Neil Goodwin's Comments
I know that Chris would not want this to be considered as an 'either, or' issue but we must be careful not to throw the baby out with the bath water. Pace setting and achieving targets have their place, and are just as essential as quality and safety for maintaining public confidence. Historical context is crucial here. It wasn't too long ago that long waiting times were the norm with the public calling for improvements. They probably contributed as much to increased morbidity and mortality as those issues highlighted at Mid Staffs. And those of us who are old enough can equally remember the mess that public services were in at the start of Mrs Thatcher's premiership, although Chris is right when he says that she - like the majority of leaders in power positions - eventually began to believe her own rhetoric that led to her downfall. The trick is to balance the achievement of performance with developing a good quality culture using appropriate leadership styles. But as I have said in one of my recent blogs, I do see a disconnect between the hierarchical practice of management and the multi-disciplinary, team-based practice of clinical care. I believe this disconnect will make it harder for management to change. Hence, I argue for the need to pause and consider the purpose, role and practice of NHS management; and for it to establish a closer relationship with the clinical professions.
Comment on: Break away from 'heroic' leadership
Good piece for stimulating discussion. I too have called for more evaluation of leadership along with a stronger emphasis on management, which with administration has been somewhat sidelined by an over-emphasis on leadership. But perhaps the most important variable to take into account is the relationship between developing a stronger NHS ethos of caring and compassion, and how these qualities are viewed in society as a whole. I would argue that whilst I share Clare's aims, unless we are seen to be a more caring and compassionate society - as is the case in many other countries - we may have limited success in changing NHS (and social care) culture. Finally, and this is another way of looking at Clare's points, there is an increasing gulf between the multi-disciplinary, team-based approach of clinical care and treatment with the hierarchical nature of leadership and management in the NHS. NHS management needs to be reinvented so that it mirrors clinical care - perhaps then we would stand a better chance of developing the improved behaviours that we talk about.
Comment on: Failed NHS managers could face blacklisting
This is tricky but not impossible. Successful implementation will rest on a number of variables including: a sound, universally understood and objectively applied performance framework; differentiation and understanding of the roles and responsibilites of the CEO, chair and board (not an issue for teachers, where I imagine performance in the class room is more clear-cut), etc. The proposal also begs at least three further issues for addressing. First, ensuring there's a sound recruitment and selection process for CEOs including, among other things, avoiding appointing first-time CEs into known difficult jobs or very big organisations. There's little point establishing the register unless the basics are in place. Second, ensuring there's an equally robust and sound process for appointing (and appraising) board chairs. If there is a stronger role for regulators in senior personnel issues then it has to be this because if there's one relationship that could precipitate failure it's that between the chair and CEO. Third, understand that just because someone fails at being a CEO it doesn't mean they will fail as a senior manager (unless what precipitated their failure was a potential criminal act). In my experience as a former SHA CEO who 'moved on' CEOs, some realised that they hadn't enjoyed being a CEO and welcomed the opportunity to pursue their career at director-level, thereby not wasting their skills. In short, for this to work successfully process will be important but perception will be crucial.
Comment on: More management, less leadership please
Thanks for the above comments, I'm most grateful. I have reflected on what you have all said and re-ordered my own thinking as follows: 1. At times of austerity life is about choices and this includes investing in leadership development. If it can't be demonstrated to have a positive result then it should be changed or dropped. A year is sufficient time in any leadership programme to draw interim conclusions. 2. From a patient perspective (and like many I have been a patient) what I believe is needed to provide efficient and effective services is good quality management and administration - we have neglected both over the years at the expense of leadership, which we also have inappropriately elevated in importance above the other two. They are all of equal importance. 3. Improving management and administration does not always require leadership. As John Kotter said, sometimes you need more management and less leadership, and sometimes vice versa. I believe that now is a time for more management. 3. The NHS is rightly judged by those who have control over its future on bottom-line performance (finance, quality, safety patient experience, etc). As a tax payer I judge it that way too and will be assured by seeing improving and sustainable bottom-line performance. If staff development investments cannot demonstrably contribute to that then - to be provocative - they will have largely been in vain. 4. Sadly but inevitably given the nature of yet another scandal, the Francis report will adversely impact on the reputation of NHS management; however, it is of course only a small proportion of managers who let the side down. I assume Francis will also comment on board capability where, based on my own inquiries into adverse board governance, much development is still required. Mid Staffs has clearly demonstrated that regulation is not the complete answer which, in my view, is having a greater focus on building good quality local boards and local management. 5. What all this says to me is twofold. First, we are in the early period of a very difficult time for NHS management and I'm not sure I have yet seen sufficient evidence from people and organisational development investments to date that a firm enough foundation exists to create universal success. Success, we can be certain, will be at best distinctly patchy. Second, changing the language - by introducing 'management' and 'administration' alongside 'leadership' will help dispel the perception that leadership is only for the few and is somehow superior to management and administration. This is, I strongly believe, an important signal for the clincial professionals who in contrast to the hierarchical approach of management, deliver care on an integrated, multi-disciplinary and often non-hierarchical team basis. Somehow we have to bridge this gap between these two styles, which for me means reinventing management so that its aproach and style mirrors that of the clincial professions. 6.Finally, it may seem strange for a leadership academic to question what is, in essence, my livelihood. But looking at the issues facing NHS managment and the clinical professions today, although leadership does have its place I'm no longer convinced it is the answer we often think it is.
Sarah's absolutely right. First, the ability to explain to others what's happening in the world around them is a consistently underrated leadership skill. And second, a simple, easily understood approach is best. Leadership is an important process but that's what it is - a process - not an end in itself. Keeping it as simple as possible is more than half the battle of making it work. My favourite explanation is that it's a threefold process: one, it's about developing relationships; it's developing a simple, easily understood vision; and three, it's creating an implementation network to get things done through others.
Comment on: More management, less leadership please
I agree Karen and thanks for responding. Of course my blog is presented in black and white terms to be deliberately provocative, as I know you know. By bottom line performance I do of course mean not just quantitative measures but also qualitative stuff such as quality, safety and patient experience; measures that are just as important in other industries that have to balance resource consumption with quality, efficiency and delivery as we know. I think the problem is past NHS performance is variable so delivering a consistent bottom line has been challenging over the years. So whilst we may need a different approach to leadership culture in some parts of the NHS we also need a greater focus on the managerial 'what' to increase the probability of delivery. It's a tough trick to pull off and to be somewhat flippent the worst of all worlds would be to end up with a better leadership but worsening delivery! Finally, continuing to be a little provocative I would argue that managers - at whatever level - are only as good as both their bottom-line (however we define that) and their last decision because delivery and decision-making are what people look to them to do (using appropriate process of course).
Good points Blair. The NHS historically has been over-fond of both searching for leadership models elsewhere and/or repeatedly inventing its own leadership model(s). What the NHS should do more of is to regularly remind itself that leadership is ninety-nine perspiration and one percent inspiration. In short, stop overcomplicating the process, and just get on and do it.
Comment on: Nursing, society and older people
I completely agree.
Comment on: Nursing, society and older people
Thanks for the comments, appreciated. In short, what I'm trying to say, perhaps not very successfully, is that it's impossible to separate out how our society views and values older people (not very positively in my view) from how we train nurses and other carers. In other words, the latter is heavily influenced by the former. We only have to look at places like China to see how older people are valued and young people are very clear about their respsonsibilities to care for their elderly relatives. Something that we very rarely see in the UK. So, how do we develop that culture would be my main question.
Comment on: The introverted leader's time has come
I completely agree with the above comment, it's just that introverted leaders receive insufficient recognition.