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Managing People – Anne Lytle Group 4 – Lisa Lynch, Melissa Oldroyd, Nikkho Shandittha and Simon Moloney Early in Life Mental Health Service Organisation Report April 2012

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Managing!People!–!Anne!Lytle!

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Group!4!–!Lisa!Lynch,!Melissa!Oldroyd,!!

Nikkho!Shandittha!and!Simon!Moloney!!

Early!in!Life!Mental!Health!Service!

Organisation!Report!

April!2012!

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Contents'!

1! Introduction!...................................................................................................................................!3!

2! Methodology!.................................................................................................................................!4!

3! Analysis!and!Evaluation!.................................................................................................................!5!

3.1! ELMHS!Inputs!.........................................................................................................................!6!

3.1.1! History!and!Environment!...............................................................................................!6!

3.1.2! Resources!.......................................................................................................................!7!

3.2! ELMHS!Strategy!.....................................................................................................................!8!

3.3! Formal!Organisational!Structure!............................................................................................!9!

3.4! Work!....................................................................................................................................!12!

3.5! People!..................................................................................................................................!14!

3.6! Informal!Organisation!(Culture)!...........................................................................................!15!

3.7! Outputs!................................................................................................................................!16!

4! Recommendations!.......................................................................................................................!16!

4.1! The!Matrix!............................................................................................................................!16!

4.2! Composition!.........................................................................................................................!17!

4.3! Goals!....................................................................................................................................!17!

4.4! Design!and!Processes!...........................................................................................................!17!

4.5! The!Change!to!Output!Funding!............................................................................................!18!

5! Conclusion!...................................................................................................................................!18!

6! References!...................................................................................................................................!19!

7! Appendix!......................................................................................................................................!20!

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Tables'!

Table!1!–!Explanation!of!the!ELMHS!Matrix!………………………………………………………………………………….…10!

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Table!2!–!Key!Performance!Indicators………………………………………………………………………………………………13!

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'Figures'!

Figure!1!–!Sigmoid!Curve……………………………………………………………………………………………………………………3!

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Figure!2!–!Methodology…………………………………………………………………………………………………………………….4!

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Figure!3!–!Congruence!Model…………………………………………………………………………………………………………….5!

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Figure!4!–!External!Key!Drivers…………………………………………………………………………………………………………..6!

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Figure!5!–!Internal!Key!Drivers……………………………………………………………………………………………………………7!

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Figure!6!–!Service!Objectives!and!example!of!strategies!for!Objective!1…………………………………………….8!

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Figure!7!–!The!ELMHS!Matrix……………………………………………………………………………………………………………..9! !

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1 Introduction'

The!Early! in!Life!Mental!Health!Service!(ELMHS)!at!Southern!Health!provides!public!tertiary!mental!

health!services!to!expectant!mothers,!infants,!children,!adolescents,!young!people!and!their!families.!!

In!2009!the!Victorian!Department!of!Health!launched!a!new!framework!for!the!next!cycle!of!mental!

health!reform,!Because'Mental'Health'Matters'(BMHM)!(ELMHS!Service!Manual,!2011).!!In!response!

ELMHS! embarked! on! a! transformational,! foresight! and! vision! driven! strategic! change! (Lytle^MP^

Term1^2012^Session3).! ! The! rigorous! process! of! review! and! redevelopment! closely! adhered! to!

Kotter’s! eight! steps! of! change.! ! After! three! years! the! service! is! now! at! Kotter’s! step! eight,!

“institutionalising!new!approaches”!(Kotter,!2007,!p.4).!

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The! redevelopment! is! generally! regarded! as! highly! successful! having! produced! an! innovative! and!

flexible! model! of! service! delivery! described! in! detail! within! the! ELMHS! Service! Manual! (ELMHS!

Service!Manual,! 2011).! !As! a! result! of! this! comprehensive! redevelopment! ELMHS!has! strategically!

placed!itself! in!a!position!to!respond!to!the!second!phase!of!reform!in!2013,!the!change!to!output!

based!funding.1!!

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There! are!now,!however,! some!early! signs!of! problems!within! the! formal! organisational! structure!

and!a!concern!that!ELMHS!is!ambivalent!about!the!move!to!output!based!funding.!This!presents!a!

challenge!for!management!in!complying!with!the!new!funding!requirements.!!!

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The! body! of! this! report! provides! an! in! depth! analysis! of! the! current! state! of! ELMHS! post^

transformation,! identified! as! stage! D! on! the! Sigmoid! Curve! (Handy,! 1995)! and! considers! its!

preparedness! to! implement! output! funding.! ! The! report! will! provide! evidence! based!

recommendations!to!assist!ELMHS!address!the!key!findings.!!!

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1 Definition of output funding, viewed 11.00pm 21/04/2012, < http://www.cihi.ca/CIHI-ext-portal/internet/EN/TabbedContent/health+system+performance/health+funding/activity+based+funding/cihi008054>.

Figure'1'–'Sigmoid'Curve'

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2 Methodology'

Nadler!&!Tushman’s! congruence!model! (1997)!was!utilised! as! the! foundation! for! this! review.! The!

methodology!involved!two!distinct!stages!and!is!described!in!the!figure!below.!

* Survey Monkey Survey One: ELMHS Management Team - 100% response rate (Appendix 2.1) ** Survey Monkey Survey Two: ELMHS Senior Leadership Team - 81.25% response rate (Appendix 2.2) *** Six interviewees were chosen based on self-selection and availability. A semi structured interview

technique was used. The Business Manager organised the interviews as requested to ensure at least one Operational Manager, one Unit Head and one Discipline Senior was represented. The ELMHS Director is a member of the syndicate group; hence a guarantee was provided to all staff that the Director would only have access to de-identified data. Interviews were coded 1 to 6. (Appendix 2.3)

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Figure'2'–'Methodology'

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3 Analysis'and'Evaluation''

Nadler!and!Tushman!(1997,!p.28)!argue!that!the!performance!of!an!organization!is!contingent!upon!

its!congruence,!“the!higher!degree!of! fit!–!“or!congruence”!–!among!the!various!components,! the!

more!effective!the!organization”.!!Although!ELMHS!has!a!high!degree!of!fit!overall,!with!its!four!key!

components! largely!supporting!the! implementation!of! its!strategy,!our!findings!have!uncovered!an!

issue! within! the! ELMHS! matrix! formal! organization! structure.! ! The! problem! is! one! of! imbalance!

between!clinical!and!operational!management.!This!structural! imbalance!is!exacerbated!by!aspects!

of!the!culture,!the!people!and!the!work.!!

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Figure'3'–'Congruence'Model'

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3.1 ELMHS'Inputs'

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3.1.1 'History'and'Environment'

ELMHS! operates! within! an! environment! of! legislation,! regulations! and! policies,! as! well! as!

professional!codes!of!conduct!relevant!to!the!delivery!of!mental!health!care.!!

The!BMHM!government!initiative!three!years!ago!was!a!key!environmental!demand!in!ELMHS!recent!

history.!!ELMHS!recognized!that!it!needed!to!change!the!way!it!“targeted,!delivered!and!evaluated”!

its! services! in! order! to! align!with! the! delivery! of! BMHM! goals! on!which! its! future! funding!would!

depend.! !BMHM!goals!were! in!turn! informed!by!other!constraints!^!changes! in!demand!for!mental!

health! services! and! new! evidence! about! what! constituted! an! effective! service! (ELMHS! Service!

Manual,!2011,!pp.3^5).!

The!various!internal!and!external!catalysts!for!change!were!utilised!by!the!ELMHS!Senior!Leadership!

team,!Kotter’s!guiding!coalition,!to!create!a!sense!of!urgency!for!change!(Kotter,!2007).! !These!are!

detailed!in!Figure!4!and!5!below.!!!

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Figure'4'–'External'Key'Drivers'

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The!decision!to!introduce!a!matrix!organizational!structure!was!made!to!support!the!new!integrated!

ELMHS!service!model,!avoid!silos!and!duplication!which!had!been!a!problem!in!the!past,!and!balance!

clinical!and!operational!functions.2!

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3.1.2 Resources'!

ELMHS! employs! 250! staff! and! treats! approximately! 2,000! patients! per! year! and! is! positively!

perceived! in! the! community! as! patient! and! family! centred.! ! Its! annual! budget! is! AUD$17!million!

(ELMHS!Service!Manual,!2011).!

The! current! funding! of! ELMHS! is! block! funding! where! a! total! annual! dollar! budget! amount! is!

received!from!the!government!to!carry!out!its!services.!!Determination!of!this!total!dollar!amount!is!

based! on! how!much! funding! the! organisation! received! in! the! previous! year.! ! As! Kerr! points! out!

(1995),!such!a!funding!system!does!not!reward!efficient!spending.!!

Under! the! new! system! of! output! funding,! due! to! come! into! effect! in! July! 2013,! funding! will! be!

contingent!on!the!number!and!type!of!patient!cases!treated!according!to!a!standardised!formula.3!!A!

hospital! can! therefore! affect! its! future! budget! by! changing! its! current! year! patient! volume! and!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2 Personal reflections of the Director 3 Using national classifications, cost weights and nationally efficient prices developed by the Independent Hospital Pricing Authority, viewed 11.00pm 21/04/2012, <http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nhra-agreement-toc~appendix_a>.

Figure'5'–'Internal'Key'Drivers'

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patient!mix.4!!The!goal! is!to!promote!greater!accountability!and!efficiency!within!a!publicly! funded!

essential!service.!

For!output!funding!to!be!implemented,!ELMHS!will!require!a!transparent!way!of!measuring!effective!

use! of! resources.! ! However! the! current! information! systems! used! by! ELMHS! are! antiquated! and!

inefficient.5!! A! number! of! different! operating! systems! are! used! for! tracking! patient! flow,! filing!

medical!records,!prescribing!medications!and!financial!administration.!

3.2 ELMHS'Strategy''

The!ELMHS!vision!is!“working!in!partnership!with!others!towards!providing!better!mental!health!in!

our!community”!(ELMHS!Service!Manual,!2011,!p.17).!!The!vision!and!associated!strategies!are!well!

conceived!for!a!public!health!care!program!and!four!service!objectives!provide!a!detailed!road!map!

for!ELMHS.!!Each!member!of!the!ELMHS!Management!Team!has!responsibility!for!one!of!the!service!

objectives! and! chairs! one! of! six! governance! committees,! each! dedicated! to! one! or! more! of! the!

objectives.!!

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According!to!Nadler!&!Tushman!(1997,!p.30),!“successful!organizations!embark!on!periods!of!major!

change!by!moulding!and!articulating!that!vision!and!set!of!objectives”.!Our!survey!findings!indicate!

that!the!ELMHS!strategy!has!been!effectively!communicated!and!is!well!understood. 6!!!

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The!four!service!objectives!and!a!number!of!the!strategies!are!exemplified!in!figure!6.!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!4 Definition of output funding, viewed 11.00pm 21/04/2012, < http://www.cihi.ca/CIHI-ext-portal/internet/EN/TabbedContent/health+system+performance/health+funding/activity+based+funding/cihi008054>. 5 Personal reflections of the Director 6 Survey Monkey: Survey One Q1. 100% of the Management Team responded ‘agree’ or ‘strongly agree’ that the ELMHS vision has been clearly communicated and Survey Two Q1. 84%of the Senior Leadership Team indicated it had been communicated. Survey One and Two Q2. 100% of respondents identified with responsibility for one or more of the Strategic Objectives.

Figure'6'–'Service'Objectives'and'example'of'strategies'for'Objective'1'

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3.3 Formal'Organisational'Structure''

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The!ELMHS!matrix!is!illustrated!in!figure!7!and!described!in!detail!in!table!1.!

Figure'7'–'The'ELMHS'Matrix'

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Model Explanation

The! three! clinical! units! are! functional! groupings!

around!important!areas!of!specialist!expertise.!Each!

unit! is! involved! in! tasks! of! pooled! and! reciprocal!

interdependence,!and! requiring!knowledge! sharing!

and! co^ordination! among! professional! peers!

(Ancona,!D.,!Kochan,!T.A.,!Scully,!M.,!Van!Maanen,!

J.!&!Westney,!D.E.,!2005).!!The!three!Unit!Heads!are!

responsible! for! developing! best! practice! clinical!

models!of!care!and!clinical!management.!

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The!three!operational!units!are!divisional!groupings!

of! three! different! types! of! service! streams.! The!

three!Operational!Managers!play!an!integrator!role!

across!the!clinical!units!(Ancona,!et!al.,!2005).!They!

are! responsible! for!management! of! all! operational!

matters! at! ELMHS! including! capital! infrastructure!

and! resources,! human! resources,! and! financial!

budgets! within! their! respective! service! streams!

(ELMHS!Service!Manual,!2011,!p.!26).!

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The!Operational!Managers!and!Unit!Heads!work! in!

partnership! to! provide! overall! operational,! clinical!

and! strategic! governance! (ELMHS! Service! Manual,!

2011,!p.!26).!

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The! five! Discipline! Seniors! and! the!

Business/Administrative! Manager! also! work! in!

partnership! with! the! Director,! Operational!

Managers! and! Unit! Heads! to! provide! advice! in!

relation! to! overarching! professional! governance.!!

(ELMHS!Service!Manual,!2011,!p.!26).!!

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Table'1'–'Explanation'of'the'ELMHS'Matrix'

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Model Explanation

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As! is! common! with! matrix! models! the! ‘matrix’! is!

replicated! throughout! all! levels! of! ELMHS.! Local!

teams! are! led! by! Consultant! Psychiatrists! and!

Senior! Clinician! Coordinators! who! work! under! the!

direction! of! their! respective! Unit! Head! and!

Operational!Manager.! ! !At!clinical! review!meetings!

these! Senior! Leaders! act! as! delegates! of! the! Unit!

Heads!and!Operational!Managers,! and!provide! the!

linking!mechanism!by!which!clinical!and!operational!

issues!or!conflicts!are!communicated!for!resolution!

higher!up!if!necessary.!!Unit!Heads!and!Operational!

Managers! interact! informally! as! needed! and!

formally! by! means! of! permanent! cross^unit!

committees! (Ancona,! et! al.,! 2005;! Bartol,! K.,! &!

Martin,!D.,!2004;!ELMHS!Service!Manual,!2011).!!

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Survey!findings! indicate!good!buy^in!to!the!new!matrix!structure!with!the!majority!of!respondents!

saying!they!understood!how!the!matrix!worked!and!that!it!was!the!right!structure!for!ELMHS.7!!!!

However,!while! the!Unit!Heads!and!Operational!Managers!are!expected!to!work!collaboratively,! it!

appears!that!the!three!Operational!Managers!are!taking!on!more!responsibility!for!day!to!day!clinical!

management!than!the!Unit!Heads.!!As!one!respondent!commented,!“On!paper!–!shared!governance,!

but!in!reality!–!it!doesn’t!feel!this!way.”!8!

The!essential! cause!of! this! imbalance! is! a! lack!of!availability!and!nonalignment!of! the!Unit!Heads.!!

The!Operational!Managers!are!full!time!and!the!Unit!Heads!are!part!time.!!This!time!allocation!was!a!

decision!based!on!the!size!of!clinical!programs,!but!also!the!prohibitive!cost!of!senior!medical!staff!in!

full!time!roles.!!!Although!the!Unit!Heads!are!contactable!by!phone!5!days!a!week,!one!respondent!

reported!“insufficient!time!to!form!alliances”.9!

As!very!senior!psychiatrists,!the!Unit!Heads!represent!unique!capital!and!are!a!scarce!resource!

within!the!public!health!system.!!They!are!also!juggling!demanding!careers!in!public!speaking,!

academia,!ministerial!advisory!positions!and!private!practice.!!These!parts!of!their!career!offer!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!7 Survey Monkey: Survey One Q.9 & 21: 90% of respondents said that they understood how the matrix was supposed to work and 10% were confused about some aspects. 80% of respondents thought that the matrix was the right structure for ELMHS with 20% undecided. Survey Monkey: Survey Two Q.13 & Q.25: 75% of respondents said they understood how the matrix was supposed to work and 25% were confused about some aspects. 58% thought the matrix was the right structure for ELMHS with 42% undecided.

8 Survey Monkey: Survey One Q22, Q.11 & Q.10: 60% felt that there was a power imbalance in their partnerships and 70% questioned the effectiveness of some of their partnerships. 9!Survey Monkey: Survey One Q .10 !

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opportunities!to!build!their!profile!and!potentially!enormous!financial!rewards,!which!tend!to!non^

align!them!with!ELMHS!strategic!goals.10!!Competing!priorities!dilute!their!attention!to!ELMHS!

responsibilities!which!in!turn!creates!a!perception!of!a!lack!of!commitment.11!!

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3.4 Work''

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The! ELMHS! clinical! model! consists! of! three! clinical! streams! of! treatment.! ! Clinical! pathways! for!

patients!also!represent!the!pattern!of!work!flow!for!employees!and!these!are!described!in!detail!in!

the!ELMHS!Service!Manual.!The!ELMHS!service!process!map!!(Appendix!1.1)!highlights!how!ELMHS!

simplified!and!standardised!a!number!of!complex!and!interdependent!tasks,!and!coordinated!them!

into!a!pooled!and!reciprocal!structure!(Ancona,!et.!al.,!2005).!The!organisation!of!work!is!based!on!

the!concept!of!‘lean!thinking’!and!efficient!patient!flow,!“where!every!clinical!structure!and!process!

adds!value”!so!maximizing!the!use!of!resources!(ELMHS!Service!Manual,!2011,!p.22).'

At! management! level,! our! research! found! that! role! clarity! was! a! key! issue.! ! One! Unit! Head!

interviewed!indicated!that!“Operational!Managers!should!not!be!getting!clinically!involved”!and!that!

they!“give!input!when!it! is!not!their!role”!which!in!turn!is! leading!to!“double!jobbing!and!delays!in!

decision! making.”12!

13!! The! perspective! of! the! Operational! Managers,! who! all! have! clinical!

backgrounds,!is!that!they!have!had!to!assume!some!of!the!responsibilities!of!the!Unit!Heads!and!are!

working! longer!hours.14!! The! lack!of! role! clarity! is! leading! to! confusion! among! staff! in! relation! to!

who!they!should!contact!when!an!issue!arises.!!!Although!seen!as!manageable,!50!percent!of!Senior!

Leaders! indicated! they! felt! overloaded! by! the! number! of! partners! and! complexity! within! the!

matrix.15!!

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!10 Personal Reflections of Director: The Unit Heads can earn substantially more per hour in private practice than for their work at ELMHS. Two of the Unit Heads also hold academic positions with KPIs around teaching, publication and research. There is intense competition for research grants and attracting good research students as it increases the employment of staff and size of research departments. Professor Louise Newman is also the Director of the Centre for Psychiatry and Psychology at Monash University. She is new to the position and building its profile particularly in the area of perinatal and infant mental health and refugee health. Associate Professor Brendan Murphy is currently completing his research doctorate and has a number of research studies underway most of which he is doing with his former employer Orygen Youth Health and with his mentor Professor Pat McGorry.

11 Survey Monkey: Survey One respondents reported , ‘different levels of dedication’ and ‘other agendas’ (Q. 11) as well as lack of ‘ownership’ of role as leaders of a clinical service’ and ‘some allowed to follow their own interest at the cost of the service’ (Q.23) 12 Interview : Interviewee No. 1 13 Survey Monkey: Survey Two Q10. 9 out of 12 thought problems in ELMHS are solved slowly 14 Interview: Interviewee No. 2 15 Survey Monkey: Survey One Q.13 & Survey TwoQ.17: 50% of the ELMHS Management Team and Senior Leadership Team indicated that sometimes they felt overloaded but it was manageable.

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A!sample!of!the!current!Key!Performance!Indicators!(KPIs)!in!the!position!descriptions!of!the!various!

managers!at!ELMHS!is!given!in!Table!2.'

Table'2'–'Key'Performance'Indicators''

Key Performance Indicators

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The!Business/Administrative'Manager!will!be!allocated!one!of! the!Early! in!Life!Service!Objective!and!associated!Strategies!to!implement!and!monitor!across!the!

entire!Early!in!Life!Mental!Health!Service.!!

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The!Unit' Heads!will! be! allocated!one!of! the!Early! in! Life! Service!Objective! and!associated! Strategies! to! implement! and!monitor! across! the! entire! Early! in! Life!

Mental!Health!Service.!!

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The! Operational' Managers! will! be! allocated! one! of! the! Early! in! Life! Service!Objective!and!associated!Strategies!to!implement!and!monitor!across!the!entire!

Early!in!Life!Mental!Health!Service.!!

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The! Senior' Clinician/Coordinators' and' Discipline' Seniors! will! be! allocated! in!partnership!with! the! Senior! Leadership!Group! responsibility! for! specific! service!

wide! KPIS! including:! for! example! an! annual! increase! of! 2%! for! each! discipline!

group! in! relation! to! the! following:! ! credentialing! (if! appropriate),! conference!

presentations,! publications,! involvement! in! ! research! and/or! quality! projects,!

enrolment! in! post! graduate! training! ,! student/intern! placement! opportunities!!

and!nomination!of!staff!!for!rewards!and!recognition!programs.!!

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A!Unit!Head,!for!example,!may!be!responsible!for!Service'Objective'1:!!Improve'services'and'health'outcomes' for' our' consumers' and! a! strategy! for! achieving! that,! for! example,! Strategy' C:! !Develop'clear'referral'pathways'to'facilitate'a'seamless'journey'for'the'consumer'through!the'tiered'system,'where'necessary!(see!Figure!6).'

Such! strategies! are! in! fact! general! goals,! to^do^lists! or! desired! outcomes!which! do! not! allow! the!

measurement! of! progress! within! a! time! frame! in! the! sense! of! typical! business! KPIs! for! example,!

monthly!sales!targets!or!production!numbers.!!Consequently,!ELMHS!current!KPIs!will!not!allow!the!

accountability!required!for!the!move!to!output!funding.!!!'

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3.5 People''

ELMHS! staff! are! highly! qualified! health! professionals! with! over! half! the! workforce! having!

qualifications! of! post^graduate! level! or! above.16!! The! findings! highlight! ELMHS! has! strong! people!

orientated!culture!adopting!a!number!of!the!seven!practices!of!!organisations!deriving!a!competitive!

advantage!through!people!(Pfeffer!&!Veiga,!1999)!specifically,!employment!security,!selective!hiring!

in! accordance!with! the! Southern!Health! iCARE! values,! extensive! training! ! and! sharing! information!

and!engagement!of!staff!through!Monthly!ELMHS!Briefings.!17!18!

Our! findings! found,!however,!a!deficiency! in!core!management!skills!among!the!three!Unit!Heads.!!

According! to! one! of! the! Discipline! Seniors,! this! is! a! “perennial! problem”! in! the! health! system! of!

“people!going!up!higher!without!strategic!ability”.!19!!One!Unit!Head!reported!feeling!uncomfortable!

with!and!disinterested! in!management!demands!and!explained! that! their!medical! training! focuses!

them!on!clinical!excellence!in!patient!care!rather!than!thinking!systemically.20!!Extensive!training!is!

required!to!be!a!skilled!manager!and!leader;!and!even!more!so!within!a!matrix!structure.!

While!the!matrix!is!still!in!its!infancy!and!it!takes!time!and!true!commitment!to!form!partnerships,!it!

may!be!that!the!Unit!Heads!have!some!resistance!as!well!to!being!more!integrated!into!the!matrix.!!

Because!they!have!to!invest!a!lot!of!time!outside!of!ELMHS!to!stay!on!the!cutting!edge!in!their!fields,!

they!probably!identify!as!“peripheral!specialists”!not!wanting!the!‘monkey!on!the!back’!of!day!to!day!

management!(Cross!&!Prusak,!2002,!p.!111).!

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!16 Personal Reflections of the Director 17 Survey Monkey: Survey Two Q12: 100% indicated the organisation was interested in their education, training, supervision, career progression and overall development. In the past financial year approximately 1/3 of the annual budget was spent on education and training.. 18 Survey Monkey: Survey Two: Q11. 75% of the Senior Leadership Team indicated that management were concerned about the experience of staff rather than just high productivity. 19 Individual Interviews: Interviewee No 3 20 Individual Interviews: Interviewee No 4

15!

!

3.6 Informal'Organisation'(Culture)'

A!transformational!change!of!the!magnitude!implemented!in!ELMHS!would!not!have!been!possible!

without! a! strong! culture! that! was! high! intensity! and! highly! crystallised! (Lytle^MP^Term1^2012^

Session4).!21!!ELMHS!culture! is!distinguished!by!support!for! innovation!and!risk!taking,!attention!to!

detail!and!people!and!team!orientation!(Chatman!and!Jehn,!1994,!cited!in!Robbins,!S.!P.!&!Judge,!T.!

A.! 2008).22!! ! There! is! also! a! “thriving”! work! culture! within! the! matrix! (Lytle^MP^Term1^2012^

Session4).!23!!!

The! “way! we! do! things! around! here”! (Schein,! 2004,! cited! in! Lytle^MP^Term1^2012^Session4)! is!

strongly!influenced!by!entrenched!power!and!status!differences!between!doctors!and!non^doctors.!!

Doctors!have!the!ultimate!authority!for!clinical/medical!decisions.!The!source!of!their!power!is!both!

their! position,! “legitimate”! and! personal,! “expert”.! Compliance! is! a! given! because! doctors! are!

perceived!as!legitimate!occupants!of!their!leadership!positions,!there!is!a!long!tradition!that!it!is!the!

proper!order!and!hospital!staff!are!loyal!and!committed.!(Yukl,!2002,!pp.!144^!145)!!

The! medical! hierarchy! has! been! a! source! of! tension! within! the! ELMHS! matrix! as! Operational!

Managers! have! needed! to! establish! their! authority! and! hold! doctors! accountable! for! hard! clinical!

outcomes.24!! There! tends! to! be! less! respect! for! management! roles! within! health! care! settings!

compared!to!business!and!even!the!Director!finds!it!difficult!to!challenge!the!Unit!Heads.25!26!!

With! authority! comes!medico/legal! liability! and! this!may!explain! the! tendency!of!Consultants! and!

Senior!Clinicians!!who!have!delegated!authority!for!a!number!of!clinical!and!operational!decisions!at!

the! local!team!level!to!not!use!their!authority!and!unnecessarily!defer!to!those!above!them!in!the!

matrix,!further!overloading!the!ELMHS!Management!Team.!27!

! !

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!21 Survey Monkey: Survey One & Two Q.8 & Q.9 80% of staff were described their colleagues as committed and 10 – 16% described their colleagues as completely passionate and dedicated. 22 Survey Monkey: Survey One & Two Q.15 & Q.18 60% of the Management Team and 33.3% of the Senior Leadership Team feel collectively rather than just individually accountable for outcomes.!!!!23 Survey Monkey: Survey One Q .6 & Q.7 Survey Two Q.7 & 8 100% of respondents viewed their colleagues as hardworking and trustworthy, and positive and energizing.

24!Individual Interviews: Interviewee No 3!

25!Personal!Recollections!of!the!Director!

26 Survey Monkey: Survey One Q 16. Only 30% indicated all staff were treated equally and all held to account. Survey Two Q 19. Only 25% indicated all staff were treated equally and all held to account. 27 ELMHS Director reported that she discovered in the absence of a Consultant Psychiatrist in clinical review a number of Senior Clinicians had requested the Operational Manager attend and sign the Clinical Review rather than perform this role themselves.

16!

!

3.7 Outputs''

Sustainable!competitive!advantage!is!not!relevant!to!public!mental!health!care!providers!as!they!are!

not! in! competition!with! each! other! for!market! share.! ! Patients! are! required! to! be! treated! by! the!

health!service!in!the!area!in!which!they!live.!!

It! is! difficult! to! identify! “performance! gaps”! within! ELMHS! where! “output! is! falling! short! of!

objectives”!because!KPIs!are!currently!ineffective!in!monitoring!performance.!Nor!do!the!managers!

themselves!identify!strongly!with!KPIs!as!a!measure!of!success.!28!(Nadler!&!Tushman,!1997,!p.31)!

'

4 Recommendations''

A! complete! formal! organisational! redesign! is! neither! required! nor! desirable.! ! ELMHS! needs! to!

stabilise!and!enhance!the!performance!of!its!management!team,!balance!the!clinical!and!operational!

functions,!and!develop!a!strategy!to!prepare!for!the!change!to!output!funding.!!!

4.1 The'Matrix''!

The! imbalance! between! the! clinical! and! operational! dimensions! of! the! matrix! has! not! yet! been!

formally! acknowledged.! ! Time! needs! to! be! made! for! the! team! to! have! a! “frank! and! fearless!

discussion.”!29!!Such!a!forum!would!allow!people!to!work!through!any!interpersonal!conflicts!and!the!

Director!could!leverage!on!the!team’s!investment!in!the!matrix!and!the!positive!culture!of!ELMHS.!

Although!the!ELMHS!Management!Team!is!currently!more!like!a!working!group,!the!Director!regards!

it! as!having! the!potential! to!become!“a! team! that! runs! things”! (Katzenbach,!&!Smith,!2005,!p.!9).!

Hence,! the!Model!of!Team!Effectiveness! (Thompson,!2008;!Collins,!2005,!cited! in!Lytle^MP^Term1^

2012^Session5)!has!been!applied!to!assist!the!ELMHS!Management!Team!improve!its!performance.!!!

'! '

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!28 Survey Monkey Survey One Q3 & 4. Whilst 100% knew their KPIs 70% did not actively monitor and 20% indicated that KPI’s were not a priority to them. Survey Two Q4 & 5. 15.4% only focus on KPI’s when directed to do so. 38.5% responded as admitted to not knowing all of their KPI metrics, 46.2% admitted that KPIs were not a priority for them. 29 Interview with Interviewee No 3

17!

!

4.2 Composition''

The! ELMHS! Management! Team! is! ! diverse! in! terms! of! functional! differences! and! has! not! yet!

developed! its!Third!Culture;! “...common!sense!of! identity! that!becomes!group!specific”! (Lytle^MP^

Term1^2012^Session5).!Time!in!meetings!needs!to!be!spent!explicitly!talking!about!what!each!team!

member!brings!to!the!group!–!what!they!‘value!add’.!!The!work!of!Cross!and!Prusak!(2002)!can!assist!

the! team! to! understand! the! overall! value! of! all! members! in! relation! to! informal! networks.! ! By!

leveraging!on!their!informal!networks!ELMHS!can!gain!an!advantage!for!example,!through!the!Unit!

Heads!via!research!grants!and!targeted!submissions!for!funding!for!new!projects.!!

!

4.3 Goals''

The!team!needs!an!opportunity!to!re^visit!the!ground!rules,!codes!of!behaviour!and!team!goals,!and!

ensure!that!there!is!clear!understanding,!agreement,!and!commitment!to!these!shared!goals.30!!The!

Director!needs!to!hold!all!members!of!the!team!responsible!for!performance!regardless!of!discipline!

and! status! using! the! Four! Step!Assertive!Message!Model! (FOCR)! (Lytle^MP^Term1^2012^Session5).!

The!director!needs!to!develop!effective!KPIs!to!evaluate!individual!and!collective!performance.!The!

reward!system!also!needs!to!be!realigned!to!ensure!collaborative!team!efforts!rather!than!individual!

efforts!are!rewarded!(Kerr,!1995).!Regular!scheduled!meetings!between!Unit!Heads!and!Operational!

Managers!need!to!be!prioritized!and!monitored!by!the!Director.!!!

!

4.4 Design'and'Processes'

The!Director! needs! to! clarify! the! role! of! the!Operational!Manager,! the! role! of! the!Unit!Head! and!

what! is! shared,! and! review! this! annually.! ! Resources! need! to! be! allocated! to! appropriate!

management!training!for!the!Unit!Heads.!

A!meeting!with!the!Senior!Leaders! is! required!to!clarify!areas!of!delegated!responsibility!and!their!

position!descriptions!may!need!to!be!revisited.!Reinforcement!of!decentralised!decision!making!will!

lessen! the! workload! of! the! ELMHS! Management! Team,! allowing! for! quicker! and! more! effective!

decision!making.!The!Circle!of!Motivation!Model!(Lytle^MP^Term1^2012^Session9)!provides!a!useful!

framework! for!assisting! the!Senior!Leaders.! ! Support!can!be!provided! in! the! form!of!management!

training! to! empower! them! and! formalise! a! succession! plan.! ! Feedback! should! be! provided! using!

FOCR! (Lytle^MP^Term1^2012^Session5).! ! ! KPIs! that! actually! measure! performance! should! be!

developed!and!rewarded.!

! '

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!30!Survey!Monkey:!Survey!One!Q.10:!Comment!“I!do!not!believe!all!have!the!same!interests!and!goals.!I!feel!

some!are!there!for!their!own!progress!at!the!cost!to!the!service”!

18!

!

4.5 The'Change'to'Output'Funding''

For!ELMHS!to!be!ready!for!the!change!to!output!funding!in!2013!its!KPIs!will!need!to!become!SMART!

goals! –! specific! and! clear,! measurable,! achievable,! results! oriented! and! time! specific! (Lytle^MP^

Term1^2012^Session9).! To! promote! accountability! each! KPI! must! be! assigned! to! a! responsible!

person.!!

It!is!recommended!that!output!funding!is!implemented!into!ELMHS,!via!the!Senior!Leadership!Team.!

This!committee!currently!meets!bi^monthly!and!supports!the!ELMHS!Management!Team!by!focusing!

on! strategic! leadership,! organisational! culture,! stakeholder! engagement! and! innovative! practices.!

(ELMHS!Service!Manual,!2011,!p.31).!It!was!Kotter’s!guiding!coalition!during!the!ELMHS!2009!review!

and!redevelopment.!(Kotter,!2007)'

The!Senior! Leadership!Team!should!act! in! the! same! role! to!prepare! the!organisation! for! this!next!

change.! !Given! the!challenge! this! represents! the! team!should!be! led!by! the!Director31!include!one!

Unit!Head,!one!Operational!Manager!and!one!Discipline!Senior!and!no!more!than!15!other!ELMHS!

staff.!

There!should!be!half!day!and!one!day!workshops!to!allow!members!to!fully!participate!and!immerse!

themselves!in!the!task.!The!team!should!begin!by!developing!a!comprehensive!project!plan!and!an!

exploration!of!the!strategies!and!enablers.!This!process!should!provide!a!road!map!in!order!to!assist!

ELMHS!prepare! for! this!anticipated!/! incremental!change! in! funding!model! (Lytle^MP^Term1^2012^

Session3).!

!

5 Conclusion'!

Whilst!ELMHS!has!some!significant!current!and!future!challenges,!it!is!not!without!its!strengths.!The!

issues! identified! in! the! analysis! are! not! insurmountable! and! the! recommendations! can! be! easily!

implemented!to!address!the!concerns!identified.!The!Director!has!an!opportunity!to!work!with!the!

committed!and!motivated!team!of!professionals!in!ELMHS!to!refocus!attention!and!resources!on!the!

two!key!priority!areas!^!the!matrix!structure!and!preparing!the!organisation!for!the!future!challenge!

of!output!funding!

'

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!31 Survey Monkey: Survey Two Q.24 41.7% of survey respondents wanted the Director to chair the Senior Leadership Committee.

19!

!

6 References'!

1. Australian!Government!Department!of!Health!and!Ageing,!!viewed!21!April!2012,!

<http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nhra^

agreement^toc~appendix_a>!

!

2. Ancona,!D,!Kochan,!TA,!Scully,!M,!Van!Maanen,!J!&!Westney,!DE!2005,!Managing'for'the'future:'Organizational'behavior'and'processes,!3rd!Edition,!South^Western!Publishing!

Company,!Cincinatti!Ohio,!pp.!13!^27,!28^32,!83^84.!

!

3. Bartol,!KM!&!Martin,!DC!2004,!Chapter!9!!‘Strategic!organizational!design’,!in!Management,'4th!Edition,!McGraw!Hill,!New!York.!

!

4. Canadian!Institute!for!Health!Information!2012,!viewed!21!April!2012,!

<http://www.cihi.ca/CIHI^ext^

portal/internet/EN/TabbedContent/health+system+performance/health+funding/activity+b

ased+funding/cihi008054>!

!

5. Canadian!Institute!for!Health!Information!2012,!viewed!21!April!2012,!

<http://www.cihi.ca/CIHI^ext^

portal/internet/EN/TabbedContent/health+system+performance/health+funding/activity+b

ased+funding/cihi008054>!

!

6. Cross,!R!&!Prusak,!L!2002,!‘The!people!who!make!organizations!go!–!or!stop’,!Harvard'Business'Review,'vol.!80!no.!6,'pp.!105!–!112.!!

7. ELMHS!2011,!ELMHS'Service'Manual,!Southern!Health,!Melbourne.!

!

8. Handy,!C!1995,'The'Age'of'Paradox.!Harvard!Business!Review!Press,!United!States.!!

9. Kerr,!S!1995,!‘The!folly!of!rewarding!A!while!hoping!for!B’,!!Academy'of'Management'Executive,'vol.!9!no.!!1,!pp.!7!–!14.!!

10. Katzenbach,!J,!&!Smith,!D!2005,!‘The!discipline!of!teams’,!!Harvard'Business'Review,!vol.!83,!July.!

!

11. Kotter,!JP!2007,!‘Leading!Change:!Why!transformation!efforts!fail’,!Harvard'Business'Review,!vol.!85,!pp.96!–!103.!

!

12. Lytle,!A!2012.!Term!1,!Managing!People,!Session!3,!Power!point!Slides.!!

!

13. Lytle,!A!2012.!Term!1,!Managing!People,!Session!4,!Power!point!Slides.!!

!

14. Lytle,!A!2012.!Term!1,!Managing!People,!Session!5,!Power!point!Slides.!

!

15. Lytle,!A!2012.!Term!1,!Managing!People,!Session!9,!Power!point!Slides.!!

!

20!

!

16. Nadler,!DA!&!Tushman,!ML!1997,!Chapter!2!‘Mapping!the!organizational!terrain’!In!

Competing'by'Design:'The'Power'of'Organizational'Architecture,!Oxford!University!Press,!New!York.!

!

17. Pfeffer,!J!&!Veiga,!JF!1999,!‘Putting!people!first!for!organizational!success’,!!Academy'of'Management'Executive,'vo.!13!no.!2,!pp.!37^48.!!

18. Robbins,!SP!&!Judge,!TA!2008,!Chapter!17!‘Organizational!culture’!in!Organizational'Behaviour,'13th!Edition!Prentice!Hall.!!!

19. Yukl,!G!2002,!‘Power!and!Influence’,!in!Leadership'in'Organizations,!NJ!Prentice!Hall,!Upper!Saddle!River,!pp.!141^171.!

!

!

!

!

!

!

!

!

!

!

!

!

!

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!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

!!

Question)25)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

Do you think the matrix model is the r ight structure for ELMHS

Answer Options Response Percent

Response Count

Yes 58.3% 7 No 0.0% 0 No and my preferred structure would be .........................answer below 0.0% 0 Undecided 25.0% 3 I am not sure which formal organisational structure would best suit ELMHS

16.7% 2

My preferred structure would be 1 answered question 12

skipped question 1 !

Number Response Date My preferred structure would be

1

Mar 14, 2012

6:42 AM

It probably is, but I think there are too many unresolved variables from the pre-existing model that negatively impact on service delivery and then cloud the true value of the matrix model.

!

!

! !

Do you think the matrix model is the right structure for ELMHS

Yes

No

No and my preferred structure would be .........................answer below Undecided

I am not sure which formal organisational structure would best suit ELMHS

!!

Appendix(2.3(Individual(Interview(Questions(!

Question)1)theme))How!do!you!think!that!we!can!enhance!the!clinical!leadership?!!

Question)2)theme)How!do!you!think!that!the!Clinical!Governance!and!Senior!Leadership!Team!can!be!improved!to!increase!staff!motivation!and!contribution?!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

!

33""

Question)23)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

There are 6 committees in the governance structure in ELMHS: ELMHS management team Clinical Operational Stakeholder Professional Senior Leadership Can you please provide your views on each committee please (you can choose more than one per committee)

Answer Options

Clear purpose/adds value/active committee -

seen as valuable

Important committee

but not sure i t is

functioning effectively

Important committee but not al l members

attend

Not sure of

purpose and

function

Too much overlap/duplication

with other committees

Does not add

anything to the ELMHS governance

Structure

I do not attend

this committee so cannot comment

Response Count

ELMHS Management team

2 1 1 1 1 0 7 11

Clinical 2 3 2 1 0 0 5 11 Operational 2 1 1 1 0 0 7 11 Stakeholder 0 1 1 0 0 0 8 10 Professional 3 0 2 1 0 0 7 11 Senior Leadership

4 7 4 1 1 0 0 12

Do you recommend we change any of the committees (provide detail) 3 answered question 12

skipped question 1 "

Number Response Date

Do you recommend we change any of the committees (provide detai l)

1 Mar 15,

2012 Talk about the difficult issues with a view to outcome without this reflecting on the individuals who raise the issues. It is hard to raise

34""

8:23 AM issues at times when one is concerned that it might backfire personally.

2

Mar 14, 2012

5:43 AM

Committees should function more like a working committees where some tasks can be worked on actively during the meeting time. Too much reviewing action lists and deferring as all members too busy to follow up outside meeting on too many things. Senior leadership group has been fantastic in the past but has lost leadership and focus and has become more of a benign reporting group. Needs to refocus and have goals more closely linked to resolving implementation issues that can't be resolved by implementation committee, active brainstorming with clear outcomes and functioning to bring together SLG team as it did over redevelopment planning stage.

3

Mar 12, 2012

9:34 PM

It would be useful for all the committees to be explained to all in lay person terms not just in purpose and function but practicality. Furthermore, how the committee relate to one another in terms of decision making and scope would be using in thinking about how best they can be used to achieve desired changes.

"

"

0 2 4 6 8

10 12 14 16 18

Clear purpose/adds value/active committee - seen as valuable Important committee but not sure it is functioning effectively Important committee but not all members attend

Not sure of purpose and function

16##

Question)21)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

Do you think the matrix model is the r ight structure for ELMHS

Answer Options Response

Percent Response

Count

Yes 80.0% 8 No 0.0% 0 No and my preferred structure would be .........................answer below 0.0% 0

Undecided 20.0% 2 I am not sure which formal organisational structure would best suit ELMHS

0.0% 0

My preferred structure would be 1 answered question 10

skipped question 0 #

Number Response Date My preferred structure would be

1 Mar 18, 2012

10:49 AM If we can continue to learn as we go and there is collective ownership and we can develop further.

#

#

# #

Do you think the matrix model is the right structure for ELMHS

Yes

No

No and my preferred structure would be .........................answer below Undecided

I am not sure which formal organisational structure would best suit ELMHS

17##

Appendix(2.2(Senior(Leadership(Team(Survey(

Question)1)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey The vision for ELMHS is ‘working in partnership with the community to provide better mental health’. I feel that the vision has been communicated clearly throughout ELMHS.

Answer Options Response

Percent Response

Count

Strongly agree 23.1% 3 Agree 38.5% 5 Neither agree or disagree 23.1% 3 Disagree 15.4% 2 Strongly disagree 0.0% 0 The vision has been communicated but in general ‘visions’ mean nothing to me

0.0% 0

answered question 13 skipped question 0

#

#

# #

The vision for ELMHS is ‘working in partnership with the community to provide better mental health’. I feel that the vision has been communicated

clearly throughout ELMHS.

Strongly agree

Agree

Neither agree or disagree

Disagree

Strongly disagree

The vision has been communicated but in general ‘visions’ mean nothing to me

18##

Question)2)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

Which of these strategic goals are you responsible for implementing?

Answer Options Response Percent

Response Count

Improve service and health outcomes for our consumers

100.0% 13

Improve services and health outcome for the population when risk can be detected

69.2% 9

Enhance the financial and operating capability of the directorate 53.8% 7

Enhance the commitment to our staff, culture knowledge acquisition and research

76.9% 10

I am not sure I am responsible for implementing any of the strategic goals

0.0% 0

I did not know ELMHS had strategic goals 0.0% 0 None the strategic goals are only the responsibility of the ELMHS Management Team 0.0% 0

answered question 13 skipped question 0

#

#

# #

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Impr

ove

serv

ice

and

heal

th

outc

omes

for

our

cons

umer

s

Enh

ance

the

finan

cial

and

op

erat

ing

capa

bilit

y of

the

I am

not

sur

e I

am r

espo

nsib

le

for

impl

emen

ting

Non

e th

e st

rate

gic

goal

s ar

e on

ly th

e re

spon

sibi

lity

of

Which of these strategic goals are you responsible for implementing?

19##

Question)4)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

Do you know what your key performance indicators are?

Answer Options Response Percent

Response Count

Yes, I know what my KPIs are and I actively monitor and track these

46.2% 6

Yes, I know what my KPIs are but I do not monitor them

0.0% 0

I only focus on my KPIs when directed to do so 15.4% 2 No, I do not know all of my KPIs 38.5% 5 No, I do not know what any of my KPIs are (I see them as irrelevant) 0.0% 0

answered question 13 skipped question 0

#

#

# #

Do you know what your key performance indicators are?

Yes, I know what my KPIs are and I actively monitor and track these

Yes, I know what my KPIs are but I do not monitor them

I only focus on my KPIs when directed to do so

No, I do not know all of my KPIs

No, I do not know what any of my KPIs are (I see them as irrelevant)

20##

Question)5)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey When you notice something that relates to a KPI does i t prompt you to change your behaviour?

Answer Options Response Percent

Response Count

Yes, always 46.2% 6 Yes, sometimes but it is not usually a priority for me 46.2% 6 I probably would not notice a change in KPIs unless someone told me

7.7% 1

I do not notice changes to my KPIs 0.0% 0 To be honest it would not prompt a change in behaviour as I do not see them as important/relevant 0.0% 0

answered question 13 skipped question 0

#

#

# #

When you notice something that relates to a KPI does it prompt you to change your behaviour?

Yes, always

Yes, sometimes but it is not usually a priority for me

I probably would not notice a change in KPIs unless someone told me

I do not notice changes to my KPIs

To be honest it would not prompt a change in behavior as I do not see them as important/relevant

21##

Question)7)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

How do you regard the majority of ELMHS employees overal l?

Answer Options Response Percent

Response Count

Hard working and trustworthy 100.0% 12 Requiring close supervision 0.0% 0

answered question 12 skipped question 1

#

#

# #

How do you regard the majority of ELMHS employees overall?

Hard working and trustworthy

Requiring close supervision

22##

Question)8)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Within your work group ( include the ELMHS Management Team and Senior Leadership Team) do you general ly see the people around you as

Answer Options Response

Percent Response

Count

Positive and energizing 100.0% 12 Negative and de-energizing 0.0% 0

answered question 12 skipped question 1

#

#

# #

Within your work group (include the ELMHS Management Team and Senior Leadership Team) do you generally see the people around you as

Positive and energizing

Negative and de-energizing

23##

Question)9)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Thinking about ELMHS as a whole, how would you rate your col leagues’ commitment to ELMHS?

Answer Options Response Percent

Response Count

Completely passionate and dedicated (go the extra mile)

16.7% 2

Hardworking and committed 83.3% 10 Good employees 0.0% 0 It is a job (pays the bills) 0.0% 0 Completely disengaged (looking elsewhere) 0.0% 0

answered question 12 skipped question 1

#

#

# #

Thinking about ELMHS as a whole, how would you rate your colleagues’ commitment to ELMHS?

Completely passionate and dedicated (go the extra mile)

Hardworking and committed

Good employees

It is a job (pays the bills)

Completely disengaged (looking elsewhere)

24##

Question)10)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

Do you feel that problems within ELMHS are general ly solved

Answer Options Yes No Response Count

Quickly? 3 9 12 Fairly? 11 1 12

answered question 12 skipped question 1

#

#

# #

0

2

4

6

8

10

12

14

Quickly? Fairly?

Do you feel that problems within ELMHS are generally solved

Yes

No

25##

Question)11)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Is the fol lowing statement true or false for your organization Management (ELMHS Management Team) is concerned with high productivity, regardless of the impact on employee morale’?

Answer Options Response

Percent Response

Count

True 25.0% 3 False 75.0% 9

answered question 12 skipped question 1

#

#

# #

Is the following statement true or false for your organization Management (ELMHS Management Team) is concerned with high productivity, regardless

of the impact on employee morale.’?

True

False

26##

Question)12)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Overall I feel supported by ELMHS in relat ion to my education, training, supervision and career progression – overal l they are interested in my development

Answer Options Response

Percent Response

Count

Yes 100.0% 12 No 0.0% 0 Haven’t really considered this as it is not important to me 0.0% 0

answered question 12 skipped question 1

#

#

# #

Overall I feel supported by ELMHS in relation to my education, training, supervision and career progression – overall they are interested in my

development

Yes

No

Haven’t really considered this as it is not important to me

27##

Question)16)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey When there are dif f icult decisions to make or dif ferences of opinion between myself and a partner, we general ly.. .

Answer Options Response Percent

Response Count

Work together and thrash it out to negotiate an outcome

91.7% 11

I make the decision 0.0% 0 I defer to my partner to make the decision 8.3% 1 I/we involve the Director and ask her to make a decision 0.0% 0

Both go in different directions 0.0% 0 Ignore the problem/issue and do not address it 0.0% 0 If your response is entirely dependent on which partnership please provide a detailed explanation

3

answered question 12 skipped question 1

#

Number Response Date

If your response is entirely dependent on which partnership please provide a detai led explanation

1

Mar 16, 2012

4:27 AM

Clinically, the decision is ultimately the Consultant Psychiatrist so I may give a view point and will speak up however I am aware that the final clinical decision is with Consultant Psychiatrist. In regards to general issues around the ward we are able to discuss issue and find a resolution. I don't find any of the above answers fit how we operate as it is very dependent upon the issue and situation.

2

Mar 15, 2012

8:17 AM Unfortunately outcomes are not always adhered to.

3

Mar 14, 2012

3:33 AM

Sometimes we can go in different directions or I can defer to my partner which tends to delay the outcome.

#

28##

#

# #

When there are difficult decisions to make or differences of opinion between myself and a partner, we generally...

Work together and thrash it out to negotiate an outcome

I make the decision

I defer to my partner to make the decision

I/we involve the Director and ask her to make a decision

Both go in different directions

Ignore the problem/issue and do not address it

29##

Question)17)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Do you feel confused by the complexity within the matrix model i .e. What you have the authority for – when to involve the Operational Manager, when to involve the Unit Head?

Answer Options Response

Percent Response

Count

Yes 8.3% 1 No 41.7% 5 Sometimes but most of the time it feels manageable 50.0% 6

answered question 12 skipped question 1

#

#

# #

Do you feel confused by the complexity within the matrix model i.e What you have the authority for – when to involve the Operational Manager, when to

involve the Unit Head?

Yes

No

Sometimes but most of the time it feels manageable

30##

Question)19)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Do you feel l ike there is a dif ference or inequity in the way people in the ELMHS Management Team/Senior Leadership Team are ‘held to account’ or held responsible for their roles and KPIs?

Answer Options Response

Percent Response

Count

Yes, I think we are all treated differently and there is no equity

0.0% 0

Yes, some members do not appear to be held to account 25.0% 3

Not sure as I do not pay attention to the performance of others

25.0% 3

No, the majority of members are treated the same although there are a few exceptions

25.0% 3

No, all staff are treated equally – we are all responsible and ‘held to account’ 25.0% 3

Why do you think some people are treated differently? 4 answered question 12

skipped question 1 #

Number Response Date

Why do you think some people are treated dif ferently?

1

Mar 16, 2012

4:30 AM

There are a variety of reasons why there may be the appearance that some members do not appear to be held to account. It could be anything from the basic role, the hours that they work, their availability to attend meetings, etc. I think it is inevitable in a large organisation that some members are not held to account as much as others.

2

Mar 15, 2012

8:19 AM Power imbalance with psychiatrists

3

Mar 13, 2012

12:36 AM

Some KPI reports are continually below target, it offends me when some teams perform below target and with no improvement

4

Mar 12, 2012

11:51 PM there seems little opportunity to really know what is going on in other parts of the service in any formal way

#

31##

#

# #

Do you feel like there is a difference or inequity in the way people in the ELMHS Management Team/Senior Leadership Team are ‘held to account’ or

held responsible for their roles and KPIs ?

Yes, I think we are all treated differently and there is no equity

Yes, some members do not appear to be held to account

Not sure as I do not pay attention to the performance of others

No, the majority of members are treated the same although there are a few exceptions

No, all staff are treated equally – we are all responsible and ‘held to account’

32##

Question)22)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Do you think that our cl ients and their famil ies receive a better quali ty of care as a result of the matrix organisational structure?

Answer Options Response Percent

Response Count

Yes 50.0% 6 No 16.7% 2 I am not sure that organisational structure has any influence on client outcomes

16.7% 2

I have no idea about client outcomes as I do not think these are measured 16.7% 2

answered question 12 skipped question 1

#

#

# #

Do you think that our clients and their families receive a better quality of care as a result of the matrix organisational structure?

Yes

No

I am not sure that organisational structure has any influence on client outcomes

I have no idea about client outcomes as I do not think these are measured

14##

Question)19)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

There are 6 committees in the governance structure in ELMHS: ELMHS management team Clinical Operational Stakeholder Professional Senior Leadership Can you please provide your views on each committee please (you can choose more than one per committee)

Answer Options

Clear purpose/adds value/active committee -

seen as valuable

Important committee

but not sure i t is

functioning effectively

Important committee but not al l members

attend

Not sure of

purpose and

function

Too much overlap/duplication

with other committees

Does not add

anything to the ELMHS governance

Structure

I do not attend

this committee so cannot comment

Response Count

ELMHS Management team

6 3 1 0 0 0 0 10

Clinical 3 6 1 0 0 0 1 10 Operational 6 0 0 0 0 0 4 10 Stakeholder 2 1 0 0 0 0 7 10 Professional 4 0 4 0 0 0 3 10 Senior Leadership

2 4 5 0 0 0 0 10

Do you recomend we change any of the committees (provide detail) 4 answered question 10

skipped question 0 #

Number Response Date Do you recommend we change any of the committees (provide detai l)

1 Mar 18,

2012 It is too early for me to say. It is a problem with Professional Governance that one of the chairs barely attends and we are not using it to drive the research agenda. I always worry with these

15##

10:45 AM committees about the balance between task based items and the use of reflection and critical analysis. Each committee should have a designated Critical friend whose role is to specifically critique the functioning of the group. Otherwise there can be a danger of groupthink or a few voices dominating. There are many great theorists who have developed within group processes to improve the functioning of groups ie. James Reason, Eileen Munros work on thinking errors, The work of Tony Morrison on learning cultures as opposed to compromised learning environments. I'd love for some of this to be presented and we introduce methodology into the running of a couple of these groups.

2

Mar 16, 2012

4:24 AM

I believe SLT is still forming & the functioning will improve as the structure is bedded down. Professional meeting is valuable & again had a number of tasks of tasks to work through & only just now reaching its full potential as the direction becomes clearer. The meeting that works the best is the Management team - clear that all items from other meetings come here for approval. This meeting has the clearest structure & direction.

3

Mar 14, 2012

3:39 AM No

4

Mar 13, 2012

1:11 AM I would eliminate the Clinical Governance meeting and address issues from this meeting at the Management Team meeting that has clinical leaders and operational managers in attendance.

#

#

# #

0

2

4

6

8

10

12

Clear purpose/adds value/active committee - seen as valuable

Important committee but not sure it is functioning effectively

!!

Appendix(1.2(The(clinical(model(

!

1!!

Appendix(1.3(ELHMS(Governance(Team(

!

! !

2!!

Appendix(2(Research(Data(

Appendix(2.1(Governance(Survey(

Question)1)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey The vision for ELMHS is ‘working in partnership with the community to provide better mental health’. I feel that the vision has been communicated clearly throughout ELMHS.

Answer Options Response

Percent Response

Count

Strongly agree 10.0% 1 Agree 80.0% 8 Neither agree or disagree 10.0% 1 Disagree 0.0% 0 Strongly disagree 0.0% 0 The vision has been communicated but in general ‘visions’ mean nothing to me

0.0% 0

answered question 10 skipped question 0

!

! !

The vision for ELMHS is ‘working in partnership with the community to provide better mental health’. I feel that the vision has been

communicated clearly throughout ELMHS.

Strongly agree

Agree

Neither agree or disagree

Disagree

Strongly disagree

The vision has been communicated but in general ‘visions’ mean nothing to me

3!!

Question)2)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

Which of these strategic goals are you responsible for implementing?

Answer Options Response Percent

Response Count

Improve service and health outcomes for our consumers

100.0% 10

Improve services and health outcome for the population when risk can be detected

70.0% 7

Enhance the financial and operating capability of the directorate 60.0% 6

Enhance the commitment to our staff, culture knowledge acquisition and research

70.0% 7

I am not sure I am responsible for implementing any of the strategic goals

0.0% 0

I did not know ELMHS had strategic goals 0.0% 0 answered question 10

skipped question 0 !

!

! !

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

Impr

ove

serv

ice

and

heal

th

outc

omes

for

our

cons

umer

s

Enh

ance

the

finan

cial

and

op

erat

ing

capa

bilit

y of

the

dire

ctor

ate

I am

not

sur

e I

am r

espo

nsib

le

for

impl

emen

ting

any

of th

e

Which of these strategic goals are you responsible for implementing?

4!!

Question)3)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey I know and monitor my progress with the implementation of the ELMHS Strategic goals

Answer Options Response Percent

Response Count

Yes, I know and monitor my progress with the implementation of the ELMHS strategic goals (it helps keep me focused)

30.0% 3

Yes, I know basically how I am tracking with ELMHS strategic goals but I do not actively monitor

70.0% 7

I only know how I am tracking as it is mentioned in meetings or when I am required to report on progress

0.0% 0

No, I do not know my progress with the implementation of the ELMHS strategic goals

0.0% 0

No, I do not know and I am not interested (I see them as irrelevant) 0.0% 0

answered question 10 skipped question 0

!

!

! !

I know and monitor my progress with the implementation of the ELMHS Strategic goals

Yes, I know and monitor my progress with the implementation of the ELMHS strategic goals (it helps keep me focused) Yes, I know basically how I am tracking with ELMHS strategic goals but I do not actively monitor

I only know how I am tracking as it is mentioned in meetings or when I am required to report on progress

No, I do not know my progress with the implementation of the ELMHS strategic goals

No, I do not know and I am not interested (I see them as irrelevant)

5!!

Question)4)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey When you notice something that relates to a KPI does i t prompt you to change your behaviour?

Answer Options Response Percent

Response Count

Yes, always 80.0% 8 Yes, sometimes but it is not usually a priority for me 20.0% 2 I probably would not notice a change in KPIs unless someone told me

0.0% 0

I do not notice changes to my KPIs 0.0% 0 To be honest it would not prompt a change in behaviour as I do not see them as important/relevant 0.0% 0

answered question 10 skipped question 0

!

!

! !

When you notice something that relates to a KPI does it prompt you to change your behaviour?

Yes, always

Yes, sometimes but it is not usually a priority for me

I probably would not notice a change in KPIs unless someone told me

I do not notice changes to my KPIs

To be honest it would not prompt a change in behavior as I do not see them as important/relevant

6!!

Question)6)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey

How do you regard the majority of ELMHS employees overal l?

Answer Options Response Percent

Response Count

Hard working and trustworthy 100.0% 10 Requiring close supervision 0.0% 0

answered question 10 skipped question 0

!

!

! !

How do you regard the majority of ELMHS employees overall?

Hard working and trustworthy

Requiring close supervision

7!!

Question)7)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Within your work group ( include the ELMHS Management Team and Senior Leadership Team) do you general ly see the people around you as

Answer Options Response

Percent Response

Count

Positive and energizing 100.0% 10 Negative and de-energizing 0.0% 0

answered question 10 skipped question 0

!

!

! !

Within your work group (include the ELMHS Management Team and Senior Leadership Team) do you generally see the people around you as

Positive and energizing

Negative and de-energizing

8!!

Question)8)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Thinking about ELMHS as a whole, how would you rate your col leagues’ commitment to ELMHS?

Answer Options Response Percent

Response Count

Completely passionate and dedicated (go the extra mile)

10.0% 1

Hardworking and committed 80.0% 8 Good employees 10.0% 1 It is a job (pays the bills) 0.0% 0 Completely disengaged (looking elsewhere) 0.0% 0

answered question 10 skipped question 0

!

!

! !

Thinking about ELMHS as a whole, how would you rate your colleagues’ commitment to ELMHS?

Completely passionate and dedicated (go the extra mile)

Hardworking and committed

Good employees

It is a job (pays the bills)

Completely disengaged (looking elsewhere)

9!!

Question)9)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey ELMHS formal organisational structure r ight throughout ELMHS is a matrix model. Do you understand the matrix model and how it is supposed to work?

Answer Options Response

Percent Response

Count

Yes 90.0% 9 No 0.0% 0 I have a basic understanding but I am confused about some aspects 10.0% 1

answered question 10 skipped question 0

!

!

! !

ELMHS formal organisational structure right throughout ELMHS is a matrix model. Do you understand the matrix model and how it is supposed to

work?

Yes

No

I have a basic understanding but I am confused about some aspects

10!!

!

Question)12)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey When there are dif f icult decisions to make or dif ferences of opinion between myself and a partner, we general ly.. .

Answer Options Response Percent

Response Count

Work together and thrash it out to negotiate an outcome

100.0% 10

I make the decision 0.0% 0 I defer to my partner to make the decision 0.0% 0 I/we involve the Director and ask her to make a decision 0.0% 0

Both go in different directions 0.0% 0 Ignore the problem/issue and do not address it 0.0% 0 If your response is entirely dependent on which partnership please provide a detailed explanation

4

answered question 10 skipped question 0

!

Number Response Date

If your response is entirely dependent on which partnership please provide a detai led explanation

1

Mar 18, 2012

10:35 AM

This was a difficult question as I have yet to have significant conflict within the program. I think I could work the issues arising in a constructive way at this stage.

2

Mar 15, 2012

5:39 AM

In the first instance my leadership style is to work collaboratively with my partner to resolve this issue, if this was unsuccessful I may involve the Director (for use as a sounding board)

3

Mar 14, 2012

5:24 AM

This question would probably have ticks in all boxes - very much depends on the urgency of the issue and the willingness of the partners involved. It is certainly noticeable that this is a draining element as this seems to occur more than was anticipated. At times another strategy is to use peers of a similar role for feedback or support in how to proceed

4

Mar 13, 2012

1:07 AM My relationships are usually with operational managers (not clinical partners) and my position is to assist them in their operational responsibilities.

!

11!!

!

! !

When there are difficult decisions to make or differences of opinion between myself and a partner, we generally...

Work together and thrash it out to negotiate an outcome I make the decision

I defer to my partner to make the decision I/we involve the Director and ask her to make a decision Both go in different directions

Ignore the problem/issue and do not address it

12!!

Question)16)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Do you feel l ike there is a dif ference or inequity in the way people in the ELMHS Management Team/Senior Leadership Team are ‘held to account’ or held responsible for their roles and KPIs?

Answer Options Response

Percent Response

Count

Yes, I think we are all treated differently and there is no equity 0.0% 0 Yes, some members do not appear to be held to account 20.0% 2 Not sure as I do not pay attention to the performance of others 0.0% 0 No, the majority of members are treated the same although there are a few exceptions 50.0% 5

No, all staff are treated equally – we are all responsible and ‘held to account’

30.0% 3

Why do you think some people are treated differently? 2 answered question 10

skipped question 0 !

Number Response Date Why do you think some people are treated dif ferently?

1

Mar 18, 2012

10:39 AM

There does seem to be a general 'we' in how things work. There are some people who carry a lesser accountability and I would say that the workload across the Management Team can never be equal. Generally speaking people put their hands up.

2

Mar 14, 2012

3:35 AM Different Disciplines. Harder to replace. !

! !

13!!

Question)18)

MBS - Review of the Governance Structure in ELMHS - Management Team Survey Do you think that our cl ients and their famil ies receive a better quali ty of care as a result of the matrix organisational structure?

Answer Options Response Percent

Response Count

Yes 60.0% 6 No 10.0% 1 I am not sure that organisational structure has any influence on client outcomes

20.0% 2

I have no idea about client outcomes as I do not think these are measured 10.0% 1

answered question 10 skipped question 0

!

!

! !

Do you think that our clients and their families receive a better quality of care as a result of the matrix organisational structure?

Yes

No

I am not sure that organisational structure has any influence on client outcomes

I have no idea about client outcomes as I do not think these are measured

!!

!

7 Appendix)

Appendix)1)Tables)and)Figures)

Appendix)1.1)ELHMS)Process)Map)