NHS Leadership Spring Debates: Collaboration

5 March, 2010

Should NHS organisations develop leaders for the whole NHS collaboratively or focus their efforts on their own future leaders?

The NLC is complementing the work on leadership development at a regional level by establishing national programmes and initiatives, for example on board development and top leaders, where there are economies of scale or added value in developing national cohorts.

Some organisations point to past weaknesses in national approaches

However, some organisations point to past weaknesses in national approaches, stress that an important current principle is subsidiarity, and argue that there will be far more success if organisations focus on developing their own future leaders, many of whom will inevitably move onto other organisations.

It is suggested that national programmes make it easier for organisations to opt out of their own responsibilities.

Others suggest that we need to develop leaders who understand the whole system and that those who have worked and trained only in one organisation or in one part of the sector offer far less to a potential employer.

Post your comments below or email them to hsj.co.uk@emap.com

Readers' comments (17)

What do you think?

Anonymous | 9-Feb-2010 9:47 am
The NHS should be developing all its staff to their full potential - and those who exhibit exceptional leadership should be encouraged and nurtured. It can only be to the benefit of the whole NHS economy if those with leadership potential are able to benefit the wider economy.
Anne Axford, from Linkedin
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Anonymous | 9-Feb-2010 11:07 am
One of the cultural issues for the NHS is that there is the notion that leadership development is a separate activity, and not part of the bloodstream of NHS management, topped up by constructive experiences to enable individuals to grow their skills, knowledge and experience as leaders. If it was culturally accepted that everyone has potential to lead then there wouldn't be the issues of unfairness that some places invest more than others and may lose the ROI. It would be part of the routine for all managers that their CPD had to be met each year for them to continue as managers.
Derek Mowbray, from Linkedin
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Anonymous | 9-Feb-2010 10:03 pm
Collaboration is about working together towards a common goal. There is no doubt in my mind that leadership development should be open to all staff groups in the NHS so that they are able to make the decision whether they want to take up the opportunity or not. It should be a collaborative decision rather than one that is open only to the select few.
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Derek Mowbray | 10-Feb-2010 9:04 am
The NHS is currently an ambiguous organisation without a clear purpose, and without a clear architecture. It is difficult to equate it with a federated organisation or franchise. Therefore, the idea that leadership development is a national activity is likely to create the attitude of abdication at the local organisational level, with local organisations developing their own ideas, based on their own perceived needs. This runs into difficulties as well, because the NHS culture has massive incentives for self interest now, and is generally managed at level 2 rather than levels 1 and 3, making the whole approach to leadership short term and devoid of future scanning, and effective person management. There are several ways to deal with this. One is to bring back the old idea of regional staff officers (calling them something else) who scanned the workforce and responded to its development needs by promoting the necessary development activities. This, combined with a Centre for Wellbeing and Performance that implements The Manager's Code - Putting People First - will give impetus to developing skills at levels 1 and 3 and provide consistency over a longer period of time. These two ideas combined with a perspective that embraces the whole of the healthcare industry (public, private, charitable, overseas, educational sectors) as a learning and development mosaic will provide the practice experiences necessary to develop all levels of skill, knowledge and experience, so long as triple loop learning is applied in practice. So, to summarise - local organisations have to look after their own development; region wide staff officers scan for their region and promote region wide development within the framework promoted and delivered by a Centre for Wellbeing and Performance, which will use the whole of the healthcare industry as a learning and development organisation. Finally, role models are essential. Local organisations need to be able to negotiate secondments for all eligible staff to work with role models. Such models will need to meet the criteria of level 1 and 3 working as set out by the Centre for Wellbeing and Performance. Level 2 skills are currently being taught all over the place, and nothing further needs to be done to make these more widely available.
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Anonymous | 10-Feb-2010 1:34 pm
Developing leaders for the NHS as a whole. Funding should be central and organisations recognised for taking on managers/supporting their own managers during leadership development eg. providing mentorship and placements. Organisational awards could be built into any of the miariad of performace reviews in which they have to participate.
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Anonymous | 15-Feb-2010 12:11 pm
I do not think that specific staff groups should be targeted for leadership development. Organisations that produce the outstanding leaders should be. There are particular NHS organisations that have historically produced well rounded, capable leaders. Perhaps it would be sensible to focus on these organisations and ask what they do differently to others.

Is it unfair that they invest "their" money in developing these leaders that benefit other parts of the NHS?

It could be viewed as unfair that their budget pays for a leader who then goes on to make numerous cost savings in another NHS department or organisation. However tax payer funds and tax payer benefits.

What needs to be worked out is how the organisations that produce the outstanding leaders produce more of them and how the overall NHS should benefit from this.

Simon Marcer, from Linkedin
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Anonymous | 15-Feb-2010 2:54 pm
This is one of the unintended consequences of the financial system we have in the NHS. The position we find ourselves in is little different from that in other sectors of the economy. In many sectors collaborative mechanisms - often brokered by Sector Skills Councils - are in place to work on leadership development. When completing the calculus people always under value the extent to which they benefit from investments by others.

Eric Galvin, from Linkedin
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Anonymous | 16-Feb-2010 9:44 am
I think the main issue in the NHS is not one of leadership, but of understanding the NHS from the bottom up. There are so many leaders in the NHS who have come from outside the NHS, who in turn have to learn, adapt and make decisions based on previous experiences, which detaches them from the fundamental issues in patient care.
Paul Jones, from Linkedin
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Kate Gleave | 16-Feb-2010 10:00 am
I think there needs to be both national development programmes and support at individual organisational level. Most of the organisations I have worked for have recognised the importance of developing future leaders (often through individual managers' support rather than organisational approach). However, in all of these organisations there have been limited or no opportunities to progress within the organisation. Thankfully, managers have been happy to support me and others to develop, whilst recognising that the likely outcome is that we will leave as a result to further our careers elsewhere in the NHS.
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Anonymous | 17-Feb-2010 1:05 pm
I think leaving to work in another part of the NHS can be a good thing as it may help to develop systems thinking.

Elizabeth Solaru, from Linkedin
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Anonymous | 18-Feb-2010 12:00 pm
I doubt the possibility of producing generic NHS leaders. To begin, the NHS has at least two types of organisation - the foreground characterised by chaos, and the background characterised by bureaucracy. In the foreground organisation, where the delivery of services to patients occurs, a role of leader is attractor, the central calming role whilst all around her is chaos relating to the nature of patient care - the uncertainty, spontaneous, eclectic responses to a patient - whilst in the background organisation there is a focus on the transactional aspects of leadership - systems, records, compliance, regulation, accounting. Often the background organisation seems to adopt a superior hierarchical position to the foreground organisation - generally a recipe for low achievement and poor standards - thus elevating the transactional role over the adaptive role needed in the foreground. We can see the results of this with a focus on background issues, such as compliance with accounting or not meeting targets, and not on foreground issues , such as successful treatment for over 1 million people a day. These two organisations require different leadership abilities in certain respects, although the same abilities in their behaviour that promotes commitment and trust. Unhappily, some successful leaders in the foreground organisation seek promotion to organisations in the background, which requires a different style. Little wonder that there are vacancies at critical points on the ladder as there is an expectation that people will want to climb the ladder, rather than an expectation that we need leaders of different styles for different purposes.
Derek Mowbray, from Linkedin
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Anonymous | 22-Feb-2010 10:43 am
Where a leader needs to initiate a paradigm shift in the organisation's life then this may make the leader unpopular with staff. This links back to the original question should a leader be sanctioned if the staff experience in a Trust is low? The answer may be no if the leader is trying to initiate a paradigm shift as change is often unpopular and will be reflected in staff experience being low. In this case staff experience being low may be an indicator of good leadership! At what point however does the answer become yes and the leader sanctioned because staff experience and performance remains low. Is low staff experience a robust indicator of poor leadership?
Brett Wright, from Linkedin
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Anonymous | 22-Feb-2010 10:48 am
Leaders need to understand that in an era of competition (between provider organisations) that a collaborative approach isn't necessarily a non-viable strategy. In fact, given the economically bleak outlook for the NHS, collaboration may be an essential method of not only reducing cost but also a viable way of ensuring continued competitive advantage. This can be done through innovative partnerships that keep patients and referrers engaged with your services and - unless a national direction is given to work as a unified NHS with no competitive element between organisations, which is unlikely - then the leadership challenge surely, is for organisations and their leaders to collaborate effectively, in order to survive and thrive ? I am surprised to date that explicit reference to this type of approach, with practical examples, hasn't formed part of any NHS Leadership text or development programme I've come across - although perhaps I've been looking in the wrong place ? When undertaking some research over recent years, I Googled "Co-opetition" - I found some interesting stuff that personally, I think may now be of real relevance to NHS Leadership development.

Darren Leech, by email
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Anonymous | 23-Feb-2010 10:55 am
No one can stop anyone from leaving the NHS. It is healthy to have leaders going out from NHS and also new blood coming into the NHS.

Mary Shek, from Linkedin
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Anonymous | 23-Feb-2010 1:10 pm
All too often I am met with limited vision and thinking by people who have been in the NHS all their lives. This lack of vision is demonstrated in the discussion above thinking that moving in and out of different NHS organisations is a change. Having worked in a number of NHS organisations, I find them worryingly similar. I think there's greater value in potential leaders having experienced a wider range of employers than NHS organisations which although vary with management styles of their leaders, perform roughly the same function - all PCTs and all hospitals are broadly the same. Try thinking outside the NHS for a while - it might open your eyes.
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Anonymous | 1-Mar-2010 1:34 pm
Having worked in a large acute trust for several years at Senior Mgmnt level and also having worked as NHS management consultant; with a further 15 years in the private sector - I now view the problem as very clear. Trust board membership recruitment is still not based on proven ability & suitability; the DOH needs to put robust recruitment processes in place for directors that are independant of the individual trusts. Giving a 90K job to any Tom, Dick or Sally who is 'safe' will never ever work.

The Project Manager
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Helen Mee | 10-Mar-2010 4:32 pm
There also needs to be engagement with the local and national educational establishements to provide adaptable training and learning for future development. There must be a shared process that validates a course no matter where and who delivers it, and clear guidance on the value for those that complete. I am keenly aware that an MSc is a 'valued' learning path, but having invested time in 1 that was way below my needs, I have wasted that opportunity.
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