Leading through curriculum development and change Professor Judy McKimm Manchester Medical Education Conference 15 April 2013.

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

Health p

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Changing leadership is needed for changing healthcare and educational contexts

What is leadership*?

* Google search 115,000,000 hits ….

“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

How can theory inform practice?

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

presentstate

desiredfuture state

transitionstate

unfreeze

refreeze

Kurt Lewin (1951)

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?

[email protected]

Developing teams and individuals

“Leadership is not an esoteric topic relevant to a select few, but a ubiquitous feature of daily life for every physician”

Gunderman, R, Leadership in healthcare, London: Springer-Verlag, 2009