Leadership: Reviewing Team ProgressLeadership: Reviewing Team ProgressIPC3 Learning Session 2

April 26-28, 2011

Denver, Colorado

ObjectivesObjectives

• Participants will understand the purpose and responsibilities of leaders in reviewing the team’s progress

• Participants will gain insight on approaches and methods to this review.

• Participants will share ideas for communication of team progress

Some Typical Sponsor Responsibilities

• Building Will for the improvement initiative.• Reach agreement on the aim for the team’s work.• Assisting the team leader in connecting the team’s work to

organizational priorities.• Helping select team members.• Working with the team to get the resources it needs (especially

support from IT, HR, Finance, etc.).• Removing barriers to improvement.• Keeping abreast of the progress of the team.• Communicating the team’s progress to the management team.• Developing a strategy to spread the work of the improvement

team.

Seven Leverage Points for Leading Transformation

Seven Leverage Points for Leading Transformation

1. Establish and Oversee Specific System-Level Aims for Improvement at the Highest Board and Leadership Level

2. Develop and executable strategy to achieve the system level aims and oversee their execution at the highest governance level.

3. Channel Leadership Attention to System-Level Improvement: personal leadership, leadership systems and transparency

4. Put patients and families on the improvement team.

5. Make the Chief Financial Officer a Quality Champion

6. Engage Physicians

7. Build Improvement Capability

Making the status quo uncomfortable

Making the future attractive

The Leadership Framework

WillIdeas

Execution

Establish the Foundation

Setting Direction: Mission, Vision and Strategy

PULLPUSH

Remember, the currency of leadership is attention!

Remember, the currency of leadership is attention!

Reviewing the Team’s ProgressReviewing the Team’s Progress

Roles and Responsibilities of Leadership

Leadership Management Coaching

The “Review” is an opportunity: The “Review” is an opportunity: • The Sange Creative Tension model: current reality and

future vision• Leadership: inspiring to the future; growing people;

generating a compelling picture of the future that others see as their own.

• Management: getting people to make promises that can be measured (Close ended questions with measurements that are reviewed regularly);

• Coaching: occurs after leadership and usually after there has been management; must be asked for; techniques include listening and asking open ended questions; providing support and alternative personal success strategies

Being Clear about the Aim of Measurement

Being Clear about the Aim of Measurement

• Accountability

• Research

• Improvement

Where does reviewing the team’s progress fall?

The Purpose of the Sponsor Review:

The Purpose of the Sponsor Review:

• To learn whether the project is on track or is likely to fail.

• If the project is not achieving the intended results, to understand why:– Lack of organizational will– Absence of strong enough ideas – Failure to execute changes

• To provide guidance, support, and stimulus to the team on will, ideas, and execution.

• To decide whether the project should be stopped, moved to another team, or…

Process of the ReviewProcess of the Review

• Not “How’s it going y’all!”

• Pre-meeting preparation

• A well executed meeting process

• System for post meeting communication

Pre-Meeting PreparationPre-Meeting Preparation

• Know the context of the project. Why are we doing this and how does it relate strategically.

• Read the report before the meeting!• Communicate with the team leader to

establish an agenda and expectations:– no big presentations– review of aims, measures– results prognosis– ideas for next cycle of improvement

The Meeting Itself: the Aim and Measures

The Meeting Itself: the Aim and Measures

• Start the review by clarifying the aim: “what exactly are you trying to accomplish?” – Is the bar high enough?

• Then ask about measurements: “Please summarize for me the measures you’re using to know whether you’re moving toward your aim”. – Look for a few solid measures– Well defined– Comparative

The Meeting Itself: Review of DataThe Meeting Itself: Review of Data

• Within 3-5 minutes you should move to reviewing the data.– Look for clear graphic displays– Spend considerable time on these results –

enough to establish that you understand the numbers and more, importantly, that you care about getting results

The Meeting Itself: EncouragementThe Meeting Itself: Encouragement

• Share with the team two or three good elements and provide encouragement– “excellent use of segmentation in breaking

this ….. up into manageable chunks”– You’ve already completed 16 improvement

cycles? that’s almost one every 2 days! Wow!”

The Meeting Itself: trends, Prognosis

The Meeting Itself: trends, Prognosis

• Discuss trends and prognosis– “OK, given your progress to date, and the

ideas you’re planning to test, make a prediction: Are you going to achieve your aim?”

The Meeting Itself: Uncertain Prognosis related to Will

The Meeting Itself: Uncertain Prognosis related to Will

• Is the failure mode primarily related to Will, Ideas or Execution? Look for the following indicators:– Will

• Resources necessary for success are not available• A few loud nay Sayers are blocking

implementation and spread of good ideas• Absence of obvious connection to organizational

strategic goals• Lack of executive or board attention• Line managers are on the sidelines. No

accountability

When the Problem is Will:When the Problem is Will:

• Excellent opportunity for Senior Leader impact

• Inspire the vision

• make resources available

• Deal with a few loud voices

• Channel attention to the importance of the work

• Make connections to key strategies

• Assign accountability to line managers

DiscussionDiscussion

• How have you worked with your teams to build will?

The Meeting Itself: Uncertain Prognosis related to Ideas

The Meeting Itself: Uncertain Prognosis related to Ideas

• Ideas– The team has not gone outside the

organization or health care to find the best ideas

– Few cycles of improvement have been attempted

– “Big Ideas” appear to be absent – changes being tested are safe, incremental, not radical redesign

– the team can’t tell you who has the best results in the world on this work.

When Ideas are a ProblemWhen Ideas are a Problem

• Ask questions:– “What ideas do you have for improvement?”– “Where are you looking for new ideas?”– “Who’s the very best in this?”

• Give explicit permission, and encouragement, to try small tests of big ideas;– “It sounds like you have some good ideas already.

How could you test one of them and have an answer by the end of the week?”

– Be comfortable pushing, supporting innovation and small tests, no matter how crazy!

DiscussionDiscussion

• How have you worked with your team to generate ideas?

The Meeting Itself: Uncertain Prognosis: related to Execution

The Meeting Itself: Uncertain Prognosis: related to Execution

• Project set up and management appear to be weak (meetings, data, reports, etc.)

• Preparation for spread is not part of the project from the beginning

• Good results on pilots, but never scales up.

If Execution is the ProblemIf Execution is the Problem

• Review good project management

• Review change leadership principles

• Review coaching techniques

• Candid discussion of organizational barriers:– culture– information systems– human resource policies

• Address “sacred cows”

A Framework for ExecutionA Framework for ExecutionAchieve

Strategic Goals

ManageLocal Improvement

DevelopHuman

Resources

Provide LeadersFor Large system Projects

Provide Day-to-DayLeadership for Microsystems

Spread and Sustain

Three areas of capabilities for getting results

Three areas of capabilities for getting results

• Ability to achieve System Level Aims – Aligned with strategic plan– Alignment of projects– With human and capital investment

• Local management and supervision– Oversight and review– Spreading and supporting – Environment of joy in work

• Development of employees to lead initiatives and manage improvement

DiscussionDiscussion

• What are some examples of “what worked” in getting results with your team?

Closing the MeetingClosing the Meeting

• “Where do you need help from me?”

Meeting Follow-upMeeting Follow-up

• Reminder call or email to the team leader weekly asking for results of tests of change

• Communicate to the team what you have done in response to their requests for help.

Common fears and antidotesCommon fears and antidotes

• “I don’t know much about clinical medicine” or …..– Using the template doesn’t require being a

content expert. – Following the template is your success

strategy!

Common Fears and AntidotesCommon Fears and Antidotes

• “I don’t know how to interpret run charts and control charts.” “What if I ask a stupid question?”– get training. know and learn the basics of QI

so that you can ask meaningful questions about the results.

– have humility: don’t be afraid to show your ignorance, and to be taught by your team members.

Common Fears and AntidotesCommon Fears and Antidotes

• “I’m concerned that by doing these reviews, I’m stepping into the area of responsibility of one of my direct reports.”– legitimate only if you do every project review.– You can model a good review and

demonstrate what it is you want them to emphasize and encourage.

Your Next Executive Team ReviewYour Next Executive Team Review

• Take the next ten minutes

• Consult your schedule– Is there a team meeting scheduled and on

your calendar?– If not, either find out when the next team

meeting is and schedule on your calendar– Or.. Schedule a team meeting Executive

Review.

Leadership: Communicating Team Leadership: Communicating Team ProgressProgress

IPC3 Learning Session 2IPC3 Learning Session 2

Communication• The spread of improvement is best

supported by informal and social communication rather than formal, hierarchal distribution

• Pay attention to means and content• Target the audience: who and how to reach• Know your opinion leaders• Measure the impact and get feedback

Leverage Communication

• 20 -30% adoption for most new improvement

• 40-50% for complicated new ways

Message

a

b

c

d

e

f

g

h

i

Sender Channel

Noise

Feedback

OpinionLeaders

OpinionLeaders

Opinion Leaders

A Multi-step Communication ModelClinical Governance Bulletin, Oct 2001, Sarah Fraser

SENDER

• Exactly who is the sender

• What is the motivating connection between sender and recipient?

MESSAGE

• Not only is the content important• The way it is shared or transmitted• Ideas will be more readily adopted when

– They are clearly better than what currently happens

– They reflect the beliefs and values of the adopters

– They can be safely tested

Important Points to the Message

• Targeted to the audience; in the language of the audience not the sender

• Make the improvement obvious

• Be clear about the relative advantage of the improvement

• Be personal, with a clear vision of the future

Channel (Method of Communication)

SHARE SHAPE

INFORMATION BEHAVIORGeneral Personal Interactive Face to

Publications Invitation activities FaceFlyers Letters Telephone 1 :1

Newsletters reports email mentoring

Videos postcards visits seconding

Articles seminars shadowing

Posters learning sets

modeling

Seven Ways, Seven Times!

Discussion

• What are some of the ways (channels) this improvement work has been communicated?– Cass Lake example

NOISE

• System Noise– Another flavor of the month?– Does the innovation align with your strategic

plan?

• Individual Noise– Culture – Is the message getting through?– What’s the source of the resistance?

Get Creative! Change things up!

Discussion

• What’s some of the “noise” that is getting in the way of this improvement work?

Opinion Leaders

• The role of the sponsor is to find and work with the opinion leaders

• Opinion leaders are usually the first to know about a good idea

• Peers look to them for guidance– Have the respect and credibility

Issues to consider with Opinion Leaders

• Find them. Ask “whose opinion do you respect on this issue?”

• Not all will agree; find them and coach them

• Expect surprises!

• By working through opinion leaders, you’ll cut down the flack!

Discussion

• Who are the Opinion Leaders in your organization?

FEEDBACK

• Are the right people getting the information?

• Support the adopters in the decision making process

• Review results

Discussion

• What are some of the ways you are getting feedback on this improvement work?

Which brings us full circle back to the review of data!

Review of Data

Communication