Leading through curriculum development and change Professor Judy McKimm Manchester Medical Education Conference 15 April 2013.
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Leading through curriculum development and change
Professor Judy McKimmManchester Medical Education Conference
15 April 2013
• Context• Leadership – what is it? What do leaders do?• A little bit of theory• Curriculum development and change• Issues and challenges – strategies and
solutions
“Leadership is like the abominable snowman, whose footsteps are everywhere, but is nowhere to be seen” Bennis and Nanus, 1985
“if your actions inspire people to dream more, learn more, do more and become more, you are a leader”
John Quincy Adams
Leadership in Health Professions Educational leadershipLeadership and management of organisations, departments, resources, research, projects, curricula, assessment, innovations
Clinical leadershipLeadership and management in the clinical setting, of teams, departments, units and of specific clinical situations
Different contexts, ‘subject expertise’, content?But common themes•Leadership at ‘all levels’ - distributed, shared, dispersed•Leading professionals with high expertise•Leadership often invested in positional or professional power
“Making change actually happen takes leadership. It is central to our expectations of the healthcare
professionals of tomorrow “Darzi, ‘Next Stage Review’,DoH, 2008
What is a leader?• ‘Someone with followers’• Someone with vision, drive (‘energy, enthusiasm
and hope’)• Guides/motivates groups, teams, organisations
towards common goals • Is a good communicator, inspirational • Has perseverance, determination• Has integrity, can be trusted• Takes action, takes responsibility • Gives credit, gives praise
Leadership theoriesAdaptive leadership Engaging leadership
Affective leadership Followership
Authentic leadership Leader-member-exchange (LMX) theory
Charismatic leadership, narcissistic Ontological leadership
Phenomenological leadership
Complex adaptive leadership Relational leadership
Collaborative leadership Servant leadership
Contingency theories Situational leadership
Dialogic leadership Trait theory, ‘Great man’ theory
Distributed, dispersed (shared) leadership Transactional leadership
Eco leadership Transformational leadership
Emotional intelligence (EI) Value led, Moral leadership
Making sense of theories ...1. Theories that focus on the personal qualities
or personality of the leader as an individual2. Theories relating to the interaction of the
leader with others3. Theories which seek to explain leadership
behaviours in relation to the environment or system
How does this help us?
Building leadership capacityBolden (2004) distinguishes between:• developing individual leaders (‘individual capital’)• developing ‘social capital’ through system wide approaches and capacity buildingStructured, programmatic development is most effective, workplace based, clearly aligned with curriculum or organisational goals and health needs
What capacities are we building?• Political ‘savvy’• Understanding the terrain• Curriculum and educational expertise• Leadership skills• Change management• Management skills• Followership • Team working
Curriculum leadership and management
Leadership – vision, ‘big picture’, strategies, non-technical/people skills, educational and organisational expertise, innovation/change
Development of ‘phronesis’ (practical wisdom) in self and others
Management – technical competencies and know how, operationalising vision/strategy, stability, standards, processes, procedures
Leadership and followership “Innovation distinguishes between a leader and a
follower” (Steve Jobs)
No-one leads all the time Followers are very rarely passive, especially professionals. Kelley (1992) suggests four roles:– Passive followership– Active followership– ‘Little l’ leadership (leading in small ways, at all levels) – ‘Big L’ leadership
Curriculum cycleNeeds
assessmentProfessional,
organisational, individual
Curriculum design
Approach, models,
resources, teaching/learnin
g/assessment methods
Implementation
Pilot, pre-test
Monitoring and evaluation
Against stated learning
outcomes and professional
standards/competencies
blog.rsc-wales.ac.uk
The curriculum – 4 perspectives1. Curriculum as a body of knowledge to be transmitted2. Curriculum as an attempt to achieve certain ends in students - product
3. Curriculum as process4. Curriculum as praxis
Smith, M. K. (1996, 2000) 'Curriculum theory and practice' the encyclopaedia of informal education, www.infed.org/biblio/b-curric.htm.
Shadow (hidden) curriculum• Covert culture(s)• Idiosyncrasies of individuals/groups/disciplines• Hidden/informal organization• Effects of social processes (internal and external)• Impact of institutional politics/policies• History, myths, beliefs, stories, rituals and routines
adapted from Egan, G (1994)Working the Shadow Side:
A Guide to Positive Behind-the-Scenes Management. New York: Wiley.
The curriculum • ‘a politicised arena’• ‘tribes and territories’ (Becher and Trowler,
2001) or a ‘jungle’ (Bolman and Gallos, 2011)• A vehicle for change
Multi-frame perspective Bolman and Deal’s ‘Four frames’ (1997)
Frame Metaphor Central concepts
Structural Factory or machine
Rules, roles, goals, policies, technology
Political Jungle Power, conflict, competition
Human resource
Family Needs, skills, relationships
Symbolic Temple or theatre
Culture, meaning, ritual, ceremony, stories, heroes
The political frameCurriculum as the place and space where different people and groups compete for power and resources
Key leadership skills for the political frame• Agenda setting• Mapping the political terrain• Networking and forming coalitions• Bargaining and negotiation skills• Identifying common external enemies (and
friends)
A new health and education workforce?
‘Tempered radicals’(Meyerson, 2004)
‘Broker, mediator and negotiator’(Hartle et al, 2008; Tennyson and Wilde, 2000)
‘Boundary spanners’(Bradshaw, 1999)
Issues and challenges• Constant changes in education and health
services • Working at the interface of health and
education• Accreditation, professional standards, quality
assurance, clinical governance• Structures, systems and funding often
misaligned to curriculum innovation
Strategies and solutions• Change is the only constant – leaders need to be
comfortable with managing and leading change • Need for expertise in health and education
systems – funding, structures, cultures• Understand and work within quality systems• Design agile, flexible curricula, in line with
educational best practice and society’s needs
OLD CULTURE
HierarchicalPaternalisticBureaucratic
Fixed boundariesControl
Risk averse
NEW CULTURE
TeamworkConnectivity
EmpowermentTrust
Risk takingInnovation
Support for action
Carnall C (1995)
Managing change in organizations
Prentice Hall
Why people resist change1. Parochial self-interest2. Misunderstanding3. Low tolerance of change4. Different assessments of the situation
Kotter, JP and Schlesinger, LA (1979). Choosing strategies for change, Harvard Business Review, 106-114
Leaders as change agentsBennis (1984) identifies 4 competencies of leadership:
• Management of attention (ability to communicate clear objectives and direction)
• Management of meaning (creating and communicating meaning so that it is understood and people’s awareness is raised)
• Trust (the ability to be consistent and clear in complex circumstances so that leaders are seen as dependable)
• Self-awareness and the ability to work with one’s strengths and weaknesses
Crises of followership
• Over-managing and bureaucracy• A belief that only senior managers know best• Isolating mavericks• A belief that only a selected few factors in the
external environment need to be addressed (missing complexity)
Brown and Weiner (1984)
Issues and challenges• Siloed working (professions, specialities,
teams, organisations, gender)• Involves working with professionals, patients
and students with different needs and demands
• Top level leaders sometimes out of touch with educational change and innovation
• Need to build up leadership/management capacity
Strategies and solutions• Communication and networking between
groups, professions, organisations – translational (‘sense making’) role
• Work with stakeholders to meet and manage expectations and needs
• Take time to keep up to date and inform others about innovation and change
Leadership Theories in practice• Great Man/Trait – personality is important• Behaviourist – styles are important• Transactional – links to reward, management• Contingency, Situational – responding flexibly • Distributive, shared – leadership at all levels• Servant, value led – leaders as stewards• Transformational - leaders as raising moral purpose• Turnaround - leaders as change agents• Collaborative – leaders as connectors• Complex adaptive – leaders as change agents• Congruent - relationships are important• Holistic / Blended – all of the above!
Listening
Commitment to the growth of people
Stewardship
Foresight
Conceptualisation Persuasion not coercion
Awareness and sensitivity
Healing
Empathy
Building a community
Facilitation
The servant-leader is servant first. It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead (Greenleaf, 1970)
The wise leader (Nonaka and Takeuchi, 2011)
• Needs more than knowledge alone• Can practise moral discernment• Can sum up complex situations quickly and grasp key
essence of problems• Creates the context for organisational learning• Communicates effectively• Exercises political power judiciously• Fosters development of practical wisdom in others
Leaders are sense makers, expected to identify and articulate emerging themes and patterns not necessarily to have to have all the answersBUT be able to ask the right questions
In summary• Leadership needs to be evidence based, theory informed, practice
driven• Provide opportunities for active followership, “little ‘l’ leaders”,
project champions – enable people to work to their strengths• Work collaboratively – share resources, actively succession plan,
keep on top of current educational practice• Look outside medical education - make and develop
cognitive/theoretical connections • Create flexible, agile curricula, use adaptive solutions to narrow the
gap between aspiration and reality• Be willing to have fierce and hard conversations – ask ‘wicked’
questions• Find the balance between transformative change and maintaining
stability through good management
Thank you!Any questions?
j.mckimm@swansea.ac.uk
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