The Pharmaceutical Journal
Vol 277 No 7432 p771
23/30 December 2006

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Health Service Journal

Developing leaders for a dynamic NHS

The NHS is going through enormous change, Alistair McLellan, editorial director at the Health Service Journal told the meeting. It must become leaner, increasingly business-focused and more patient-centred. Organisations must look beyond their traditional boundaries and work in partnership with a range of organisations both within and outside the NHS. To succeed in this new environment, NHS leaders must rapidly adapt their leadership styles and develop new approaches to tackling the challenges of running a 21st century health care organisation.

Cynthia Bower, chief executive of NHS West Midlands, explored the future shape of NHS organisations and the role of their leaders. She asked: “What is the nature of the leadership challenge for the NHS today and what qualities do we need to succeed?” Her conclusion was that leadership is to be found at all levels and that all people can and should be leaders. “However, this needs competence, authenticity and desire, certain personal qualities, a willingness to be challenged and knowledge of our impact on other people. It is in reality, much harder than a lot of the technical things that we do,” she said.

It is important to start with context, she went on. Most successful leaders are constantly reflecting on the external environment and the changes around them. “This is especially important at this time when the context in which we are delivering services is shifting like it has never shifted before and when the most innocent thing that you do can become tomorrow’s banner headline.”

The focus should be more and more on the patient and public perspective with a shift from a monolithic NHS to a responsive and more business-like local one with engaged clinicians delivering new models. There are currently particular problems in engaging people when traditional ways of doing things and jobs are under threat. Equally it is difficult to harness the enthusiasm and energy of the voluntary and community sector, monitor standards and progress, hit targets and not stifle innovation. It is important to look for the changes which will impact on the future as well as delivering today.

Ms Bower put forward some “top tips” for achieving success and creating a leadership team:

• Sell the vision
• Deliver on targets
• Make decisions
• Pick energy givers
• Pick people who will challenge you
• Do not pick people who make you feel safe
• Enthuse the workforce

She went on to describe how to manage the external environment and external perceptions: “Consider how local problems are solved. You will be judged on your ability to solve local problems rather than hitting national targets. Create alliances, and partnerships and strong implementation networks. Find who can say yes or no in alliances. Deal with problems and work across agencies. Tackle difficult issues including difficult people. People will watch how you help people in different environments and how you cope when things go wrong.”

She urged participants not to forget that leadership is core managerial business. “Managers think all problems can be managed. But you need to find the leaders, and sometimes they are difficult to find.” Leaders need to:

• Have a consistent approach

• Be a good partner

• Seek feedback and challenge themselves

• Make sure the little things are attended to

• Support people whom they put in difficult positions and encourage them to take risks

• Attend to their own development

• Close the gap between themselves and the “front line” by letting people know that they have listened and understood

• Be enthusiastic

• Take responsibility, because failures are rarely one person’s fault

Concluding, Ms Bower said that the NHS needs to take the development of the next generation of leaders seriously. There should be more holistic development, with managers and clinicians developing together.

Fit for purpose?

Neil Goodwin, leadership consultant academic and former chief executive of Greater Manchester Strategic Health Authority, expressed the view that NHS leadership development is not fit for purpose. “It should be NHS core business but is not pursued systematically,” he said.

He told the meeting that the new NHS chief executive, David Nicholson, takes this seriously. “He understands leadership and the importance of investing in its development. However, leadership development is hard work. People develop best when dealing with local issues, not case studies from other industries. Leadership is an interpersonal dynamic process, creating an agenda for change using a strong vision, building a strong implementation network to get things done through other people.”

Mr Goodwin pointed out that leaders do not always succeed and anyone who says they have never failed is deluded. he reminded that audience of the words of Winston Churchill, who said that success is the ability to go from one failure to another with no loss of enthusiasm. “We often fail for interpersonal reasons, especially if we are not prepared to tackle difficulty. A leader is immediately weakened if issues are allowed to drift.”

A dangerous myth

Beverly Alimo-Metcalfe, professor of leadership studies at Leeds University, said that it is a dangerous myth that people instinctively resist change. “People resist change if they don’t know why they are being required to change and deeply resent change that doesn’t involve them. The challenge therefore becomes how to enable people to be co-designers and co-owners of change,” she declared.

There is a causal link between readiness for change and successful change initiatives, she said. Staff who hold positive views about the need for change see positive implications for themselves and the wider organisation and actively contribute to change initiatives.

Cultures that resist change tend to be inward-looking, bureaucratic, autocratic and task-focused. Senior managers might have lost contact with the needs of the organisation and employees. They may also be making decisions that frustrate the change efforts and failing to develop the culture that is a pre-requisite for change.

She told the meeting that change must be led by middle managers and the “shop floor” for it to be successful. Characteristics of successful change include:

• A proper understanding of the need for change
• High quality, frequent, two-way communication
• Supported middle managers
• The opportunity to participate and to think laterally and innovatively
• A supportive culture
• A sense of high efficacy
• Regularly reviewed personal development plans

The most appropriate leadership style to aim for is one which shows increasing engagement, creating a culture where people want to give of their best and be involved.

“Readiness for change is not an option. Leadership is the key; it must strengthen engagement and not necessarily be based on people’s competencies,” she concluded.