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Performance Improvement and Leadership in the Health Service IrSPEN_10 March 2015

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Performance Improvement and Leadership in Health Care.

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Performance Improvement and Leadership in the Health Service IrSPEN_10 March 2015

  1. 1. Performance Improvement and Leadership in the Health Service Dr Steven Kinnear Physician and Management Consultant IrSPEN Satellite Symposium, Dublin, Tuesday 10 March 2015 @drstevenkinnear | @kinnearconsult
  2. 2. PERFORMANCE IMPROVEMENT IN HEALTH CARE
  3. 3. What is performance in health care and why improve it? If one cannot increase the supply of a resource, one must increase its yield. And effectiveness is the one tool to make resources of ability and knowledge yield more and better results. - Peter Drucker
  4. 4. Performance Improvement More can be gained and more lives saved through the development of the science of performance in clinical care, than any development in genome or laboratory techniques Atul Gawande “Better”
  5. 5. What is performance in health care and why improve it? • If one cannot increase the supply of a resource, one must increase its yield. And effectiveness is the one tool to make resources of ability and knowledge yield more and better results. • Clinical quality & productivity is healthcare performance • Clinician time & expertise is the high value resource (expensive, limited availability) • Value is – Operational (cost benefit), outcome (clinically effective) /experiential (customer perceived quality) (Young, 2008) – Outcome, financial, functional, patient satisfaction (Walburg 2005) From PiMMs Project, Tim Trebble
  6. 6. Wicked problems and great conundrums Quality Activity Increased flow of patients Utilisation of available capacity Efficiency (Waste) Time spent on procedures (slow &careful) Time spent with patients Error by checking and review Are quality and productivity the same thing? Can they sometimes oppose each other? How do we get the balance right? When is busy understaffed? Figure from PiMMs project, Tim Trebble
  7. 7. Options for improving performance Sweat the assets Work smarter, not harder
  8. 8. Motivation Intrinsic • Autonomy, mastery, purpose • Self-actualisation, peer group respect, enablement • Recognition and fairness Extrinsic • Personal desire • Able to influence rate of work with reward • Easy to modify behaviour • Hard to sustain Psychologist Ernest Becker – Man is driven by an essential “dualism”; he needs both to be a part of something and to stick out.
  9. 9. Problems with management • The problem is our obsession with the tools of management obscures our apparent ignorance of the art – Tools biased towards measurement and analysis – Can we measure the value of a turned-on workforce??
  10. 10. Robin the ED Ward Clerk • Comes in early/stays late when needed • Knows/has a good relationship with everyone • Organised, efficient, able and affable • Knows where everything is • Nothing is too much trouble • Works outside his job description • His job is to do whatever needs done to keep things running smoothly • The glue that holds the department together • Pretty much the lowest paid member of staff in the department
  11. 11. Why? • Intrinsic motivation • Autonomy • Purpose • Respect and appreciation from seniors, peers and patients • Recognition • Dualism – a part of something and sticking out
  12. 12. Elton Mayo and the Western Electric Hawthorne Plant
  13. 13. Harness the power of the front line • Empower teams to solve their own problems • Develop and support effective ways of working • Develop and manage talent • Be a CHRO – Chief Hurdle Removal Officer • Trust your staff • Don’t cater for the lowest common denominator
  14. 14. Listen to the pissed off people • They are the only true source of innovation • Nurture the dissenters
  15. 15. Problems controlling quality in a service industry • Not like a production line • What gets produced in a service business and what gets consumed happens at the same time • How do you get tens, hundreds, thousands of people to adhere to roughly the same high standard of quality?
  16. 16. Getting the best out of your people Nothing succeeds like success Label a man a loser and he’ll start acting like one
  17. 17. HSC Changeday
  18. 18. LEADERSHIP IN HEALTH CARE
  19. 19. What is Leadership (in healthcare)?
  20. 20. What is Leadership (in healthcare)? Leadership is about maximising the realisation of human potential.
  21. 21. What does leadership mean?
  22. 22. Problems with leadership in the health service • Most great leaders I can think of where chosen by the people • Most people in leadership positions in the health service are chosen by the hierarchy
  23. 23. If you want to know who the leaders are, look to see who people are following vs
  24. 24. Leadership in the Health Service • Not all leaders are good • Not all leadership is good
  25. 25. Leadership in the Health Service • Toxic leadership causes great damage • Look out for it • Learn from it • Do something about it if you can
  26. 26. How can I be the kind of leader the Health Service needs? • Be in the disturbance business • Be a disruptive leader • Be an innovator
  27. 27. How can I be the kind of leader the Health Service needs? • If you can lead without authority you can darn sure lead with it • The converse is not true
  28. 28. How can I be the kind of leader the health service needs? Leader CQ IQ EQ PQ
  29. 29. How can I be the kind of leader the health service needs?
  30. 30. How can I be the kind of leader the health service needs?
  31. 31. How can I be the kind of leader the health service needs?

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