What is Leadership in the NHS? Manager vs Leader…
Peter Beresford, academic and activist:
We seem to live in an age dominated by the idea of managers. Leadership is a different kettle of fish and doesn’t mean it has to be hierarchical, by one person or a one-sided relationship. The best leadership is inclusive, addresses diversity and can engage us all.
Karen Lynas, interim managing director, NHS Leadership Academy:
I don’t know whether this distinction is that helpful anymore. Like all of our respective roles the boundaries are really blurred. Of course you can be a leader without being a manager and a manager without being a leader, but the roles do vary. As soon as you get into a position where your leadership is part of your authority and role then you will also need to have some management skills. Clinical leaders will need clinical skills, leadership ability and some grasp of management: making things happen and getting things done. Managers will have management as part of their technical skills set so should have broader and deeper knowledge.
Ben Gowland, director and founder Ockham Healthcare, former clinical commissioning group chief executive:
A key difference is that people follow leaders, whereas managers have to focus on following rules. An NHS built around clinicians needs those delivering care to move together to make it better, and this requires leaders, often clinical leaders. Managers have the skills to make change happen, but this needs to be alongside great leadership.
What qualities do good leaders have?
I think from what service users say that good leaders are people who can listen, listen, and then listen, treat diversity with equality, be honest and open, show they are well informed and up to date and are reliable.
Mark Duman, non-executive director, Patient Information Forum:
Integrity. Humility. The ability to say “I don’t know but I’ll find out”. Skills wise: measurement. As Bruce Keogh says “If you don’t know how to measure what you’re doing, you should not be doing it”
Good leaders provide two things: clear consistent direction, and the desire in other people to follow the direction set. One out of two does not make a good leader!
Create hope and optimism: not through some horrible rose tinted glasses but by focusing on what we know and can do. Irrespective of the turmoil we are living in, people will continue to have babies, get ill, get old, need care, support and love. That’s why the NHS is here, and the need for wonderful, compassionate care hasn’t changed. Great leaders put common purpose and collective endeavour front and centre and help people understand and manage the complexity without being utterly paralysed by it.
Is there a role for leaders and leadership in the NHS?
Dr Mike Holmes, clinical lead, Royal College of GPs’ supporting federations programme:
I think it is imperative we have it – leadership is not a one-dimensional entity and all people within the NHS can display leadership traits/qualities in whatever they do – we can lead on an individual level through our own behaviour, we can lead teams delivering services, lead organisations and also in the inter-organisational space – each area is important. Good communication, listening, empathy, seeing things from others’ perspectives are key wherever you lead.
Leadership, in today’s NHS, involves tough decisions. Whatever you decide, some people are not going to like it, and so it is not realistic to expect leadership positions to be easy or welcoming. They will be tough, but they are necessary, and key is making sure that all decisions are made with patients’ best interest at heart.
How can we encourage leaders in the NHS to stop being so insular and recognise value and importance of the other sectors?
I think a lot of the insularity comes from lack of confidence and competence. If leaders felt more valued for their contribution and were able to competently operate in their role, they would be much less defensive about relinquishing power and control. And we still regard ourselves first and foremost as an illness service, so don’t value the contribution of other sectors enough.
The challenge for local NHS leaders trying to operate effectively with the wider social sector is the hierarchical top down nature of the national NHS, and the way that local NHS leaders are put under pressure to act in certain ways by their regional and national masters. I don’t think it is a failing of local leadership, but of the system within which they operate.
I think we are beginning to see genuine cross-sector working – something I feel is imperative if we are going to deliver patient-centred care at all times. I’ve come across lots of example where primary care, secondary care, local authorities, mental health and the community and voluntary sectors are exploring ways to work in partnership. The will is there: sometimes there are barriers – finance, bureaucracy, workload, contracts etc but I am beginning to see and hear that these are being overcome … The culture is beginning to change.
How can NHS leadership become more representative of its diverse workforce?
We know it’s getting worse now not better, and without repeating myself the events of the last few days are not likely to help. The homogeneity of our senior leadership community is breathtaking in 2016. Lots of things contribute to that, not least our risk aversion in making appointments at senior levels. Everyone working in health and care has a responsibility to question their own behaviour in this area – what are you personally doing to make a difference?
Joan Saddler, associate director, NHS Confederation:
In terms of diverse leadership both skill and will apply. Understanding the benefits of diverse leadership and making it happen are in the gift of leaders, bringing in skilled enablers to reach this goal where necessary.
From Our Perspective – How we add Value to your Trust
As you read the above quotes, I suspect you knew the principles behind them already.
Where Gables adds value is in the way we demonstrate and guide our clients on the “HOW” of Leadership by encouraging them to think differently (to the above).
For example: Gowland speaks of making decisions with the patients’ best interests at heart. We help to expand this view by showing the programme participants what they are notseeing when addressing this point. How limiting to our thinking is it to consider the patients’ best interests? What else is equally important? How can asking this question of a Health Trust provoke thought and increase cognitive complexity on the subject of health care provision?
If we address health care provision from the perspective of the patients, what parts of the equation are we not addressing that matter just as equally?
Asking those people who work in the health care industry to consider these questions is provocative and sometimes confrontational, but without this potential confrontation, how are we to adjust our thinking on the subject? Acquiescing to the thinking status quo gets us nowhere, and is in fact the best way to ensure nothing ever changes. If we are to progress a service as important as the NHS, we need radical thinking that upsets the apple cart, whilst understanding the values and principles at play that make it an important national service.
Lynas talks about the NHS being insular, which she derives from the lack of competence. She says that: …”if leaders felt more valued for their contribution and were able to competently operate in their role…” At this point we need to stop the conversation and address the difficult question no one is asking: WHY are they in that role if they were not already competent to perform in it? If the size of the person does not fit the size of the role, they should not be in said post. See this page for more details on role alignment. The image at the bottom of this page has the role alignment mapped out.
Driving Standards of Care for a 21st century service
We offer a Vertical Development Programme that walks NHS employees through an introductory two-day course on changing their thinking. By the end of this short programme, each participant should be able to answer the following questions:
- Who will hold me accountable for my decisions and outcomes?
- Who will I hold accountable for their decisions and outcomes?
- What are my top 3 [“what-by-when”] priorities for which I agree to be held accountable in the next year?
- What are the top 3 [“what-by-when”] priorities by which I will empower my subordinates and hold them accountable in the next year?
- What are the top 3 identifiable risks / barriers to successful outcomes?
- Who are the key stakeholders with whom I will establish and maintain mutually beneficial working relationships?
- Who are the top three subordinates whom I will seek to develop?
- What are my own top 3 personal / professional-development priorities?
- What are the top 3 external drivers likely to impact my role within the next 3 years?
If you recognise any of the above taking place in your NHS Trust, we are happy to come out to open a dialigue with you how we increase your Vertical Development so you think differently about how you continue to provide your excellent service, not only with the patients’ interest at heart, but also the long term ramifications of your decision-making process. Give us a call today.
Source Document: https://www.theguardian.com/healthcare-network/2016/jul/08/role-of-leadership-nhs?CMP=Share_iOSApp_Other