Leading Out of the Mess    Michigan Primary Care Association Fall 2009 Annual Conference  Roger L. Chaufournier Executive ...
Objectives of the Workshop <ul><li>1)  Understand how to utilize a leadership Framework to drive improvement in the organi...
Overview <ul><li>Chapel Road Case Study </li></ul><ul><li>Framework for Leadership </li></ul><ul><li>Leading Transformatio...
CHAPEL ROAD HEALTH CENTER
Chapel Road Health Center  <ul><li>Single site FQHC located in an urban environment </li></ul><ul><li>Leadership turned ov...
Common Leadership Practices <ul><li>Reactive vs. Proactive </li></ul><ul><li>Blame the people </li></ul><ul><li>Throw peop...
All Leadership Approaches Work! <ul><li>Autocratic-Top Down-Controlling </li></ul><ul><li>Hands Off </li></ul><ul><li>Team...
“ Hardly a competent workman can be found who does not devote a considerable amount of time to studying just how slowly he...
“ We trained hard...but it seemed that every time we were beginning to form up into teams we would be reorganized.  I was ...
 
Peter Drucker “ Every few hundred years in the history of Western society a transformation takes place. The transformation...
Transformational Leadership <ul><li>Problem Solving: System Focused not People Focused </li></ul><ul><li>Strategic vs. Rea...
Small Group Dialogue <ul><li>What would you do to right the ship? </li></ul><ul><li>What role should the Chief Medical Off...
Baldrige Health Care Criteria for  Performance Excellence Framework A Systems Perspective 4 Information and   Analysis 6 P...
Peter Drucker’s Effective Executive: Eight Practices <ul><li>They ask “what needs to be done” </li></ul><ul><li>They ask “...
PULL PUSH 1.  Set Direction: Mission, Vision and Strategy <ul><li>3. Build Will </li></ul><ul><li>Plan for Transformation ...
Leadership <ul><li>Build will through a clear vision people want to buy into </li></ul><ul><li>Communicate </li></ul><ul><...
Strategic Leadership <ul><li>Clear vision and mission </li></ul><ul><li>Constant Fingerprinting of the vision </li></ul><u...
Quality Initiatives Must be Broad Enough and Deep Enough to Move the Big Dot <ul><li>Organization message :  this year, pa...
Aligning  Work to your Business Imperative Community Health Health Health  Center Center Assessment  Strategic Plan QI Pla...
Information Management and Analysis <ul><li>Set of system level measures for the organization </li></ul><ul><li>They focus...
SJHS Performance Metrics <ul><li>Balanced </li></ul><ul><li>High level </li></ul><ul><li>Linked to trended run and control...
09/30/09 Dashboards Informed decisions through the use of appropriate and timely data Source: Richard Davis, Johns Hopkins...
Work Process Management <ul><li>Put people to work on building the better mouse trap </li></ul><ul><li>Use change methods ...
Every Leader Needs a Toolkit of Improvement Methods To Lead Change <ul><li>Improvement Methods: </li></ul><ul><li>PDSA </l...
Value Stream Mapping Phases Preparation Current State Future State Planning Agreeing on what process to study, how to map ...
 
Standards Identified (selected examples....) <ul><li>98% overall accuracy rate of registration </li></ul><ul><li>90% compe...
PICOS Groups Redesign Registration Processes <ul><li>Key metrics for each group </li></ul><ul><li>Vision for new processes...
Revenue Recovery  Accomplishments     Activity Baseline FY00  FY01  FY02  FY03  FY04 FY05 (Q2) Competency Scores 65% 80% 9...
Work Force Management <ul><li>Create an environment that breeds success  </li></ul><ul><li>Recruit great people </li></ul>...
What Leads to Intrinsic Motivation? <ul><li>Control over the variables </li></ul><ul><li>Feedback </li></ul><ul><li>The ab...
Role of Recognition <ul><li>The Carrot Principle  Gostick and Elton 2007 </li></ul><ul><li>200,000 employee ten year study...
Recognition Formula <ul><li>Annual expenditures $1000 per employee or 2% of payroll </li></ul><ul><li>Every 7 days thank f...
Empowerment <ul><li>How do you build an empowered organization? </li></ul><ul><li>Philosophy </li></ul><ul><li>Delegated a...
BRINGING IT ALL HOME <ul><li>What do I do now? </li></ul>
Bring it All Home-Key Points <ul><li>Leadership can be viewed as a system </li></ul><ul><li>A framework can help you impro...
Action Planning <ul><li>What three steps can you take upon return? (new concepts you want to explore) </li></ul><ul><li>Wh...
Where to find more information <ul><li>Malcolm Baldrige National Quality Award </li></ul><ul><li>IHI.org  Monograph:  The ...
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Leadership Workshop - Leading Out of the Mess

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  • Leadership and Organizational Behavior Session 1: History of Management Theory (May 2000) TAYLOR was a factory worker who was going blind and was moved into a management position. He was asked to analyze the factory work flow so he did time-motion studies. Father of the “scientific method of management”. He said that the best way to increase output was to improve techniques used by the workers and standardize procedures. The role of the manager is to design work so that it is fool proof, then motivate people. But people were instruments to be manipulated by management. Workers are to do what they are told, do not deviate from work tasks. The result was that workers had to adjust to management. In the 1930’s when Taylor was making factories efficient, where did the money go? ****Answer: Corporate boardrooms not the labor. Created the “sweat shop.” Led to the age of “touchy- feely” management. We will be talking in later classes about six sigma and other improvement methods. The goal of six sigma is to standardize operations (Jack Welch did this well at GE). How do you reconcile your reaction to Taylor’s work with the current six sigma movements? 2.00 8:26 Chip
  • Leadership and Organizational Behavior Session 1: History of Management Theory (May 2000) QUOTE: Petronius Arbiter,  Roman Legionnaire 210 B.C [Read the military quote and ask the currently displayed site the question.] Answer: Petronius Arbiter,  Roman Legionnaire,  210 B.C. After Fayol, Max Weber (Va-Ber) came along and expanded his theory of bureaucracy. He said people need rules and regulations at work. Management needs to implement policies and procedures, delegate authority and tasks, need hierarchy and span of control. 1.00 Videoconference: Site: ______________________ 8:18 Chip
  • Leadership and Organizational Behavior Session 1: History of Management Theory (May 2000) We’ll use this quote to signify a shift in thinking that occurred in the early 1900s. Luther Gullick, a Harvard guy, built on the work of Fayol, Weber and Taylor. Said you need structural stuff, but there are also core competencies of management THAT CAN BE TAUGHT (this, incidentally, led to the creation of the Harvard Business School. Harvard developed these into courses that guide the school to today!). Gullick created a role for managers, which led to an explosion of “how to” manuals. Planning, Organizing, Scheduling, Delegating, Coordinating, Resource Management, Budgeting. But these cannot become the goal itself; they must be considered as tools and strategies toward an end in order to be successful. During this time, up to WW2, US factories were cranking, productivity had skyrocketed. In fact, many historians credit the fact that we had our act together in the factories as a reason we won the war. We had the ability to produce arms and material and send them out. However, increased productivity eventually led to a fissure between management and labor. From the 30s-60sm the growth of labor and the strain between labor and management led to the rise of the humanistic movement or “touchy feely management”.
  • Leadership and Organizational Behavior Session 1: History of Management Theory (May 2000) DRUCKER [ Read the quote .] Wrote a book that captures the epics of management over time. Described three-four epics in our history representing profound shifts in society. These epics triggered shifts in management practice. 2.00 8:01 Chip
  • Leadership and Organizational Behavior Session 1: History of Management Theory (May 2000) Drucker argues that to be an effective executive, you can be all over the map in terms of personality, attitudes, values, strengths, weaknesses…extroverted, reclusive, easy-going, controlling, generous or parsimonious. This SYSTEMATIC APPROACH can help any executive get things done. Effective executives get the right things done.
  • … and the department aim would be CABG ssis, or BSIs in one particular ICU with one particular subset of patients…etc.
  • Leadership and Organizational Behavior Session 4: Strategic Planning (May 2000) What you are looking at is the 30,000 ft level view of performance measures. From an organizational perspective, performance measures should provide enough detail to allow us to understand performance along a number of perspectives (Remember What we discussed about Systems Theory). Just as the dashboard of a car provides just the right information to make informed decisions, without getting you bogged down in data that doesn’t serve you while you are driving, performance measurement in business should follow a similar model by identifying elements critical to daily operations. A dashboard is a graphical representation of performance. It generally provides a very quick visual guide to how we are progressing currently and over time on numerous parameters. The individual and the group should be able to use the performance measures and understand how the pieces of the system fit together. A good set of performance measures will look at the organization from a number of viewpoints. At Hopkins we have an established Balanced Scorecard Dashboard that measures performance on 4 spectra: Fiscal Clinical Service, and Infrastructure Other spectra that can be used include: Financial – Summarizes economic consequences of actions. Provides an overview of the financial state of the organization in terms of growth, sustainability and areas of concern Customers – Identifies customers and market segments Measures Segment specific drivers - Product and service attributes, Customer relationships, and Image and reputation Learning and Growth – Identifies the infrastructure that an organization must build to achieve its strategic imperatives People and any reskilling that is required, Information systems that need to be enhanced, Procedures that need to be aligned to future vision Internal Business Processes – Identifies critical business processes and focuses on the processes which will have the greatest impact on customer satisfaction and achieving financial objectives Innovation, operations, post sales service Keep in mind whenever you are reviewing dashboards and similar types of performance measures, that they are not… A detailed report – they only provides a summary picture of the operation The Final product – Metrics should be updated to account for changes in operations and strategic objectives A computer solution – Determine what you want to measure before you put in onto the computer. Try it to see if it truly measures what you are trying to measure. Ron Petersen, Judy Reitz, etc will have a dashboard developed that will show the operating model for each unit on a daily / weekly basis. The data that you provide / input will feed directly into these dashboards so that they can see progress overall and on specific projects. If they detect problems from these charts they will come down and ask you about the issues and what your plans are to resolve them, also what can they do to help.
  • Customer requirements for a Workshop A date commitment 2-4 weeks in advance Sponsor to give 15 min. introduction to Workshop and attend Leadership Panels Sponsor must support the implementation changes (this could mean significant change) All Workshop participants required to commit full-time to Workshop Prepare for Workshop in advance, with TWI assistance Workshop to be held on consecutive days, and customer must provide supplies (suitable room, flip charts, dry-erase markers, projector)
  • Chip 2.00 8:49
  • Leadership Workshop - Leading Out of the Mess

    1. 1. Leading Out of the Mess   Michigan Primary Care Association Fall 2009 Annual Conference Roger L. Chaufournier Executive Director CSI Solutions, LLC September 2009
    2. 2. Objectives of the Workshop <ul><li>1) Understand how to utilize a leadership Framework to drive improvement in the organization </li></ul><ul><li>2) Understand best practices of leadership in driving organizational change </li></ul>
    3. 3. Overview <ul><li>Chapel Road Case Study </li></ul><ul><li>Framework for Leadership </li></ul><ul><li>Leading Transformation </li></ul><ul><li>Bringing it All Home: Next Steps </li></ul>
    4. 4. CHAPEL ROAD HEALTH CENTER
    5. 5. Chapel Road Health Center <ul><li>Single site FQHC located in an urban environment </li></ul><ul><li>Leadership turned over </li></ul><ul><li>List of challenges to overcome </li></ul><ul><li>What are your impressions of this organization? </li></ul>
    6. 6. Common Leadership Practices <ul><li>Reactive vs. Proactive </li></ul><ul><li>Blame the people </li></ul><ul><li>Throw people or policies at the problem </li></ul><ul><li>Gimmicks </li></ul><ul><ul><li>Slogans/campaigns </li></ul></ul><ul><ul><li>New Policies/Approval Process & Signatures </li></ul></ul><ul><ul><li>Reorganizations </li></ul></ul><ul><ul><li>Use of extrinsic motivation (carrot and stick) </li></ul></ul>
    7. 7. All Leadership Approaches Work! <ul><li>Autocratic-Top Down-Controlling </li></ul><ul><li>Hands Off </li></ul><ul><li>Team based </li></ul><ul><li>But certain leadership principles lead to higher levels of performance …. </li></ul>
    8. 8. “ Hardly a competent workman can be found who does not devote a considerable amount of time to studying just how slowly he can work and still convince his employer that he is going at a good pace. Under our system a worker is told just what he is to do and how he is to do it. Any improvement he makes upon the orders given to him is fatal to his success.” Frederick Taylor
    9. 9. “ We trained hard...but it seemed that every time we were beginning to form up into teams we would be reorganized.  I was to learn later in life that we tend to meet any new situation by reorganizing; and what a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization.” Who do you think said this and in what era did they live?
    10. 11. Peter Drucker “ Every few hundred years in the history of Western society a transformation takes place. The transformation transcends all aspects of society; the government, the schools, the values, religion, culture, etc. The transformation is not sudden, but takes place over a 50 year or more period. The transformation is so profound that the children born in that era can not comprehend the time in which their parents were born and in which their grandparents lived.”
    11. 12. Transformational Leadership <ul><li>Problem Solving: System Focused not People Focused </li></ul><ul><li>Strategic vs. Reactionary </li></ul><ul><li>Focus on Quality as a Business Strategy </li></ul><ul><li>Measurement and Feedback as a driver for change </li></ul><ul><li>Leadership as a system; continuous reflection and improvement </li></ul><ul><li>Build organizational capacity for excellence </li></ul>
    12. 13. Small Group Dialogue <ul><li>What would you do to right the ship? </li></ul><ul><li>What role should the Chief Medical Officer Play? </li></ul><ul><li>If you were the CEO, what would you do? </li></ul><ul><li>How can the CEO best work with the Medical Director to develop a game plan? </li></ul>
    13. 14. Baldrige Health Care Criteria for Performance Excellence Framework A Systems Perspective 4 Information and Analysis 6 Process Management 2 Strategic Planning 5 Staff Focus 1 Leadership 3 Focus on Patients, Other Customers, and Markets Organizational Profile: Environment, Relationships and Challenges Malcolm Baldrige National Quality Award 7 Organizational Results
    14. 15. Peter Drucker’s Effective Executive: Eight Practices <ul><li>They ask “what needs to be done” </li></ul><ul><li>They ask “what is right for the enterprise” </li></ul><ul><li>They develop action plans </li></ul><ul><li>They take responsibility for decisions </li></ul><ul><li>The take responsibility for communicating </li></ul><ul><li>The focus on opportunities rather than problems </li></ul><ul><li>They run productive meetings </li></ul><ul><li>They think and say “we” rather than “I” </li></ul>Give the executive the knowledge they need Convert the knowledge into effective action Ensure that the whole organization feels responsible and accountable
    15. 16. PULL PUSH 1. Set Direction: Mission, Vision and Strategy <ul><li>3. Build Will </li></ul><ul><li>Plan for Transformation </li></ul><ul><li>Set Aims/Allocate Resources </li></ul><ul><li>Measure System Performance </li></ul><ul><li>Provide Encouragement </li></ul><ul><li>Make Financial Linkages </li></ul><ul><li>Learn Subject Matter </li></ul><ul><li>Work on the Larger System </li></ul><ul><li>5. Execute Change </li></ul><ul><li>Use Model for Improvement for </li></ul><ul><li>Design and Redesign </li></ul><ul><li>Use Change Leadership Model </li></ul><ul><li>Review and Guide Key Initiatives </li></ul><ul><li>Spread Ideas </li></ul><ul><li>Communicate results </li></ul><ul><li>Sustain improved levels of </li></ul><ul><li>performance </li></ul>Make the status quo uncomfortable Make the future attractive Leadership for Transformation <ul><li>4. Generate Ideas </li></ul><ul><li>Read and Scan Widely, Learn from other Industries/Disciplines </li></ul><ul><li>Benchmark to Find Ideas </li></ul><ul><li>Listen to Customers </li></ul><ul><li>Invest in Research &Development </li></ul><ul><li>Knowledge management </li></ul><ul><li>Understand Organization as a System </li></ul>IHI 2003 2. Establish the Foundation <ul><li>Reframe Operating Values </li></ul><ul><li>Build Improvement Capability </li></ul><ul><li>Build Relationships </li></ul><ul><li>Develop Future Leaders </li></ul><ul><li>Personal Preparation </li></ul><ul><li>Choose and Align the Senior Team </li></ul>
    16. 17. Leadership <ul><li>Build will through a clear vision people want to buy into </li></ul><ul><li>Communicate </li></ul><ul><li>Clear system level metrics </li></ul><ul><li>Clear system priorities </li></ul><ul><li>Empower staff to move the dots </li></ul><ul><li>Align organization and remove barriers </li></ul>
    17. 18. Strategic Leadership <ul><li>Clear vision and mission </li></ul><ul><li>Constant Fingerprinting of the vision </li></ul><ul><li>Set a limited number of core strategic drivers-the vital few </li></ul><ul><li>System of accountability </li></ul>
    18. 19. Quality Initiatives Must be Broad Enough and Deep Enough to Move the Big Dot <ul><li>Organization message : this year, patients will not acquire catheter-related bloodstream infections, surgical site infections, or ventilator-associated pneumonia </li></ul>IOM aim : Care should be safe JHHS-level goal : patients will not be infected as a result of being in our hospital Projects (often cross-departmental) : CABG surgical site infection initiative, ICU catheter initiative, laminectomy initiative, etc. Each absolutely MUST have clear metrics: you manage what you measure. If you don’t capture the data, develop a way JHM Strategic Priority : Clinical excellence Source: Richard Davis, Ph.D. Johns Hopkins Medicine
    19. 20. Aligning Work to your Business Imperative Community Health Health Health Center Center Assessment Strategic Plan QI Plan & Monitoring System Priorities for Participation in Improvement Projects and Priorities for Spread Collaborative Team Established Plan Act Do Study Cycles Plans For Spread Based on Successful PDSA Monthly measures <ul><li>Improved </li></ul><ul><li>Health </li></ul><ul><li>Center </li></ul><ul><li>Performance </li></ul><ul><li>lower cost </li></ul><ul><li>> clinical </li></ul><ul><li>outcome </li></ul><ul><li>>patient & </li></ul><ul><li>staff </li></ul><ul><li>satisfaction </li></ul>Update the plan
    20. 21. Information Management and Analysis <ul><li>Set of system level measures for the organization </li></ul><ul><li>They focus on “moving the dots” </li></ul><ul><li>Information is available to front line work force </li></ul><ul><li>Data driven decision making </li></ul>
    21. 22. SJHS Performance Metrics <ul><li>Balanced </li></ul><ul><li>High level </li></ul><ul><li>Linked to trended run and control charts </li></ul><ul><li>Indicator-specific comparative rates (green circle) </li></ul><ul><li>Adds focus to “move to the outside circle” </li></ul><ul><li>Some successes </li></ul>
    22. 23. 09/30/09 Dashboards Informed decisions through the use of appropriate and timely data Source: Richard Davis, Johns Hopkins Business of Medicine Program
    23. 24. Work Process Management <ul><li>Put people to work on building the better mouse trap </li></ul><ul><li>Use change methods to drive improvement </li></ul><ul><li>Empower staff with the tools to study and improve work </li></ul><ul><li>Drive the improvement efforts </li></ul>
    24. 25. Every Leader Needs a Toolkit of Improvement Methods To Lead Change <ul><li>Improvement Methods: </li></ul><ul><li>PDSA </li></ul><ul><li>PICOS/Lean </li></ul><ul><li>Six sigma (DMAIC) </li></ul><ul><li>AIM </li></ul><ul><li>Kaizen </li></ul><ul><li>Reengineering </li></ul><ul><li>These tools are specific to the improvement task at hand. </li></ul>All have similarities in approach: applying the scientific method to improvement: defining, measuring and testing
    25. 26. Value Stream Mapping Phases Preparation Current State Future State Planning Agreeing on what process to study, how to map it and who will participate. Agreeing on a well understood map of the current situation. Agreeing on a shared vision of a lean future state. Agreeing on how to implement the future state vision Adapted from Lean Enterprise Institute
    26. 28. Standards Identified (selected examples....) <ul><li>98% overall accuracy rate of registration </li></ul><ul><li>90% competency rate of registration staff </li></ul><ul><li>100% of claims include referral/auth. </li></ul><ul><li>95% insurance verification and precert. </li></ul><ul><li>90% TOS payments collected/counseled </li></ul><ul><li>Reduce denial rate </li></ul><ul><li>Increase patient satisfaction </li></ul><ul><li>Standards to guide PICOS groups </li></ul>
    27. 29. PICOS Groups Redesign Registration Processes <ul><li>Key metrics for each group </li></ul><ul><li>Vision for new processes </li></ul><ul><li>Action items </li></ul><ul><ul><li>Short Term: implement immediately after workshop </li></ul></ul><ul><ul><li>Long Term: implement over 12 months while group continues to meet </li></ul></ul>
    28. 30. Revenue Recovery Accomplishments     Activity Baseline FY00 FY01 FY02 FY03 FY04 FY05 (Q2) Competency Scores 65% 80% 90% 92% 91.4% 92.5% 93.5%   Admin. Denial Rate 1.4% 1.4% 1.4% 1.4% 1.4% 2.0% 1.7% Clinical Denial Rate 2.3% 1.7% 2.0% 2.0% 1.8% 1.8% 1.8% TOS Collections $13.8m $17.5 $8.7m* $10.1m $8.6M $9.5M $4.4M   Collection Rate 85.6% 87.4% 87.5% 88.1% 88.6% 89.3% 87.9%   Days in A/R 118 96 75 61 56.3 50.6 53.7 Late Charges 9% 4% 4% 3% 2.6% 3.1% 2.5%       Cumulative Revenue FY00 – FY05 = $98,000,000
    29. 31. Work Force Management <ul><li>Create an environment that breeds success </li></ul><ul><li>Recruit great people </li></ul><ul><li>Train and empower the work force </li></ul><ul><li>Recognition as a driver or performance </li></ul><ul><li>Building “Good to Great” cultures </li></ul>
    30. 32. What Leads to Intrinsic Motivation? <ul><li>Control over the variables </li></ul><ul><li>Feedback </li></ul><ul><li>The ability to make a contribution and succeed </li></ul><ul><li>Variation </li></ul><ul><li>Recognition </li></ul><ul><ul><li>Make work like a Nintendo game! </li></ul></ul>
    31. 33. Role of Recognition <ul><li>The Carrot Principle Gostick and Elton 2007 </li></ul><ul><li>200,000 employee ten year study </li></ul><ul><li>Frequent, variable, meaningful praise tied to: </li></ul><ul><ul><li>Goal Setting </li></ul></ul><ul><ul><li>Communication </li></ul></ul><ul><ul><li>Trust </li></ul></ul><ul><ul><li>Accountability </li></ul></ul>
    32. 34. Recognition Formula <ul><li>Annual expenditures $1000 per employee or 2% of payroll </li></ul><ul><li>Every 7 days thank for free (hand written note, verbal, email) </li></ul><ul><li>4-6 /year above and beyond wards ($100-$2000 </li></ul><ul><li>$100 annually- 2 times per year event award </li></ul><ul><li>$200 year Service Awards (90 day;1 yr;3 yr; 5yr;10yr; every five year thereafter </li></ul>
    33. 35. Empowerment <ul><li>How do you build an empowered organization? </li></ul><ul><li>Philosophy </li></ul><ul><li>Delegated authority </li></ul><ul><li>Training </li></ul><ul><li>Monitoring </li></ul><ul><li>Communication </li></ul><ul><li>Reinforcement </li></ul><ul><li>Celebration </li></ul>
    34. 36. BRINGING IT ALL HOME <ul><li>What do I do now? </li></ul>
    35. 37. Bring it All Home-Key Points <ul><li>Leadership can be viewed as a system </li></ul><ul><li>A framework can help you improve your leadership system </li></ul><ul><li>Each Domain of the Framework has principles and best practices you can learn to master </li></ul><ul><li>You should maintain a continuous learning environment </li></ul>
    36. 38. Action Planning <ul><li>What three steps can you take upon return? (new concepts you want to explore) </li></ul><ul><li>What next step do you need to do to continue your learning journey? </li></ul>
    37. 39. Where to find more information <ul><li>Malcolm Baldrige National Quality Award </li></ul><ul><li>IHI.org Monograph: The Seven Leadership Leverage Points </li></ul><ul><li>Built to Last ; Jim Collins and Jerry Porras. </li></ul><ul><li>First, Break All the Rules: What the World’s Greatest Mangers Do Differently , Marcus Buckingham and Curt Coffman </li></ul><ul><li>The Leadership Challenge , James Kouzes and Barry Posner </li></ul><ul><li>The Carrot Principle Gostick and Elton 2007 </li></ul>
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