This document discusses leadership styles and motivating colleagues in a shrinking world. It covers leadership styles and how they can motivate or demotivate people. It also discusses clinical engagement in the NHS and how leaders can motivate staff through aligning goals, communication, and involving staff in decision making. The document presents two case studies, one where medical staff cuts were achieved through consultation and one with ongoing conflict from a lack of engagement. It emphasizes that clinical engagement, positive leadership, and involving staff in decisions can result in high motivation, while disengagement and lack of consultation can lead to low morale and embitterment.

1. Managing and motivating
Colleagues in a shrinking
World
Dr Mike Roddis 21 October 2011 1

2. Topics to cover today
 Leadership styles and motivation
 Clinical engagement – what the NHS says
 What leaders do vs. how leaders do it
 Motivating people and how to do it (or not)
 The shrinking world and what it means
 Case studies
2

3. Leadership styles and motivation: one
approach
Question:
Can you motivate others or can you only
produce a climate in which they motivate
themselves?
3

4. Leadership styles and motivation: one
approach
Daniel Goleman. Leadership that gets results. HBR March 2000
Style: Negative
Coercive Most strongly positive
Authoritative Positive
Affiliative Positive
Democratic Negative
Pace-setting Positive
Coaching
Climate:
4

5. Leadership styles and motivation: one
approach
 Native style
Innate preference
 Adaptability
Changing circumstances
Different individuals
 Effect on outcomes
5

6. Clinical engagement: an NHS buzz-phrase
Engaging Doctors: Can doctors influence organisational
performance? Hamilton et al. AOMRC and DH 2008
“The essence of clinical leadership is to motivate, to
inspire, to promote the values of the NHS, to empower
and to create a consistent focus on the needs of the
patients being served. Leadership is necessary not
just to maintain high standards of care but to
transform services to achieve even higher levels of
excellence.”
6

7. Clinical engagement: Where are you now?
The Medical Engagement Scale
 Organisational opportunity scales which reflect the cultural
conditions that facilitate doctors to become more actively
involved in leadership and management activities
 Individual capacity scales reflecting perceptions of
enhanced personal empowerment, confidence to tackle
new challenges and heightened self-efficacy.
7

8. What leaders do vs. how they do it
What you do: competencies
The Medical Leadership Competency
Framework
How you do it
Transformational leadership questionnaire
(Prof Beverly Alimo-Metcalfe)
8

9. Engaging transformational leadership
(Real World Group)
9

10. Motivating people and how to do it – some
tips
 Motivate yourself
 Align your goals with that of your people
 Try to understand what motivates them
 Talk to them
 Listen to them
 Observe them
 Don‟t make assumptions about them
 Adapt your systems to support the process
10

11. Motivating people and how to do it – some
tips
 Hold 121 meetings
 Develop skills in delegation
 Praise good performance and affirm positive contributions
 Focus on behaviours not personalities
 Reward what you see rather than focusing on what you
feel
 Use appraisal and performance management systems
actively
 Explain how behaviours contribute to success.
11

12. The Shrinking World
Service restrictions
Service reconfigurations
12

13. Service restrictions
 Absolute budget cuts
 Efficiency gains
 New ways of working
 Changed balance between the professions
13

14. Service reconfigurations
 Networks
 Rationalisation/centralisation
 Public sector mergers and takeovers
 Private sector involvement
14

15. Case study – 1
 The problem:
 A Partnership Trust with a 20% decrease in income from
commisssioners
 Chief Executive removes £3M from the medical staffing budget
and suggests traditional cuts with ward closures, recruitment
freeze etc
 The Trust has 90 consultants, 70 SAS staff
 60 – 70 trainees
15

16. Case study – 1
 The solution:
 Agree trainees remain untouched
 Shed 50 SAS posts
 Reduce medical support to one post per consultant
 Establish consultant-delivered service
 No reduction in workload
 Savings achieved
16

17. Case study – 2
 The problem:
 Two merged DGHs with duplicate services
 Enormous cash deficit
 No history of joint clinical working
 No culture of clinical engagement or medical involvement in
management
 Possible forced implementation of service reconfiguration
17

18. Case study – 2
 The current position:
 No service changes
 On-going conflict and disputes across the sites
 Multiple internal workshops and reviews
 External facilitation and mediation failed to bring about
change
 Future of all clinical services remains in doubt
18

19. Why were the results so different?
19

20. In conclusion
Factors associated with high levels of motivation:
Clinical engagement
Positive leadership climate
Medical staff and board goals aligned
Extensive internal consultation on plans
Effective communication
Staff opinions and expertise actively sought
Effective delegation and empowerment
20

21. With other end of the spectrum:
Disengagement
Poor morale
Cynicism
Bitterness
21

22. Chronic embitterment:
(taken from paper by Dr Janet Ballard to the European
Association of Public Health Medicine 2010)
Embitterment:
“An emotion encompassing persistent
feelings of being let down, insulted or
being a loser, and of being revengeful
but helpless.”
22

23. Chronic embitterment:
Features: History
• Manifests itself in the context of a relationship that has
„gone wrong‟.
• Events cited as evidence of having been let down or
badly treated by superiors or by the organisation as a
whole
• Lack of resolution of event(s)
• Present distress attributed directly to event(s)
• Strong convictions about fairness, justice or
anticipated support
23

24. Chronic embitterment:
Contributory factors
Personal:
• Strong personal aspirations (especially strong principles
and
sense of justice)
• Perceived breach of the psychological work contract
Organisational:
• Nature of precipitating event(s)
• Attempts to resolve the precipitating events and their
aftermath
• Lack of adequate attention to organisational justice 24

25. Chronic embitterment:
Management of the organisation
Increase awareness of the condition (including
causes and consequences)
Reduce collusion with rumination (balancing need
not to be perceived as dismissive)
Encourage open and responsive communications
Prompt response to investigations/grievances
Attention to procedural justice
25

26. Chronic embitterment:
Management of the individual
Coaching to:
• Acknowledge the problem (including behaviours)
• Reduce unhelpful behaviours
• Develop strategies to reduce rumination
• Review personal goals
• Reduce likelihood of escalation
26

27. Thank you