Politics reopens the age-old leadership question

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19 April, 2010

What a fascinating week for week for politics and leadership with the leaders’ debate at the centre of the age-old question whether leadership is about personality or substance. The BBC’s political editor, Nick Robinson seemed slightly surprised when reporting that people on the street were expressing more views about the leaders’ personalities than the content of their policies. Move immediately to after the first leadership debate, where the media deemed Nick Clegg the winner, and Gordon Brown said leadership was more to do with substance than personality and David Cameron said he would be focusing much more on exposing Nick Clegg’s policy content.

So, where does this take us in terms of understanding leadership, the most researched and perhaps the least understood component of the management sciences? Well, first and foremost it’s naive for political party leaders to say politics is all about policy content and substance. But it’s naive to assume it’s solely concerned with personality. The reality is it’s about both but character rather than personality and not necessarily in equal amounts.

To be a leader the individual has to establish an empathetic relationship with potential followers. We often forget that it’s followers who create leaders, not the other way round. Just because you’re a chief executive, chair or director it doesn’t automatically follow that you’re a leader, which is why leadership is status-free. The potential leader has to have a compelling vision and a story of how to achieve it as the basis of their relationship with followers. So, if there’s no vision and content, there’s no leadership. Simple as that.

But if push comes to shove, what are potential followers looking for most of all? Well, it has to be the character of the potential leader before any consideration of the supporting team. Do people believe that the potential leader can lead them from where they are now to a better future? Does the potential leader have the strength of character, the energy, the personal resilience and flexibility of approach in managing their team and working with stakeholders to achieve the compelling vision?

It is this that is at the heart of leadership - and at the heart of the political leaders’ debates currently taking place. And it is the same for those NHS senior managers who want to be more than managers and aspire to lead their organisations and health systems to a better future the other side of the recession.

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Readers' comments (11)

Dr Paul Worthington | 19-Apr-2010 4:01 pm
Alexandre Ledru-Rollin said "There go the people. I must follow them, for I am their leader." (memorably paraphrased by Jim Hacker in Yes Minister). The quote is fun, but it also sets out a robust comment on the dynamics of NHS leadership. As Manager, we're expected to listen, respond and even follow the views of patients, communities etc.
However, we'd be daft to pretend that we're solely passive, empty vessels waiting to be told what to do and think. As professionals working in - and even passionate about - health, we haven't got views about services and the way they should/could be delivered. The 'could' is crucial; leading often means setting out a vision which others can test or challenge, or (maybe better still) shaping an environment in which a vision and and actions can be developed by a range of voices. That demands a classic 'tight-loose' approach; provide and maintain a structure for debate, so that many voices can be heard. Instead of saying "my view is this; follow me", but more about saying, leadership can be about creating a framework which says "I have views about where we want to be, and they are these, but I want to hear your views too.Then we'll agree what can and needs to be done, and how I can make sure it happens".
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Dr Paul Worthington | 19-Apr-2010 4:18 pm
Sorry - just spotted my typo ! The above should read 'As professionals working in - and even passionate about - health, we have got views about services and the way they should/could be delivered'. I think that changes somewhat the way it should read............!!
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Anonymous | 20-Apr-2010 12:17 pm
The sooner we get away from this sudo-intellectual-middle-class leadership proselytising, the better. It's like a comfort blanket for the bewildered in positions of authority. Neil you talk about "status free" and "character rather than personality" then with virtually the same breath give us the pants-outside-trousers "achieve the compelling vision?" hero nonsense.

I recommedend another look at Francis Wheen's 'How Mumbo Jumbo Conquered the World - A Short History of Modern Delusions', if only to break the monotony.
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Neil Goodwin | 20-Apr-2010 3:40 pm
Thanks for the above comment. It always interests me that we receive so many anonymous comments on HSJ blogs sites. I wouldn't have thought that commenting on leadership would be seen as so contentious? But no matter, all comments are equally interesting.

I don't know what leadership is if it isn't about vision and aspiration and how to achieve them. Perhaps I'm missing something (and I'm always happy to admit when I do) but isn't the 'vision thing' the bit that a lot of leaders - including political ones - struggle with? And, as an example, isn't this one reason why the election appears to be so wide open at the moment - where's the compelling vision?

Maybe sometimes we do approach leadership in a pseudo-intellectual way but isn't this because we like to think it's more complicated than it actually is? Perhaps we prefer to talk about it and constantly try to re-define it rather than generate a bit of perspiration by getting down to it and tweaking it as we go along?
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Lorna Garner | 21-Apr-2010 0:19 am
I'd like to think political leadership is rather different than leadership in an organisation like the NHS. Politicians are expected to have active and overt opposition - the cut and thrust is what cements their identity. They are defined as much by how effectively they can rubbish their rivals as they are by their expressed values. The whole process of how party leaders are elected constrains the way in which we get a national leader anyway.

I agree that real leadership is status free. Those who know me well will know that my mantra is leadership is about stature not status. Stature is conferred upon an individual as a consequence of the value others place on them, but status is the title that demands recognition. We all know the value of a willing follower!

I don't think leadership can exist without vision and values, and the ability to articulate and share them. So is it that the 3 main contenders lack vision and values and the substance to support them, or are they so similar that they cannot be clearly separated from each other, with the result that all that is left for the public to use as a deciding factor is personality?

What is interesting for me just now is how powerful the anti vote can be. How many people will vote not for what they want, but because of who they don't want? The success of each party is dependent upon their having identified the right leader to deliver them victory. Translated into an environment like the NHS, I wonder how much damage is done when the wrong person is placed in a position of authority and leadership, and is there internal sabotage because people simply can't vote with their feet?
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Clive Peedell | 21-Apr-2010 1:24 am
Neil,
On the issue of medical leadership in the NHS, I wonder if you could square a circle for me?
It is well recognised that clinical leadership is essential for healthcare reforms to be successful. Chris Ham has published on this subject and has concluded:
" Without doctors, attempts at radical large-scale change were doomed to fail.”
This is also the view of Donald Light and Michael Dixon:
“The root lesson from Kaiser Permanente is that clinicians need to run the health service”
http://www.bmj.com/cgi/content/full/328/7442/763
It is also supported by the Mayo model of healthcare delivery

Since the current vogue for NHS reform seems to be swinging towards integrated care models, the statement by Light and Dixon is particularly important.

So if we all agree that clinician leadership is important, what do we do about the problem of the anti-professional nature of our market based healthcare system? We have a managerialist system (NPM) which reject the public service professional ethic in favour of private sector micromanagement practices of audit, inspection, performance indicators, league tables and monitoring). Doctors are viewed as "knaves rather than knights". The "trust model" of delivering a healthcare system has been rejected in favour of the market model.
We have had referral management centres, choice advisors, an attack on medical training (PMETB and MMC), and attacks on self regulation. This is not surprising considering that fact that doctors control access to the healthcare market. After all, in a market based system, we can't have GPs referring to trusted consultant colleagues in their local hospitals, can we? In the words of Professor David Marquand, “Professionals are in a profound sense not just non-market, they are anti-market”.
In the United States, where the commercialisation of medicine exists in its most extreme form, the American medical profession lost public support faster than any other professional group during the managed care era. (See Blendon R. “The public’s view of the future of medical care” JAMA 1988 259: 3587-3593)

It is no wonder that the BMA is now campaigning against a market based system - David Marquand has been proved correct in his analysis.

So we now have a situation in a market based system, where the profession of medicine is under attack and yet clinical leadership is fundamentally important to the successful functioning of the healthcare system. The policy wonks want doctors to lead their reforms, but also expect them to take a good kicking as a reward.

This is yet another example of market failure in healthcare - (and quite a fundamental one!)

It is time for policy makers, politicians, NHS managers and management gurus to accept that markets do not work in healthcare and show the necessary leadership to abandon these polices. This is where the “change agents” need to be.
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Dr Paul Worthington | 21-Apr-2010 4:40 pm
Couple of issues to pick up from Clive Peedell's response:
- Of course clinical leadership (and involvement in decision-making) must have a critical role in health, but are we really saying it's the only appropriate source or model of leadership ?
- surely we shouldn't also assume that clinical leadership always means medical leadership ?
- slightly unnerved at the notion that audit, inspection, performance indicators and monitoring are nothing but evil and devilish private sector micromanagement practices. Audit, whether clinical or financial, has a key role in good governance and delivery of high quality services. I've also walked many a hopsital corridor with CHCs (and others) on inspection visits which have resulted in better ward and other patient care environments. Equally, the right performance indicators and monitoring can be a really useful tool to any team(clinical or otherwise) that wants to look at their delivery and impact on patient care. Don't lets chuck out bathwater and baby.
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Clive Peedell | 21-Apr-2010 10:58 pm
Hi Paul,
I accept that there is a role for audit and I also think that peer review (which we have in the cancer community) is a good thing. I'm much more concerned with the fact that professional autonomy, the public service ethic and the social contract with patients is being eroded by modern managerial methods. I echo back to my point about doctors controlling access to the healthcare market - this is a serious problem for the market to work effectively. We are seen as a major problem, but also part of the solution. It will be a difficult paradox to resolve!
Best wishes,
Clive
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Neil Goodwin | 22-Apr-2010 12:03 pm
Very interesting comments above. Thank you.

I think we may be confusing the principles of how the NHS should delivered (government policy) versus how it should be managed and delivered. Whatever the system (whether market or not), it has to be led and managed professionally with the direct involvement and leadership of clinicians of all disciplines. And whatever we think of targets and their imperfections they have delivered the single biggest improvement in access to services for patients.

The principles of leadership are the same whatever system underpins the NHS and whoever is delivering leadership, whether managers or clinicians. And is there really such a thing as professional autonomy? All professionals (doctors, other clinicians, lawyers, accountants, etc) have multi-faceted accountability - to their professional body, to their patients or clients, to their employers, etc.

I don't think the current operating structure of the NHS is anti-professional. I do however think that the most successful managers (and therefore organisational cultures) are those who fully engage with clinical staff and recognise that the managerial role is to understand their service and its future development, support them in service delivery, and provide organisational and system-wide leadership so that clincial leaders can strategically develop services within and beyond the organisation's boundaries.

I hope this helps.
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Anonymous | 26-Apr-2010 10:07 am
Commenting on leadership clearly is a bit contentious, especially for a few of us who work in organisations that provide leadership development (hence the anonymous, sorry!).

Neil I'm grateful for your later comments especially the "getting on with it". Unfortunately I'm surrounded by some of sudo-intellectuals who churn out the mountains of meaningless garbage with which to educate our future leaders, clinical or otherwise. There is so much mitigated language and secondhand eloquence it's hardly surprising nobody is getting on with whatever it is!

In my experience vision without action is called hallucination, and I've never seen so many numpties full of vision in positions of authority as we have now - standing on mountain tops with their pants outside their trousers immersed in their panoramic vision.

Dump Leadership (politics) go for Values (care). The thing with values is you don't have to define them just keep telling people it's good to have them and work close to them whatever they are. I can hold a 'value' in the palm of my hand and use it with every patient I meet today.
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Anonymous | 26-Apr-2010 3:31 pm
Love the use of "sudo" ... very clever analogy for a privileged few!!
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