Performance Improvement and Leadership in Health Care.

1. Performance Improvement and
Leadership in the Health Service
Dr Steven Kinnear
Physician and Management
Consultant
IrSPEN Satellite Symposium, Dublin, Tuesday 10 March 2015
@drstevenkinnear | @kinnearconsult

2. PERFORMANCE IMPROVEMENT IN
HEALTH CARE

3. What is performance in health care and why
improve it?
If one cannot increase the supply of a resource, one
must increase its yield. And effectiveness is the one tool
to make resources of ability and knowledge yield more
and better results. - Peter Drucker

4. Performance Improvement
More can be gained and
more lives saved through
the development of the
science of performance in
clinical care, than any
development in genome or
laboratory techniques
Atul Gawande
“Better”

5. What is performance in health care and why
improve it?
• If one cannot increase the supply of a resource, one must increase its yield.
And effectiveness is the one tool to make resources of ability and knowledge
yield more and better results.
• Clinical quality & productivity is healthcare performance
• Clinician time & expertise is the high value resource
(expensive, limited availability)
• Value is
– Operational (cost benefit), outcome (clinically effective)
/experiential (customer perceived quality) (Young, 2008)
– Outcome, financial, functional, patient satisfaction (Walburg
2005)
From PiMMs Project, Tim Trebble

6. Wicked problems and great
conundrums
Quality Activity
Increased flow of
patients
Utilisation of
available capacity
Efficiency
(Waste)
Time spent on
procedures (slow
&careful)
Time spent with
patients
Error by checking
and review
Are quality and productivity the same
thing?
Can they sometimes oppose each
other?
How do we get the balance right?
When is busy understaffed?
Figure from PiMMs project, Tim Trebble

7. Options for improving performance
Sweat the assets Work smarter, not harder

8. Motivation
Intrinsic
• Autonomy, mastery,
purpose
• Self-actualisation, peer
group respect, enablement
• Recognition and fairness
Extrinsic
• Personal desire
• Able to influence rate of
work with reward
• Easy to modify behaviour
• Hard to sustain
Psychologist Ernest Becker – Man is driven by an essential
“dualism”; he needs both to be a part of something and to stick out.

9. Problems with management
• The problem is our obsession with the tools of
management obscures our apparent
ignorance of the art
– Tools biased towards measurement and analysis
– Can we measure the value of a turned-on
workforce??

10. Robin the ED Ward Clerk
• Comes in early/stays late when needed
• Knows/has a good relationship with everyone
• Organised, efficient, able and affable
• Knows where everything is
• Nothing is too much trouble
• Works outside his job description
• His job is to do whatever needs done to keep things
running smoothly
• The glue that holds the department together
• Pretty much the lowest paid member of staff in the
department

11. Why?
• Intrinsic motivation
• Autonomy
• Purpose
• Respect and appreciation from seniors, peers
and patients
• Recognition
• Dualism – a part of something and sticking out

12. Elton Mayo and the Western Electric
Hawthorne Plant

13. Harness the power of the front line
• Empower teams to solve their own problems
• Develop and support effective ways of
working
• Develop and manage talent
• Be a CHRO – Chief Hurdle Removal Officer
• Trust your staff
• Don’t cater for the lowest common
denominator

14. Listen to the pissed off people
• They are the only true source of innovation
• Nurture the dissenters

15. Problems controlling quality in a
service industry
• Not like a production line
• What gets produced in a service business and
what gets consumed happens at the same
time
• How do you get tens, hundreds, thousands of
people to adhere to roughly the same high
standard of quality?

16. Getting the best out of your people
Nothing
succeeds like
success
Label a man a
loser and he’ll
start acting
like one

17. HSC Changeday

18. LEADERSHIP IN HEALTH CARE

19. What is Leadership (in healthcare)?

20. What is Leadership (in healthcare)?
Leadership is about maximising
the realisation of human potential.

21. What does leadership mean?

22. Problems with leadership in the
health service
• Most great leaders I
can think of where
chosen by the people
• Most people in
leadership positions in
the health service are
chosen by the
hierarchy

23. If you want to know who the leaders are, look
to see who people are following
vs

24. Leadership in the Health Service
• Not all leaders are good
• Not all leadership is good

25. Leadership in the Health Service
• Toxic leadership causes great damage
• Look out for it
• Learn from it
• Do something about it if you can

26. How can I be the kind of leader the
Health Service needs?
• Be in the disturbance
business
• Be a disruptive leader
• Be an innovator

27. How can I be the kind of leader the
Health Service needs?
• If you can lead without authority you can darn
sure lead with it
• The converse is not true

28. How can I be the kind of leader the
health service needs?
Leader
CQ
IQ EQ
PQ

29. How can I be the kind of leader the
health service needs?

30. How can I be the kind of leader the
health service needs?

32. How can I be the kind of leader the
health service needs?