused on co-production and peer support. This project is also a key element to my final project case study.

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FutureNHS is a collaboration platform that empowers everyone working in health and social care to safely connect, share and learn across boundaries.

FutureNHS is safe, easy to use and supports a growing network of people who want to connect with others to accelerate their work. Members of the platform can join or create workspaces and communities to connect with others, learn and share.

The collaboration platform played an important role during the COVID-19 pandemic by helping teams to connect and share across boundaries, and it continues to be central to supporting the system to deliver recovery work.
You can register for free today
Collaborate | Connect | Share | Learn

Who uses FutureNHS?

FutureNHS is open to anyone working in or for health and social care. The platform supports commissioners, providers, senior management, front line staff, clinicians, health and social care colleagues, voluntary and community sector organisations, commercial sector and other interested stakeholders.

NHS England and NHS Improvement teams and regions, primary care networks, integrated care systems and academic health science networks are some of the thousands of groups and organisations using the platform to connect and work online securely.

Why should I join FutureNHS?

Many members of FutureNHS use local collaboration tools like Microsoft Teams and FutureNHS to deliver their work. Both platforms work together to enable health and social care colleagues to work effectively and share safely online.

FutureNHS is owned and managed by an expert team within NHS England and NHS Improvement and is a safe and secure place for people working in health and social care to save, access and share resources and content.

It is a transparent, open and accountable platform. Users cannot post content anonymously on FutureNHS and workspace managers have access to an audit log to track activity.

Workspaces can be set up to deliver work within or in collaboration with the NHS. Workspace managers can manage the permissions of their workspace and specific content within it to only allow access to specific audiences.

There is an ever-growing library of case studies on the platform, owned by and curated by FutureNHS members and workspace managers.

Interested in collaborating on FutureNHS?

Register for free today and join one of the largest communities of health and social care staff delivering transformation and innovation across the NHS.

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FutureNHS is a collaboration platform that empowers everyone working in health and social care to safely connect, share and learn across boundaries. FutureNHS is safe, easy to use and supports a growing network of people who want to connect with others to accelerate their work.

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The Change Equation (Beckhard & Harris 1987)

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The Change Equation (Beckhard & Harris 1987)

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D + V + F > R

D = Current levels of dissatisfaction

If dissatisfaction exists within the area where the change will take place the workforce will be far more motivated to support it. For example, an inefficient process of sending queries to senior managers will frustrate employees and the suggestion of a new system will gather support. Change initiatives can be successful even when employees are content with current systems and processes, but generating support will be more difficult.

V = Shared vision of a better future

The proposition of a different future must be attractive to all employees for a change to be successful, as they must see a benefit to their day-to-day activites. If the result of the change only appeals to a few employees it will be difficult to generate enough support for it to be a success.

F = First steps in direction of new vision

The first steps of any initiative will be the most crucial. This is the opportunity to demonstrate to employees the result of the change is not only desirable but also possible. The initiative must be carefully planned and communicated across the organisation to ensure everyone is on board with it. As the first few steps are taken, individuals will start to believe in it and support will grow.

R = Resistance to change

Unfortunately, resistance to change is inevitable as individuals become comfortable with their day-to-day processes, even if they are inefficient. Even if a change initiative aims to bring about a better process it is often hard to envisage how this would work and employees are also unwilling to learn and adapt to a new process. Employee resistance is by far the largest barrier to change.

Beckhard, Richard, and Reuben T Harris. (1987). Organizational Transitions. Reading, Mass.: Addison-Wesley Pub. Co., 1987. Print.

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What is needed from stakeholders to ensure success?
How do we change resistance?
Mapping
Sell the ideas/solutions
Believe the solution outweighs what we are currently doing.
Operational change - to meet demands, new ways of thinking to help improve health outcomes.

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A fishbone (aka cause and effect) diagram is a visual way to look at cause and effect. It is a more structured approach than some other tools available for brainstorming causes of a problem (e.g., the Five Whys tool). The problem or effect is displayed at the head or mouth of the fish.

Advantages and Disadvantages of Fishbone Diagrams

Advantages go in accordance with the purpose and method of the diagram.

Help identify cause and effect relationships with underlying problems,

Help facilitate joint brainstorming discussions,

The brainstorming process encourages broad thinking, keeping teams from limited thinking patterns that can lead to getting stuck,

The process of asking why something happened repeatedly at each stage helps drill down to one or more root causes,

Help prioritise relevant causes, so underlying root causes are addressed first.

Disadvantages

The brainstorming process can produce irrelevant potential causes along with relevant ones, which can result in confusion and a time drain.

Complex diagrams with multiple factors can lead to a jumbled mess that is too difficult to display in a fishbone diagram.

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Leading Transformational Change in Health Systems (14/09/22)

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Leading Transformational Change in Health Systems (14/09/22)

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The definition of transformational change is the emergence of an entirely new state prompted by a shift in what is considered possible or necessary which results in a profoundly different structure, culture or level of performance. In health and care, the concept of transformational change is complicated by the context. It calls into question what is meant by the term ‘transformational change’ in health and care.

There is a tension in the current system between the time needed for transformation and the sense of urgency for it to happen. Therefore, two things are key:

a strengthened focus on how we learn together as a health and care system, understanding and connecting efforts, and building from this rather than starting afresh. This requires time and support to build skills, relationships and confidence

a form of leadership that is collaborative and distributed, bringing together people from disparate groups to harness their collective potential.

Transformational change in health and care requires our collective focus to address the areas highlighted in this report: to strengthen understanding and approaches, to create effective ways of dealing with the barriers, to unlock the tremendous human potential of staff and communities, to optimise the environment to ensure it supports them, and to foster the collaborative leadership that can bring about transformation.

Reference https://www.kingsfund.org.uk/publications/transformational-change-health-care

There is a pressure to deliver national transformation programmes at the same time of pressure to manage extra need in health care post pandemic which is impacting on access/capacity and demand.

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We hear from the leaders from our four case study sites - in Birmingham, Bromley by Bow, Northumbria and Buurtzorg -about their transformational change projects, what made them a success, what impact they had on patients and staff, and their advice for implementing transformational change in health and social care settings.

The definition of transformational change is the emergence of an entirely new state prompted by a shift in what is considered possible or necessary which results in a profoundly different structure, culture or level of performance. In health and care, the concept of transformational change is complicated by the context. It calls into question what is meant by the term 'transformational change' in health and care.

The stories of Bromley by Bow, Birmingham, Northumbria and Buurtzorg illustrate that transformation is multi-layered, messy, fluid and emergent. It is not merely about changing how a service operates, but also about shifting mindsets, changing relationships and re-distributing power. Our stories suggest that transformational change requires the use of organic methods that centre around a core purpose of improving people's lives, allowing models and plans to develop around this. This resonates with Don Berwick's advice to favour 'curiosity and invitation' rather than 'command and control'.

There is a tension in the current system between the time needed for transformation and the sense of urgency for it to happen. Therefore, two things are key:

a strengthened focus on how we learn together as a health and care system, understanding and connecting efforts, and building from this rather than starting afresh. This requires time and support to build skills, relationships and confidence

a form of leadership that is collaborative and distributed, bringing together people from disparate groups to harness their collective potential.

Challenges to face

Our stories show that staff working in health and care are motivated by a vision of safe care and better ways to deliver quality. But in the face of a need to transform, there can also be a sense of inertia and preservation of the status quo. This needs further study to understand and address the underlying causes.

The nature and uses of power to ensure positive impact is important. Our stories show examples of old power (held by a few, closely guarded and inaccessible) colliding with new power (enabled by people at a grassroots level who have agency). However, they also demonstrate how old power can enable new power. There is a need to develop skilful leadership practices that can work across both domains.

A pressing dilemma for those we interviewed was how to work effectively within current system constraints while also championing fundamentally different structures to support transformation. It is likely, in the short term, that a dual focus is needed by working within existing limitations while also nurturing new ways. In the longer term, wider debate is needed about how best to propagate these efforts through the presence of a learning and supportive system that can enable and sustain great change.

When organisations or services embark on transformational change there are often tensions between radical innovation and protecting people from harm; between pace of change and taking time to engage people fully; between focusing on frontline care now or the less 'visible' opportunity to prevent ill health in the future. Hence, there are questions about the scale of transformation and what 'success' looks like. Our stories imply that the answers lie with communities and frontline staff. If that is the case, there is a need to reconsider who is leading and driving current transformational change.

Across our examples, transformations were sparked by people seeing and acting on local needs. The human motivation to make a difference was very powerful. Previous experiences of leaders, their access to broad networks of experts, and the skills to understand academic resources helped the 'sparks' to become 'flames'. More needs to be done to help people to nurture change sparks and bring about change.

Communities also displayed the power to make change: driving health and care innovations, providing ideas that shaped new primary care models, reshaping plans for hospital provision, sparking career choices that transformed care across cities, regions and countries. There is a need to reconsider the relationship between health and care organisations and communities and service users.

Our stories suggest that technology that makes it easier and simpler for staff to do their work to provide quality support for the people who need it is critical. Data can be a powerful tool in transformation, as can stories, experiences and relationships. Transformational efforts can be strengthened by building on this.

Our stories show the need for individuals with skills to kick-start and drive through transformation in a way that is inspiring, approachable and supportive. They also show the importance of 'sponsorship' by forward-thinking commissioners, politicians, managers and those willing to work around system constraints to enable testing of these new ways.

The stories show the need to understand staff and create positive cultures that enable transformational change. Maintaining a focus on team members' motivation, which often draws on a desire to make meaningful improvements for patients, can be a source of personal joy. Our work on collective leadership shows the importance of developing cultures to support effective teamworking.

Our stories show the importance of proactively identifying invisible forces with an open and enquiring mind. For example, recognising the value of physical spaces and personal contact, the impact of job titles, the diversity of attitudes and preferences, or the presence of less visible needs in the community. These forces can be both invisible and impassable, terminating transformational change efforts or steering them towards difficulty unless surfaced early and dealt with skilfully.

We also heard about the power of staff and communities to drive transformation: the importance of giving people time and space to think through the purpose of transformation; to understand the struggles and worries they face; to offer support instead of demanding change with no time to prepare or engage. More fundamentally, our stories show the need to reconsider the structures that impact on their ability to do this - regulation, funding, training, organisational cultures - and to create ways to make it easier for staff to lead transformational change efforts.

A collective focus

Transformational change in health and care requires our collective focus to address the areas highlighted in this report: to strengthen understanding and approaches, to create effective ways of dealing with the barriers, to unlock the tremendous human potential of staff and communities, to optimise the environment to ensure it supports them, and to foster the collaborative leadership that can bring about transformation.
Read the report.

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Transformational change in health and care: reports from the field

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We hear from the leaders from our four case study sites - in Birmingham, Bromley by Bow, Northumbria and Buurtzorg -about their transformational change projects, what made them a success, what impact they had on patients and staff, and their advice for implementing transformational change in health and social care settings.

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What is compassionate leadership?
This involves a focus on relationships through careful listening to, understanding, empathising with and supporting other people, enabling those we lead to feel valued, respected and cared for, so they can reach their potential and do their best work.
Good leaders need time on the balcony not just on the dancefloor.
Leadership styles can clash, we often remember incidents that impact on team dynamics - this can cause a toxic environment.
Be empathic - feel it, not hear it!

Key skills;

Authentic, trusting, self-aware, adaptable, curious about differences, vulnerable (which is a source of strength to be present with someone),

flexible, open minded, doing and being, humorous, focused on personal development to raise to their own consciousness and that of their organisation.

Get the balance between leadership and management.

Leadership to me is having a vision, creating energy, inspiring others, being a change agent, a coach and a facilitator.

So, it is something else that managing a team or an organization. Managing means getting results with the available resources. It is about organising, planning, processes and procedures.

Tensions

There are three kinds of tensions:

Practical or process tension: e.g. no Internet access, meetings that go on for hours and drain energy, orders that are delivered too late or projects that go over time and budget.

Personal tension: e.g. not feeling able to do what is expected, low self-esteem, feeling resistance to change, dread giving presentations or getting stress because goals are not reached (e.g. a sales target or quit smoking).

Interpersonal tension: e.g. not getting along with a colleague, manager, customer or supplier; having conflicts with them or not feeling comfortable in their company.

Psychological safety:

Psychological safety is the belief that you won't be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes. At work, it's a shared expectation held by members of a team that teammates will not embarrass, reject, or punish them for sharing ideas, taking risks, or soliciting feedback.

All team members should feel they can ask for help.

There are three core leadership behaviours which support psychological safety in teams. These may seem simple, but in practice they extend to every single leadership behaviour and every single aspect of communication. Those three core behaviours (thanks to Amy Edmondson for codifying these) are:

Frame work as a learning problem, not an execution problem. Everything is an experiment. The outcome of work should not exclusively be the output; it must also be learning how to do it better next time.

Acknowledge your own fallibility. By admitting when you make a mistake or don’t know the answer, you allow (indeed, encourage) others to do the same.

Model curiosity and asking questions. Stay curious, ask other people what they think, and ask them to contribute. By asking questions and asking for help, you’re creating a space and a need for people to speak up, which is essential for psychological safety and for high performing teams.

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I was able to reflect and use the work from Heifetz and Linsky (2009) coined the
phrase ‘Moving from the dance floor to
the balcony’ to help me understand my current situation. I used metaphors to understand how my behaviour may been perceived and how I see the impact of other behaviours - some can dance to a tune, others need a little help with their moves, or just need to come off the dancefloor and take a little time to study the dance moves of others. But maybe when this person does take time off the dancefloor, as a leader, we could engage in a chat about the best dance moves.

Interestingly Adaptive Leadership has four dimensions;

There are four dimensions that adaptive leaders keep in mind:
- navigating complex environments
- leading with empathy
- learning through self-correction and reflection
- creating win-win solutions.

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It's important to understand ones own vulnerability, and to feel confident in sharing this as a leader, as a way to help build a level of trust. This will help with team 'buy in' and thus they will feel comfortable in being transparent and not avoiding.

5 Dysfunctions of a team explained;

1.       Absence of Trust. Teams who lack trust conceal weaknesses and mistakes, hesitate to ask for help, jump to conclusions about the intentions of others, hold grudges and dread meetings.

2.      Fear of Conflict. A lack of trust leads to the fear of conflict. In these companies, employees worry more about politics and personal risk management than solving problems. Meetings are often boring because controversial topics are avoided.

3.       Lack of Commitment. When teams become conflict-avoidant, a fear of failure develops. These teams have difficulty making decisions and second guess themselves.

4.       Avoidance of Accountability. Second-guessing and a lack of common objectives then leads to an inability to develop standards for performance. Team members miss deadlines and deliver mediocre work.

5.       Inattention to results. When teams lack focus and clear objectives, team members stagnate, become distracted, and focus on themselves

These cause confusion, misunderstanding, negative morale and can impact entire organisations.

Create a positive team dynamic -
Especially the dynamics and patterns in the leadership team. Because these patterns cascade down the organisation, causing all sorts of effects. It’s isomorphic: what happens in one place happens in another place.
Leaders need to feel they can 'call it out', rather than avoid the elephant in the room. However, for any one person to 'call it out' there needs to be a level of trust.

It's important for a group to collectively reflect on an emotional experience, and demonstrating trust – and feel they can discuss any conflict.

Build trust

Look at where they can influence change

Discover what are the drivers and anchors for success

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Are you looking for The Five Dysfunctions of a Team quotes by Patrick Lencioni

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It can be difficult to remain rationale and this can significantly distort perspectives in conflict situations.
As a leader, having difficult conversations is challenging, so it is important to prepare for such situations.

Give the other person advance notice of what you’d like to discuss allows them to prepare, too, and establishes clear expectations for you both.
It's important to consider the language used, rephrasing for example instead of saying 'we need to talk about what happened in our team meeting', this could be rephrased as, 'I'm curious to hear your thoughts on the different opinions that came up in our team meeting. Can we chat about this?'
It's important to focus on facts not feelings and consider what outcome.

Build the conversation backwards once you know the desired outcome.
Make some notes ahead of time of things.

When it comes to our own emotions it’s important to find a good balance between being composed and being authentic.
Offer regular and trusting feedback sessions with a team.
The ultimate goal when addressing a difficult situation isn’t necessarily seeing eye-to-eye, but rather finding a sense of understanding between two people.
A successful conversation means finding the most productive solution, not being right or proving a point.

IMPORTANT
Offer help and support where you can
Acting as a team player and contributing to the solution when employees are having a tough time shows leadership, and helps build a stronger, more supportive team.

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Focus on what is being said (including body language) rather than composing your next thought or statement; and notice what is not being said, which can be extremely significant : The process of asking better questions can be accompanied by expressing opinions and advocating for a position.
Power imbalances and coercive settings are corrosive to dialogue.

'Thinking together implies that you no longer take your own position as final. You relax your grip on certainty and listen to the possibilities that result simply from being in a relationship with others -possibilities that might not otherwise have occurred' (Issacs 1999)

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Gibbs - 6 step model
Description - what happened?
Feelings - what you think and feel?
Evaluation - what was good and bad about the experience? (Consider signs of safety model also)
Analysis - what sense can be made out of the situation?
Conclusion - what else could be done?
Action plan - if the situation arose again how could this be managed?

Reflections;
Description - ensure there are pure facts - consider the following questions;

What are the brief facts of the situation?

What occurred? Who was involved?

What did I do? What did others do?

Feelings - consider the following questions;

How was I feeling at the time?

Were there influences affecting others actions/behaviour?

Were there any known or perceived difficulties with the activity, timing, location, information or resources etc.?

Evaluation - along with what worked well and what didn't  consider the following;

How might the facts and feelings (from stage 1 and 2 above) have affected actions/behaviour

What other circumstances may have affected actions or thoughts?

How issues might influence the activity or practice related feedback?

Analysis - consider the following;

Why choose this incident to reflect on?

What sense can I make of it?

What is the main area of concern or focus on the future?

Conclusions - consider the following;

What have I discovered?

What have I learned from this incident and circumstances?

What questions remain?

Action Plan;

What will I do differently from now on or the next time this arises?

What resources/help will you need?

Reference

Gibbs, (1988) Learning by Doing: A Guide to Teaching and Learning Methods Further Education Unit, Oxford Brookes University, Oxford.

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What is Professional Judgement - Refections

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What is Professional Judgement - Refections

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This is not evidence-based but using knowledge and understanding of the context of a situation/service user/colleague to manage appropriately.
'Knowing that' - Explicit knowledge
'Knowing how' Tactic knowledge

It's important to appreciate uniqueness.
Consider to do more reflection in action.

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Professional Judgement (https://www.proceduresonline.com/nottinghamshire/scb/user_controlled_lcms_area/uploaded_files/Briefing%20note%20What%20is%20Professional%20Judgement%20and%20when%20it%20needs%20to%20be%20used_%20V2%20Final%20July%202020.pdf)
'Applying knowledge, skills and experience, in a way that is also informed by. professional standards / knowledge, laws and ethical principles, to develop an opinion or decision about what should be done to best serve clients'.

This judgement allows professionals to utilise their understanding of the context of
the situation and client / service user, their professional knowledge and their training
in order to identify concerns and take relevant action.

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Group thoughts - learning, reflection, asking, thinking time, planning, structure, development, sustainability, theory, process, management, oversight, self-aware

Reflective practice is the ability to reflect on one's actions so as to engage in a process of continuous learning.

Definition - serious thought or consideration.
Need to be mindful of self.

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We do not learn from experience, we learn from reflecting on experience. Todays session was really thought provoking - considering self-awareness and reflective practice.  Being self-aware in my leadership will help me inspire and engage others as I am not only aware of my own capacity, graces, behaviours but by being aware of my vulnerability I can create a openness and transparency which is the basis for trust. Trust within a team creates a more inclusive, respectful climate

Video snip - Tasha Eurich - self-awareness 'if we spend too  much time looking in the rear mirror, we will crash in to what's in front of us' .

How self-aware am I? Do I practice what I preach?

“With the right approach and a true ongoing commitment, you can foster a culture that encourages communication and feedback at all levels; one where honesty trumps hierarchy and even the lowest-ranking member feels safe putting problems on the table.”
―  Tasha Eurich, Insight: Why We're Not as Self-Aware as We Think, and How Seeing Ourselves Clearly Helps Us Succeed at Work and in Life

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My Daring Leadership assessment;

You have strengths (scores ≥ 8).

You have both strengths and opportunities for growth (scores ≥ 5 and <8).

You have solid opportunities for growth (scores < 5).

Rumbling with Vulnerability: 7.9 / 10

Rumbling with vulnerability is an area where you have both strengths and opportunities for growth. Stay brave, stay curious, and keep learning!

Vulnerability is the emotion that we experience during times of uncertainty, risk, and emotional exposure. It’s having the courage to show up, fully engage, and be seen when you can’t control the outcome.

The willingness and ability to rumble with vulnerability is the foundational skill of courage-building. Without this core skill, the other three skill sets are impossible to put into practice. Consider this carefully: Our ability to be daring leaders will never be greater than our capacity for vulnerability.

Most of us didn’t grow up believing vulnerability was courageous, so our first challenge is overcoming the myths we’ve learned over the years. Myths like thinking we can opt out of vulnerability, or that we can engineer the uncertainty and discomfort out of vulnerability, or simply that vulnerability is weakness. Exercise #2 from our free downloadable workbook will walk you through this.

The second step is developing the skills and grounded confidence to stay in vulnerability when it feels overwhelming. Many of us either avoid vulnerable situations, armor up for them, or completely tap out when it gets too uncomfortable or awkward. Building grounded confidence means developing all of the skills and practices explored in Part One, Sections One through Five in Dare to Lead. It’s half the book because it’s that important. It’s also half of the exercise in the downloadable workbook.

Living Into Your Values: 7.5 / 10

Living into your values is an area where you have both strengths and opportunities for growth. Getting clear on your two primary values and the behaviors that support those values might be a big next step in your practice.

A value is a way of being or believing that we hold most important. Living into your values requires a clear understanding of your core values, having a strong sense of the behaviors that are in alignment with those values, recognizing when your behavior is out of alignment, and course-correcting as needed.

When we’re vulnerable, we will face self-doubt, hurtful comments, and fear.  Our clarity of values is the essential support during these difficult times. If we don’t have our values to remind us why we’re being courageous, the cynics and the critics can bring us to our knees.

Living into our values means that we do more than profess our values, we practice them. We walk our talk—we are clear about what we believe and hold important, and we take care that our intentions, words, thoughts, and behaviors align with those beliefs.

More information about the importance of living into our values and aligning with organizational values as well as teaching on how to build this skill set can be found in Dare to Lead, Part Two.

Braving Trust: 6.9 / 10

Braving trust is an area where you have both strengths and opportunities for growth. It’s important that you dig into the seven elements of trust (BRAVING) and identify the gaps and behaviors that are getting in your way.

Trust is built in small gestures and over time.  It is an iterative process between two people or within a team that is based on behaviors in seven specific areas. These areas are captured by the acronym BRAVING (Boundaries, Reliability, Accountability, Vault, Integrity, Nonjudgment, and Generosity).

Because talking about trust is tough, and because these conversations have the potential to go sideways fast, we often avoid the rumble. And that’s even more dangerous. First, when we’re struggling with trust and don’t have the tools or skills to talk about it directly with the person involved, it leads us to talk about people instead of to them. Second, trust is the glue that holds teams and organizations together. We ignore trust issues at the expense of our own performance, and also at the expense of our team’s and organization’s success.

The BRAVING Inventory download is a great place to start working on building trust.  It includes more definitions of the seven trust elements. Specific skills practice for braving trust can be found in Dare to Lead, Part Three.

Learning to Rise: 7.5 / 10

Learning to rise is an area where you have both strengths and opportunities for growth. Learning how to reset after disappointments, failures, and setbacks is a critical skill set in rapidly changing environments. Dig into the rising process to figure out how to build this skill.

The Learning to Rise process is about getting up from our falls, overcoming our mistakes, and facing setbacks in a way that brings more learning and strength. As tough as it is, the payoff is huge: When we have the courage to walk into our hard experiences of failure and disappointment, and own those stories, we get to write the ending. And when we don’t own our stories of failure, setbacks, and hurt—they own us.

Our research shows that leaders who are trained in rising skills as part of a courage-building program are more likely to engage in courageous behaviors because they know how to get back up after taking risks and being brave.

The Learning to Rise process involves learning from setbacks and disappointments and applying key learnings to future situations. Finding the key learnings depends on recognizing and getting curious about emotion and comparing the story in our heads with the facts.

Mistakes, failures, and setbacks provide key learnings for the future, we just have to be brave enough to own the story.

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Effective systems leadership relies on a composite set of capabilities and behaviours, which can be grouped under the following four domains (NHS Leadership Academy Systems Leadership Framework):

innovation and improvement

relationships and connectivity

individual effectiveness

learning and capacity-building

NHS - System Leadership;

NHS moves to end ‘fractured’ care system (NHS England, 2017) says, Integrated care systems (ICSs) are a critical part of the biggest national move to integrating care of any major western country.

With no basis in law, ICSs are entirely dependent on a collaborative approach to leadership and a willingness on the part of the organisations involved to work together.

Leadership in ICSs is very much a form of systems leadership, but with new and unique challenges, such as the need to exert influence across an even larger range of organisations and co-produce services with people who use them.

System Leadership is collaboration between commissioning, providing and using public services (Bolden, 2019).

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Functional leadership theory (Hackman & Walton, 1986; McGrath, 1962).
The Functional theory of leadership emphasizes how an organization or task is being led rather than who has been formally assigned a leadership role. In the functional leadership model, leadership does not rest with one person but rests on a set of behaviours by the group that gets things done. Any group member can perform these behaviours so that any member can participate in leadership.

Model the way
Inspire a shared vision
Challenge the process
Enable others to act
Encourage the heart.

Reflection: I like this model of leadership - it gives room for team buy-in and would help build a more confident team.

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Authoritative

Democratic

Affiliative

Visionary

Pace-setting

Coaching

1. Authoritative leadership. This first leadership style is based on discipline. People who follow this style prioritize maintaining discipline above all.

2. Democratic leadership. This leadership style states that it’s very important to take everyone’s opinions into account when making a decision.

3. Affiliative leadership. The third type of leadership is based on creating bonds between the team members. That way, they’re able to work and collaborate in harmony.

4. Visionary. Leaders who use this leadership style motivate their employees with a clear and exciting vision. They also help each person see their role within that vision.

5. Pace-setting leadership. The role of a pace-setting leader is to set a course of action and make sure everyone sticks to it.

6. Coaching leadership. The last type of leadership is based on helping the members of a group find their strengths and weaknesses.

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In modern society, we do almost everything in groups. That’s why leadership is such a fundamental skill. Many psychologists have studied this...

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Trait leadership is defined as integrated patterns of personal characteristics that reflect a range of individual differences and foster consistent leader effectiveness across a variety of group and organizational situations (Zaccaro, Kemp, & Bader, 2004; Zaccaro 2007).
Understanding the importance of these core personality traits that predict leader effectiveness can help organizations with their leader selection, training, and development practices (Derue et al., 2011).
Understanding the importance of these core personality traits that predict leader effectiveness can help organizations with their leader selection, training, and development practices (Derue et al., 2011).

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Theories & Models of Leadership - 06/04/2022

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Theories & Models of Leadership - 06/04/2022

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Research historical and contemporary leadership.
Heath & Care Bill (2021)
Integrated Care Systems - new partnerships between the organisations that meet health and care needs across an area, to coordinate services and to plan in a way that improves population health and reduces inequalities between different groups.
The NHS Long Term Plan confirmed that all parts of England would be served by an integrated care system from April 2021.
Consider own style of leadership - reflect on this and explore my own model of leadership.
'Management is about coping with complexity, leadership is about coping with change' (Dawson, 2006).

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Firstly our facilitators went through the course expectations/criteria.
Course requirement - 85% attendance including ALS.
Library offered a presentation - I have identified that due to my time out of academic learning I would need to refresh on referencing - Harvard.

Qualities of a good leader;
Provides a platform for people's views to be heard.
Builds a team who shares the same vision.
Unbiased, but knowing when to change views.
Confident in self/decision making.
Guiding/supporting those around you.

Integrity
Ability to delegate
Communication
Being self-aware
Gratitude

What do CYP appreciate;
Honesty
Being heard
Engagement
Respect
Ability to adapt to CYP needs/differences
Empathy
Positivity
Good communication skills
Showing an interest in their story/world

Issue                                          Ideal
Power imbalance                      Equality
Preconceptions                         Open mind
Condescending                         Respect

Consider the IAPT principals
PARTICIPATION
ACCOUNTABILITY
ACCESSIBILITY
EVIDENCE BASED PRACTICE
AWARENESS

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Model for Action Learning Sets with times

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Second problem brought to ALS;
Resistance to changes in service.
How do you get the most from a team?
Offer a clear and consistent explanation of changes with timeline/capacity issues impacting on service requirements - be transparent.
Offer an incentive - is this achievable?
I suggested - Being transparent and recognising the teams worth.
Offer a narrative on the service requirements - impact on outcome measures. Be honest about how long the change is in place for.
Maybe consider a team development day - open up discussion around the impact these changes are having on the team - give a space for reflection and team ideas.
What works well/what needs developing.
Identify any additional staff training needs.
Feedback from presenter - good ideas from the group, they would look at how the message is being delivered by management. They like the idea of a team day - buy in from staff.
Initially start with a survey to identify staff needs.
Offer space for reflection.

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Leadership self-assessment

Based on the answers you gave your leadership style mix is:

Well developed styles: | 3
Styles that need some further development: | 2
Styles that need a lot of further development: | 1

Overall, you have a good mix of leadership styles and the potential to be a well-rounded, effective leader. There is however, always potential to further improve your leadership styles.

See our page: Developing Your Leadership Style for more information.

Your 3 well-developed leadership styles are:

Authoritative leaders move people towards a vision, so are often described as ‘Visionary’. This style is probably best summed up as ‘Come with me’. It is the most useful style when a new vision or clear direction is needed, and is most strongly positive. Authoritative leaders are high in self-confidence and empathy, acting as a change catalyst by drawing people into the vision and engaging them with the future. An affiliative leader values and creates emotional bonds and harmony, believing that ‘People come first’. Such leaders demonstrate empathy, and strong communication skills, and are very good at building relationships. This style is most useful when a team has been through a difficult experience, and needs to heal rifts, or develop motivation. It is not a very goal-oriented style, so anyone using it will need to make sure others understand that the goal is team harmony, and not specific tasks. It is probably obvious from this that it cannot be used on its own for any length of time if you need to ‘get the job done’. The democratic leader builds consensus through participation, constantly asking ‘What do you think?’, and showing high levels of collaboration, team leadership and strong communication skills. This style of leadership works well in developing ownership for a project, but it can make for slow progress towards goals, until a certain amount of momentum has built up. Anyone wishing to use this style will need to make sure that senior managers are signed up to the process, and understand that it may take time to develop the consensus.

You have 2 fairly well-developed leadership styles, these are:

Pace-setting leaders expect excellence and self-direction, and can be summed up as ‘Do as I do, now’. The Pace-setter very much leads by example, but this type of leadership only works with a highly-competent and well-motivated team. It can only be sustained for a while without team members flagging. Like the Coercive leader, Pace-setters also show drive to succeed and initiative, but instead of self-control, these are coupled with conscientiousness. A coaching leader will develop people, allowing them to try different approaches in an open way. The phrase that sums up this style is ‘Try it’, and this leader shows high levels of empathy, self-awareness and skills in developing others. A coaching style is especially useful when an organisation values long-term staff development.

Your least well-developed leadership style is:

Coercive leaders demand immediate obedience. In a single phrase, this style is ‘Do what I tell you’. These leaders show initiative, self-control, and drive to succeed. There is, of course, a time and a place for such leadership: a battlefield is the classic example, but any crisis will need clear, calm, commanding leadership. This style does not, however, encourage anyone else to take the initiative, and often has a negative effect on how people feel.

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The key to being an effective and long-lasting leader is being able to lead in a variety of situations and with a variety of different people. In order to achieve this you need a good mix of leadership styles.

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Understanding styles of leadership helps create a successful team.
6 types;
Authoritative;
An authoritative team leadership is not restrictive. It propels advancements when:

A leader is truly competent to take charge.

Detailed instructions are not required.

Employees already have the tools they need to do their most effective work.

Transactional;
Transactional leadership may be appropriate when:

You are working with team members who are new to a certain type of project or need detailed guidance.

Clear goals and a plan to get there will increase productivity.

The team will benefit from celebrating victories together or holding each other accountable when someone doesn’t do the work they’re supposed to.

Servant;
You might want to employ a servant leader mindset when:

A team is in desperate need of a great example to look up to and learn from.

A team has conflict and needs mending.

Big projects require all hands on deck.

Democratic;
A democratic leadership style could help teams when:

A new project that will benefit from brainstorming is introduced.

There is a problem to tackle and fresh ideas are needed.

Tight-knit, highly collaborative teams are in the formation stage, like those at start-ups or new small businesses.

Empathic;
Empathetic leadership can be effective when:

A competent team knows the job they need to do and how to effectively execute that.

Little direction is needed from the leader.

The team will benefit more from space and independence to complete tasks than micromanaging.

Narcissistic - the style to avoid:
This leader is self centred, they don't lead they dictate.

Leadership is about collaboration and intrinsic motivation.

At this point I see my style of leadership as transactional and democratic, I thrive being innovative, taking solid risks to achieve outcomes. I respect my teams opinions and ideas, to be effective, having team involved in planning and change is essential.

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Your natural leadership style may be a result of your personality, your values and your strengths and experiences. But effective business leaders avoid a one-size-fits-all approach to leadership. They know they need to adapt to the needs of their teams in order to effectively lead.

The leadership style you're naturally inclined to may not be appropriate for every situation. When used inappropriately, it can fail to motivate those you're leading.

For example, if your preferred approach is serious, dry and aggressive, you may have trouble connecting with a team craving empathy and sensitivity from a leader. If you tend to be more soft-spoken and hands-off, you could fail your team in a situation that demands take-charge leadership.

Effective leadership is important for the workplace because managers account for at least 70 percent of variance in employee engagement at work, Gallup reports. That's why it's best to take a situational approach to leadership, and adapt based on what you're facing.

It can help to take a leadership self-assessment so that you recognize your prevalent style. You should also learn other types of leadership styles and situations where they can be effective, so you can lead appropriately and be there for your team.

Here are six types of leaderships styles and what types of situations they work best in.

1. Authoritative Leadership

The authoritative leader knows the mission, is confident in working toward it, and empowers team members to take charge just as she is. The authoritative leader uses vision to drive strategy and encourages team members to use their strengths and emerge as leaders themselves.

The authoritative leader provides high-level direction, but she lets those she leads figure out the best way to get there. Authoritative leaders are always striving for progress. They inspire others to adopt a similar attitude.

When This Type of Leadership Style Works Best

An authoritative team leadership is not restrictive. It propels advancements when:

A leader is truly competent to take charge.

Detailed instructions are not required.

Employees already have the tools they need to do their most effective work.

Those who adopt an authoritative leadership style when they don't have the appropriate experience, or when they try to wield authority over others in an aggressive way, will fail. An authoritative leader must be confident and have the experience to back it up in order to be successful.

Download the eBook
2. Transactional Leadership

A transactional leader may be in a position of leadership, such as in a managing role, but this leader is not necessarily one to embrace going above and beyond what is expected. The transactional leader dangles a carrot in front of each workhorse. If the employee does something positive, they are rewarded. If they don't meet the exact expectation, they may be punished.

This type of task-oriented leadership focuses on meeting basic expectations. The transactional leader may decide roles and ways to monitor performance so that results are delivered. But encouraging innovation isn't as prevalent with this type of leadership style.

When This Type of Leadership Style Works Best

Transactional leadership may be appropriate when:

You are working with team members who are new to a certain type of project or need detailed guidance.

Clear goals and a plan to get there will increase productivity.

The team will benefit from celebrating victories together or holding each other accountable when someone doesn't do the work they're supposed to.

The downside to transactional leadership is that this type of style focuses on the work, not the people. Employees want to feel like their work has a broader purpose and want to meaningfully connect with work. Transactional leadership doesn't foster the human-work connection.

3. Servant Leadership

Servant leaders get in the trenches with their team. Their goal is to achieve the best outcome. To do that, these types of leaders make themselves available to help with issues, work alongside those they manage, and develop those they manage into better employees.

Servant leaders coach. They're willing to stay late and get in early when it's called for, just like everyone else. Servant leaders are focused on constantly transforming their teams into stronger, more efficient, more productive and happier entities. Servant leaders are empathetic and use emotional intelligence to guide their leadership decisions.

When This Type of Leadership Style Works Best

You might want to employ a servant leader mindset when:

A team is in desperate need of a great example to look up to and learn from.

A team has conflict and needs mending.

Big projects require all hands on deck.

Servant leadership can have many positive outcomes, but it's also time-consuming. Servant leaders must also be aware that they need to avoid doing all the work. When they give too much of themselves, they don't give team members as much of a chance to learn. That can create inefficiencies and missed opportunities to lead in other areas.

4. Democratic Leadership

Just like a political democracy, where people with diverse opinions work together to come up with a consensus for decisions, a democratic leader gets everyone involved. The whole team is a part of creating a vision and the ideal way to get there. Democratic leaders embrace group meetings and surveys. They value transparency in decision-making. They want their team to feel as involved in work processes as they are.

Employees who work for a democratic leader are aware that they're part of a larger team. They learn the value of collaboration and know they play a role in the evolution of their work environment. Democratic leaders foster discussion, but they also are able to step in when needed and make a decision that's guided by overall input.

When This Type of Leadership Style Works Best

A democratic leadership style could help teams when:

A new project that will benefit from brainstorming is introduced.

There is a problem to tackle and fresh ideas are needed.

Tight-knit, highly collaborative teams are in the formation stage, like those at startups or new small businesses.

Using this type of democratic, team leadership theory on a constant basis can have drawbacks, though. A leader who never really takes charge and instead lets everyone else debate every decision can lose respect as an authority. Team members may not understand why they're even reporting to someone who only leads in a democratic style in the workplace.

5. Empathetic Leadership

The empathetic leader recognizes that great work starts with engaged workers. This type of leader strives to create strong emotional bonds on a team so that those working on it feel a sense of belonging. The empathetic leader makes it a priority to make teammates satisfied with them as a manager and with their team. The empathetic leader focuses on people first, then work.

Empathetic leaders aren't micromanagers. They empower team members to do their work, and offer themselves up as a resource whenever their team members need them. They're quick to dole out praise and offer support when needed.

When This Type of Leadership Style Works Best

Empathetic leadership can be effective when:

A competent team knows the job they need to do and how to effectively execute that.

Little direction is needed from the leader.

The team will benefit more from space and independence to complete tasks than micromanaging.

An empathetic leader who only focuses on the people and not the work, though, can leave employees confused and unmotivated. With no clear direction, a hands-off approach to work-related leadership can lead to mistakes, inefficiencies and poor results.

6. Narcissistic Leadership: The Style to Avoid

One type of leadership that is best avoided in most work situations is the narcissistic leader, also known as a coercive leader. Instead of empowering team members to work toward the best possible outcome, the narcissistic leader has an agenda and aims to coerce those they're leading to carry it out.

Narcissistic Traits

Narcissistic leadership is self-centered. It's not often results-focused, and it is disrespectful to the team. This type of leader doesn't lead - he dictates.

Leadership should foster collaboration and intrinsic motivation. A narcissistic leader who lacks empathy will instead breed disinterest or resentment.

There is one exception to when a narcissistic leadership style may be appropriate - when quick action is needed to avert a crisis, like a battlefield situation. But in the workplace, be aware when narcissistic leadership traits are emerging. Try to avoid those actions.

Find the Most Effective Leadership Style for You

If you recognize that there is one type of leadership style that dominates your work style, look for opportunities to put other leadership styles into practice when they're appropriate.

If you haven't connected with your team members on a personal level, put on your empathetic leader hat and have some one-on-ones where you get to know each team member's perceived strengths and career goals. If you've taken a more hands-off approach to leadership, think about future projects where being more vocal can enhance the results.

Shifting your leadership style based on the situation or team member you're dealing with doesn't make you inconsistent. It can make you more successful, because you can connect more effectively and guide your team toward better results.

For more leadership insights, download our free ebook, The Executive's Guide to Leading Millennials, Gen Xers and Baby Boomers.

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Which Leadership Style Is Best for Your Team?

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Your natural leadership style may be a result of your personality, your values and your strengths and experiences. But effective business leaders avoid a one-size-fits-all approach to leadership. They know they need to adapt to the needs of their teams in order to effectively lead.

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The first problem presented;
Staff expectations around having time off for appointments, change of hours, home working.
Considerations - flexible working, reasonable adjustments and the individuals needs and circumstances.
Balancing the service needs and the well-being of the individual.
My thoughts - fairness across all services, is there a policy (post Covid) from HR/Service Directorate that offers a narrative for all staff around any changes to working patterns - hybrid, specific working hours, TOIL, times where the service needs are more demanding.
Disseminate to all staff and make time available for feedback from teams.
Could use supervision to unpick this problem - share this problem with the leadership team.
Consider the impact on other members of the team if one individual is making more requests than others. Could this create any division within the team, cause any conflict which could impact on the team dynamic and performance?
The presenter shared that some of the team were frustrated, others seemed to have a more empathic understanding.
Equality for all staff - leadership team to relay a consistent message to all teams.
Remind staff of the functions of the service and at the same time validate the teams performance - 'buy in' from the whole team.
The presenter also reflected on how such problems may challenge their leadership style - consider how this impacts on self and confidence in managing such problems.
Could also consider Stress Risk Assessment for the individual - this give them the opportunity to identify any challenges (conscious/unconscious), it also allows for a personal action plan.

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I was curious to know what the ALS would consist of, I had an idea that this was very much a reflective space where the group would bring a topic for discussion.
The concern needs to be real. In this space it is encouraged that we are curious and can be reflective.
Discussion needs to be converted in to and action and for a solution to be found.

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Action Learning_An Introduction and Methods