Cascading Leadership: Creating Organization

Opportunity

National Health Leadership ConferenceTuesday June 5, 2012

Jocelyn Bennett, Senior Director, Urgent and Critical Care

Jody Tone, Nursing Unit Administrator, General Internal Medicine

Rio de Janeiro

Rocky Reach Dam, Columbia River OR

Development of Emerging Leaders

• The next generation of leaders is already working for you- start now to groom our future

• Successful leadership development begins with strong executive engagement and development of healthy work places

• Direct attention towards personal development of individual talent within the organization

Dion et al, Developing Tomorrow’s Nurse Leaders. DecisionCritical.com

Sherman & Pross, Growing Future Nurse Leaders to Build and Sustain health Work Environments. Onlin Journal of Issues in Nursing

If You’re Not Developing… You’re Not Leading!

Releasing Time to Care©•An international initiative from the National

Health Services in the UK that increases the time nurses spend with patients, improving the patient experience, and contributing to a safer environment

•A front-line, top-enabled approach to improving patient care and work environment

•Based on Lean principles •Structured, continuous quality improvement•A way to build leadership at the front line

Modules of The Productive Ward

Knowing

Knowing How we Are Doing

Knowing How we Are Doing

An approach to measure and track, and help determine if the changes you make are meeting with the core objectives

Well Organized Ward

Simplify the workspace and reduce waste using lean principles. “Everything in the right place, at the right time, ready to go”

Patient Status at a Glance

Using visual management to show important patient information inorder to improve communication, pt experience and patient flow

RTC Outcomes

• Increased percentage of direct care time for patients

• Decrease number of patient falls and pressure sores

• Increased transparency and accountability through visual displays of quality measures

• Improvement in patient satisfaction• Improvement in nurse satisfaction

Leadership

“ Leadership is about engaging with nurses, listening to them and developing the structures and processes that will enable them to grow and develop”

Donner, G.& Wheeler, J. New Strategies for Developing Leadership

Leadership and RTC

• RTC promotes leadership development:– by giving nurses more control over their work environment– by providing tools to improve their work environment– the opportunity for leaders to mentor and coach staff

• Empowers staff:– to get rid of waste in the environment so they can spend

more time on direct patient care– to design safer more reliable care processes– to solve problems by providing information

RTC - EvaluationGoal: To understand the impact of RTC on staff

nurse engagement and leadership development.

Sample/Methods• Pilot unit evaluation (16 months post initiation)• 3 focus groups (N= 19)• Facilitated by the 2 RTC co-leads

• Interview guide based on NHS Staff Sustainability Factors

NHS Sustainability Model and Guide

Reference

Staff Sustainability Factors

1. Training and Involvement• Support and engagement

2. Behaviours/Attitudes• Ideas and empowerment

3. Senior Leaders• Trusted and enabling

4. Clinical Leaders• Trusted and enabling

LEADING

PARTICIPATING

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Cascading Leadership

ENGAGING

LEADING

PARTICIPATING

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Leading • Clinical leading valued

• Leading what is relevant

• Levelling the hierarchy

• Leading beyond

Participating• Engagement

• All participation is active

• Control over practice

Culture Shift• Lead from where you stand

• Ownership

• Peer expectation

Enablers

• Release time

•Tests of change

• Hardwiring improvement

• Visible organizational leadership

Cascading LeadershipO

RG

AN

IZATIO

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Participating• Engagement

– Precursor to participating– Role of early adopters– Multiple methods essential– “Bottom up” process – Integrated with other work (i.e. Practice Council)

• All participation is active– Direct and indirect participation– Participating in being informed – Voice

• Control over practice– Staff choices (i.e. timing of FASST Rounds)

The bug list….What Bugs You?

Leading (1)• Clinical leading valued

– Role of clinical co-leads– Facilitated engaging – Ideas are shared with the co-leads

• Leading what is relevant– Shared leading relative to role and practice – Engaging leaders beyond the unit

Leading (2)

• Levelling the hierarchy– Shift in attitude about manager’s role

• “we work together on unit issues i.e. staffing, orientation of new staff, providing feedback to each other”

– Interaction with other formal leaders• Leading beyond

– Leading others, acknowledgement of expertise – Supporting beyond

Culture Shift• Lead from where you stand

– Shared leadership from the middle – Tools and supports to lead

• Ownership– From “my” to “our”

• Within the unit• Beyond the unit

– For sustainability of changes• Peer expectation

– Aspirational – Role of “we”

Enablers• Release time • Tests of change

– RTC work is part of the PDSA cycle - if it doesn’t work, try something different

• Hardwiring improvement – Things are becoming routine, built as routine

• Visible organizational leadership– Issue dependent– Outcome versus process focussed – Structures for participation exist

Conclusions

• Engagement enables growth on the continuum from participating leading with ownership of:– Processes– Outcomes

• Senior leadership– Enabling, available and accessible support

• Built in release time - ROI

Next Steps

• Monitoring metrics

• Staff leadership development

• Evolving role of the unit manager

• Replication across the organization

Google images

Questions?Contact information

Jocelyn Bennett Senior Director, Urgent and Critical Care416-586-4800 x2397jbennett@mtsinai.on.ca

Jody Tone Mount Sinai Hospital Nursing Unit Administrator 600 University Avenue416-586-4800 x2397 Toronto On., M5G 1X5 jtone@mtsinai.on.ca