TOP-TEN December 2010

LEADerShip at a Glance

LEADS “Top Ten” Suggested Readings

Anderson, L., Malby, B., Mervyn, K. and Thorpe, R. (2009). The Health Foundation’s position statement on effective leadership development interventions. London: The Health Foundation.

The Health Foundation (the Foundation) commissioned this research to reveal and clarify the key, effective interventions that the Foundation believes work in creating leadership knowledge, behaviours, skills, competences, or ‘habits of mind’, relating to quality improvement. The Foundation wants to ensure that it is providing, via its leadership development consultants (LDCs), leadership program interventions that are really effective in developing leadership.

The Centre for Innovation in Health Management (CIHM) has itself been curious about this area and provided a brief piece of scoping research for the Northern Leadership Academy, based on a literature review and a focus event with 60 public sector leaders in the north of England (CIHM 2007). This report was a starting point for this work, as it provided a known basis for effective interventions – for example, base them on ‘real work’, and make the most of multiple perspectives (provide ways of enabling participants to step into the shoes of others). What it does not do is provide deeper insight into ‘how’, in other words which processes do this really well.

The broader background to this study is that the nature of leadership development is changing in some organizations and sectors from courses and classroom sessions to more experientially based approaches. This method is particularly prevalent in the Foundation’s leadership development interventions. It is difficult, however, to collect evidence about the impact of these methods because prevalent models of evaluation are designed around traditional models of delivery. This study is an attempt to assess what works in leadership development in the Foundation’s programs using the views of experts rather than trying to devise and implement inappropriate metrics.

The study was therefore designed to elicit the Health Foundation’s position statement on effective leadership development interventions, which we present in this report as the findings, followed by the methodology and the data behind the results.

Arbinger Institute, (2010). Leadership and Self-Deception: Getting Out of the Box. San Francisco: Barrett-Koehler. Leadership and Self-Deception.

It is important for all of us to understand the ideas presented in this book by the Arbinger Institute. “Leadership and Self-Deception” is deceptively short and simple. Its ideas are deeply spiritual, powerfully effective, and absolutely fundamental to leadership in any arena. Self-deception touches every aspect of life – in fact, it determines our experience of life. It blinds us to: the effect we have on others; a perception of others as they really are, and other corrective feedback from life.

The book defines self-deception as a kind of “insistent blindness.” This blindness puts us “in the box.” And when we are in the box not only do we not solve problems effectively, but also we actually create problems for ourselves and others. When we are in the box, we provoke people to resist us. When we are in the box when we are relating to someone, we are creating a “people problem.” And because of self-deception, we don’t know that WE are the problem – we blame everyone and everything else. This systematically incorrect view of reality is embedded in most of our institutions, our families, our “parenting skills”, and our “human resources management.” And when you stay in the box, you have BETRAYED yourself.

It helps to stay out of the box if we focus on:

– Not trying to change others. (Others’ problems are not why you are in the box).
– Not resigning yourself to “cope” with others. (It’s disguised blaming).
– Not simply walking away from the situation. (It just moves your box).

Here is a checklist of things to think about as you carry out your leadership roles:

– Are you really focused on results, or on your own needs?
– Are you open or closed to correction?
– Do you always try to learn, and teach others when you can?
– Do you hold yourself fully accountable in work, or shift responsibility when things go wrong?
– Do you move quickly to solutions or take perverse delight in problems?
– Can you earn people’s trust?

Finally, always remember that it is progress, not perfection, you should be looking for.

Bowles, M. (2009). Implementing successful transformational leadership competency development in healthcare. Working Futures Research Paper 09-3.

Time, effort and scarce financial resources are being exhausted as healthcare organisations efforts to improve their capacity to change are being frustrated by the poor success rate of their efforts to raise the transformational competence of their leaders. With the advent of the Global Financial Crisis, healthcare organisations know they have to balance the risk of previous failures against the growing criticality of having leaders that can inspire others and champion change. This paper explores how healthcare organisations can successfully build transformational leadership competency frameworks. Examination is initially be made of the nature of change in healthcare and what a transformational leadership approach must encompass. The study explores some of the myths that have caused the failure of many initiatives. By addressing the myths the paper provides a viable approach any healthcare organisation can use to build a transformational leadership competency development framework

Ferris, G. R., Blickle, G., Schneider, P. B., Kramer, J., Zettler, I., Solga, J. and Noethen, D. (2008). Political skill construct and criterion-related validation: a two-study investigation. Journal of Managerial Psychology, Vol. 23 No. 7, pp. 744-771. Emerald Group Publishing.

Political skill is measured with the political skill inventory (PSI), and the construct is composed of four distinct dimensions. Previous validation studies of the PSI found evidence in support of the four-factor structure, but only using self-reports. The present research expands on prior work and report on a two-study investigation of both the construct validity and antecedents and consequences of the political skill construct (Social astuteness, networking ability, interpersonal influence and apparent sincerity). The results of Study 1 confirmed both a four-factor and a single higher-order factor solution of the political skill construct, thus supporting our hypothesis. Study 2 constructively replicated the Study 1 factorial validity results, and supported hypotheses regarding the dispositional and developmental experience antecedents, career-related consequences, and mediation of these antecedents and outcomes by political skill. These two studies test the construct validity of political skill using both self and other-reports. Further, this is the first research to test the Ferris et al. conceptualization of political skill, by examining its antecedents, consequences, and mediation of the antecedents-consequences relationships.

Heading, G. (2009). Strategic leadership, culture and change in health services. Discussion Paper. New South Wales, AUS: The Cancer Institute.

This Discussion Paper aims to identify issues related to strategic leadership and its impact on
change management in cancer services in order to develop an understanding of the relationship between strategic leadership and health service culture change. Preparation of this document included review of literature on leadership, organizational change, psychology, sociology and anthropology of culture and management. Details of these sources are referenced in the text and listed at the end of the document.

The concept of change management has dominated organizational literature since the 1980’s. Within health, the impetus for system transformation is evident. Despite the range of approaches to change management, there is a clear belief that leadership and leadership development are solutions to identified problems and are appealing responses to bring about desired change (Storey 2005). Leadership literature has dealt with change for decades, encompassing various theoretical positions drawn from the disciplines of psychology, sociology, anthropology, management and leadership. Recently the organizational and health literature has engaged in broader debates about the role culture and communication play in change and has explored challenges associated with change.

Service improvement is a stream of change management that is particularly applicable in the health setting. It focuses on process mapping, analysis and innovative service redesign. Pedler and Abbott (2008) claim that the concept of service improvement is complex and problematic. A variety of positions were also found in relation to responsibility for service improvement, ranging from responsibility lying with those who hold the relevant qualification to it being part of “everyone’s job”. They found agreement, however, that service improvement was a state of mind, a developmental process, and not a set of tools. This position challenges some of the leadership and organizational literature that promotes a mechanistic, linear approach to change, with a focus on tools, while overlooking broader influences on change and local issues. Evaluation of service improvement strategies in the United Kingdom indicates the need to combine “top-down pressure with bottom-up concerns”. This means that management must show a willingness to embrace the ideas, actions, questions and doubts of followers. Without facilitated “middle ground” dialogue, top-down policy implementation tends to result in compliance rather than sustainable service change. Strategies such as action learning, whole systems thinking and development of communities of practice have been identified as useful for more effective service development (Pedler and Abbott 2008; Attwood et al 2003).

Katzenbach, J. and Kahn, Z. (2010). Leading Outside the Lines. San Francisco: Jossey-Bass.

The authors offer an ell-new examination of the modern workplace, and how leaders and managers must embrace it for success. Together they reveal how two distinct factions form the bigger picture, for how organizations actually work; the more defined and visible ‘formal organization’ of a company—the management structure, performance metrics, and formal strategy—and the ‘informal organization’—the culture, social networks and ad hoc communities that spring up naturally and in equally vital but different ways, can accelerate or hinder and organization’s success. The author’s use case studies from enterprises around the word (private and public sector) to explore how top-level organizations balance the informal and formal elements of organizations too achieve outstanding results.

NHS Institute for Innovation and Improvement. (2010). Evaluation of the Leadership Qualities Framework 360 review process. Coventry: NHS Institute for Innovation and Improvement.

The NHS Leadership Qualities Framework (LQF) was launched in 2002 specifically for senior leaders within the NHS. The framework was developed using research undertaken with a number of high performing chief executives working in the NHS. The resulting leadership model is based on the leadership qualities that were identified in the high performing chief executives. The LQF is supported by a 360 review tool, designed to support individuals identify where their strengths and development needs align with the NHS Leadership Qualities. Undertaking an LQF 360 includes gaining confidential feedback from line managers, peers, and direct reports in order to access an individual on their strengths and address areas where there is need for further development. In 2010 the NHS Institute for Innovation and Improvement (NHS Institute) commissioned an evaluation of the impact the LQF 360 tool has on the individual, the organization and the wider NHS. The evaluation aim was to develop a robust evidence base demonstrating the effectiveness of the LQF 360 tool in helping participants identify and develop their leadership abilities, in ways that meet changing service needs and demands. The evaluation draws upon qualitative and quantitative data gathered from both senior leaders and other individuals working in the NHS who have participated in an LQF 360 review. The findings are based on participants’ first-hand experience and views, which are supported by the literature review also provided in the full report.

Pomey, M. P., Lemieux-Charles, L., Champagne, F., Angus, D., Shabah, A., and Contandriopoulos, A. P. (2010). Does accreditation stimulate change? A study of the impact of the accreditation process on Canadian healthcare organizations. Implementation Science, 5:31.

One way to improve quality and safety in healthcare organizations (HCOs) is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care. The context in which accreditation took place, including the organizational context, influenced the type of change dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for (i) accelerating integration and stimulating a spirit of cooperation in newly merged HCOs; (ii) helping to introduce continuous quality improvement programs to newly accredited or not-yet-accredited organizations; (iii) creating new leadership for quality improvement initiatives; (iv) increasing social capital by giving staff the opportunity to develop relationships; and (v) fostering links between HCOs and other stakeholders. The study also found that HCOs’ motivation to introduce accreditation-related changes dwindled over time.

Snowdon, A., Shell, J. and Leitch, K. (2010). Innovation Takes Leadership: Opportunities & Challenges for Canada’s Health Care System. Toronto: Ivey School.

The health of a population is directly related to its productivity and a country’s economic, growth and competitiveness. Yet, Canada’s health care future is uncertain. Our system faces a rapidly rising demand for quality health care services that are timely and accessible to an aging population experiencing increasing rates of chronic illness1. To ensure Canada’s future economic competitiveness, we must work to ensure the sustainability of a strong health care system. How? The Ivey Centre for Health Innovation and Leadership believes the answer lies in health system innovation: technological, procedural and cultural. Yet a 2008 McKinsey & Company report found that Canada earns a “D” grade in innovation, placing 13 among 17 developed nations in this economic and future prosperity indicator2. Furthermore, exacerbating the “innovation adoption deficit” is a shortage of leadership in our health system. Nationwide, we lack highly qualified, skilled managers in the health care industry with knowledge and skills to drive change and push the adoption of new and good ideas3. While Canada boasts the second most highly educated population in the world4 and our institutions produce world-class doctors, nurses and other health care professionals, these professionals need to directly engage in innovation in order for health system innovation adoption to be successful. The case is made in this paper that to ensure the sustainability of its health care system, Canada must improve its innovation practices, and develop the leadership and management skills necessary to support and encourage innovation adoption.

Tholl, W., Weber, G. and Robertson, R. (2010). Twenty Tips for Surviving and Prospering in the Association World. Toronto: Canadian Society of Association Executives

By its very nature, the world of associations is assumed to be “kinder and gentler” than the world of business. As it turns out, this is not necessarily so. The world of association executives has become increasingly complex. This guidebook begins with a careful assessment of dominant trends and patterns cutting across professional associations, charities, trade associations and single advocacy organizations. The study finds that the average tenure rate of an association CEO is seven years and that most have 3-4 CEO-level assignments during their career. The authors also find that the for profit and not-for-profit sectors converging in a number of important ways, especially around financial accountability and transparency. Successful CEOs, in both sectors, are able to see the future faster, adapt strategies quicker and use a wider range of leadership capabilities. Based on 40 key informant interviews, the authors are able to identify six steps in the life cycle of a leader: “apprenticeship”; “look before you leap”; “proceed with caution”; “full steam ahead”; “the danger zone”; and “your services are no longer required”. The authors then identify some twenty practical tips that will help reduce the odds of costly, premature and often avoidable departures. They conclude with what Boards need to know to attract and retain high caliber CEOs.