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Resilient NHS managers lack required leadership skills, DH research says

NHS leaders are resilient and intellectually capable but suffer from over-confidence and a “gung-ho” attitude, Department of Health research has found.

Assessments of the 800 managers on the DH’s Top Leaders programme found they performed significantly better on average than their private sector counterparts on verbal reasoning and slightly better on numerical reasoning tests.

They were also very resilient and good at strategic thinking.

But three quarters were creating a “demotivating culture”, according to Lubna Haq, associate director of the Hay Group, which carried out the research.

Presenting the findings to the NHS Confederation conference on Wednesday afternoon, Ms Haq said most of the NHS “top leaders” had a similar leadership style involving “rolling their sleeves up” rather than delegating.

While this ensured things got done, it also meant leaders were not always listening or engaging with colleagues, she said.

“People were quite strong minded and focused on getting the job done but not necessarily taking other people with them,” she said.

She added: “You’d think that 10 years of a target driven [culture] would have resulted in a particular style of leadership and that’s exactly what we’ve found. What’s important is that isn’t the kind of leadership that’s going to deliver the results now or in the future.”

NHS top leaders were more likely than average to be “overly confident of their abilities…not necessarily understanding what their limitations were,” she said. Some were “a bit gung-ho”.

They also scored relatively poorly at “entrepreneurial leadership”, “influence” and “partnership working”.

The results conveyed “quite a startling message,” Ms Haq said.

The results showed little variation across sectors, gender and whether people worked in foundation trusts or not.

NHS Top Leaders director Karen Lynas said: “We have a community of leaders who have led a significant renaissance in the NHS over the last 10 years.

“…That doesn’t address the issue that going forward we will have to operate in a very different way. The challenges we face cannot be resolved by working ever faster and dragging people along behind us.”

The findings have been presented to the NHS Management Board and will inform the NHS Commissioning Board’s “systems and processes”, she said.

A separate assessment of GP pathfinders found they were more likely than the “top leaders” to use a “visionary” leadership style and encourage participation from others.

The DH today this week launched its Leadership Academy, aimed at boosting clinicians’ management skills.

Health secretary Andrew Lansley said at the launch on Tuesday: “The job of managers and clinicians will change and grow, but you will not be alone.  For while the centre will no longer dictate, it will support.  And that goes especially for leadership.”

The academy would set national standards for leadership development, prepare “aspiring leaders” and “challenge poor or inappropriate leadership behaviour wherever it finds it,” he said.

Readers' comments (27)

  • No - I think you'll find that says more about the selection process for top leaders than it does for NHS managers. We all saw the usual suspects including some real liabilities on the list, and some fantastic people overlooked. It was 'who you know'. Correlation with 'gung ho'? Imagine my surprise.

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  • How do I get onto this DH’s Top Leaders Programme? :p

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  • Agree to a large extent with 2:59. There was no selection for this list just a process of nominations. Is it any wonder that the picture was very much the same across the board when the list was put together by people picking those they saw as Top Leaders (usually those that were just like them)?
    However, is this just about the list or can this be applied to the selection of top leadership teams across the NHS? Is there still a lot of picking those 'just like me' and therefore diversity of thought, style, word, approach or deed is limited.

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  • Are we suggesting that people who have shot to the top of the NHS tree without ever having worked in the system and with no reality or connection to the people and services they are meant to be representing could possibly be over confident - and that those same people who sit in ivory towers with a belief that you need never step-out into the real world as everyone will come to you, and besides you might meet some of those awful patients, are being found as failng in their ability to inspire and are in fact demotivating others... well I never... who could have seen that one coming?

    Oh, and read 'rolling up their sleeves' as 'think they are always right and so take no direction from their more experienced staff whom they trample underfoot on their way to the top'...

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  • This is interesting stuff. Having worked at very senior manager level in the NHS my experience of most CEOs and Directors is that they are intellectually capable and good politically and good at networking. Where they are often lacking is the ability to create cohesive teams (management skils in this area are often near Klingon and encourage competition between direct reports and consequent tennis playing over accountabilities). Anyone who has ever done Myers Briggs for Boards will know that there are too many ENTJs and similar types and not enough diversity. But we need to remember that the fish rots from the head; the DH has always been a toxic place to swim and we should not be surprised when we fnid that the NHS' many local rock pools are similarly dysfunctional.

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  • i agree totally with Anonymous 2:59 am. And it in not just soar grapes. I looked at who was on the courses and it just made me sad.

    In my organisation those with the gung-ho attitude are the ones who push themselves to the top and sod any one else on their path.... no surpises here. It was no different in other NHS organisations i have worked at in the NHS.

    Sad but all very obvious.

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  • I always thought that its the American gung-hoism that all sectors wanted to emulate. The bullish attitude has become very acceptable in many senior management and the CEO who do not encourage this are seen to be weak.

    Leadership should be genuinely about hearts and minds not delusion

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  • I agree- 'leaders' in the NHS are not listening and are so worried about their own jobs, that they end up pushing colleagues out and having a 'I can/want to do everything'.

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  • 12.18pm - Absolutely spot on ... 'the fish rots from the head' ( cf Bob Garrett book of same name ). What is happening, practically speaking, in the system at the moment is that we are 'pouring old wine into new bottles'. There may be a few cases of vintage bottles of learning and leadership we would want to keep - but don't expect any real change from this leadership cohort ...' if you always do what you've always done, you'll always get the same' ( Mark Twain ... I think ).

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  • Agree with 11.51

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  • Looking at the comments being made so far, there is a danger in repeating what we see so much in the media now, which is the negative generalisation of a large number of people.
    There was always something curious about the nomination process for the Top Leaders programme and we all can think of people whose rise to the top is a triumph of ambition over talent.

    However, many of our senior leaders continue to be people who are in the NHS for real public service values and who are bending backwards to integrate the conflicting political and organisational priorities they are facing. They're not perfect and neither would we be in their position.

    What this article demonstrates again is that if the NHS develops and then treats its leaders with respect, many of the rest of us would notice the difference!!

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  • David Hooper

    What does it say about these nameless commentators that they can only be identified by the timre of the posting.

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  • Too busy trying to keep their jobs to do their jobs.

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  • The last two contributors miss the point - people who speak their mind in the NHS, even reasonably, find their career options closing down. My perception is that nearly everyone is working hard in terms of long hours but effectiveness is limited by culture and organisational processes. It really is obvious if you think about it - the last year has been disastrous for the NHS on almost every level - so managers are bound to be caught up in the mess and need to ventilate before getting on with the job.

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  • After ten or more years of mushroom management, why should we be surprised that we can only grow mushrooms? The DoH/NHS culture has been one of central direction, so many good managers have been effectively disabled. In 35 years of working in and around the NHS, I have never met as many demotivated peole as this year (at all levels) - so much wasted potential is a human tragedy.

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  • I believe that managers have been deliberately drawn into a trap by the DoH. The DoH required Senior Leaders to undertake the course/assessment or risk not being allowed to undertake a senior role within the NHS. Then virtually the entire managemnt is assessed as no longer suitable, but lo and behold the new GP pathfinders are seen as absolutely perfect. What a surprise. Be prepared for Stalinist type purges within the NHS.

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  • My experience of Senior Management is not "gung ho" at all. Rather they would prefer to defer/devolve/sit on a decision rather than make one. Hence why there are so many meetings/committees/groups in the NHS and why so much time is wasted.

    Apologies for being controversial but there need to be more men, particularly at Director level, employed in the NHS to balance the sexes. This is not sexist; too many of either sex is not a good thing!

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  • After ten or more years of mushroom management, why should we be surprised that we can only grow mushrooms? The DoH/NHS culture has been one of central direction, so many good managers have been effectively disabled. In 35 years of working in and around the NHS, I have never met as many demotivated peole as this year (at all levels) - so much wasted potential is a human tragedy.

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  • One line in the article is absolutely key -

    "What’s important is that isn’t the kind of leadership that’s going to deliver the results now or in the future" -

    this will be the epitaph of Sir DN's reign

    in the meantime, will keep my head down and my postings anonymous as otherwise the inherent NHS bullying machine will see me on its radar

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  • mike batt

    Why are NHS managers like this, hmm lets see:

    Real world CEO: I need you to make sure you get output up to 10,000 widgets
    Real world Director: Widgets are not a popular product, we would be better to make 2000 widgets and 8000 wodgets.
    Real World CEO: Ok, lets discuss this at products comittee and make a decision.

    NHS CEO: I need you to get production up to 10,000 widgets
    NHS Director: We need more wodgets than widgets. If we do more widegts we can't do any wodgets and patients need wodgets.
    NHS CEO: Listen the SHA are very concerned about our widgets, not our wodgets - so make more widgets, ok. I am concerned about your performance and so are the NEDs.
    NHS Director to staff: make widgets quicker NOW.
    NHS Staff: There is no point making more widgets, it doesn't actually help patients.
    NHS Director: I am concenred about your performance and attitude. I want an Widget improvement action plan and a monitoring sub-comittee set up.

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