Viewpoint: 'To drive up quality we must release diverse leadership talent'
The NHS needs high quality leadership to deliver high quality care for patients.
Leadership development is not an end in itself; it is about improving the service we deliver - it has a purpose.
The solution has to be to take positive action to ensure we get the diverse leadership talent we need
We need maximum creativity to drive up quality and we must release all the diverse leadership talent available.
We know that diversity is one key to success. CBI president Helen Alexander describes the most successful boards as those that are the most diverse.
We know from Erhardt et al in their review of corporate governance that diversity is positively associated with financial indicators of firm performance.
Such diversity prevents the likelihood of “group think”, which minimises conflict in order to reach consensus but can result in reaching hasty, irrational decisions because there has been no critical thinking, analysis or evaluation.
Hart, in his study of small groups and policy failure, identified group think as “one of the causes of major fiascos in foreign policy, large planning projects and strategic management”.
Is there a similar correlation between diversity and patient safety? A possible analogy may be the safety issues associated with the Challenger space shuttle disaster. While a physical failure caused the calamity, group think was a contributing factor, according to the presidential commission report into the explosion.
If we accept the need for diverse leadership and accept that the talent pool is not diverse enough, we need to ask why, and what should be done.
The answer to the first question is that it is a human response to appoint “mirror images” of oneself and so we end up with a very homogenous group of leaders.
And because of group think, the board or management team feels cohesive and likely to deliver results because they are “all going in the same direction”. For this, read “limited independent thinking” and reduced creativity.
The solution has to be to take positive action to ensure we get the diverse leadership talent we need.
We need to identify what groups are under-represented in leadership roles and give them the confidence and competence to take these roles on - although success in appointment must be down to merit.
A specific example is my work with the 12 allied health professions. Different clinical settings bring different perspectives and, while ensuring all clinical leadership programmes are now opened up to all clinicians is a step in the right direction, such an under-represented group as allied health professions does require positive action.
The allied health professions leadership challenges are aimed at raising their profile as leaders and provide them with the confidence to translate their clinical skills in analysis, diagnosis, problem solving and the ability to motivate, into leadership.
There is also the issue of clinical roles at board level that limit which professions can sit on the board. If we limit ourselves in such a way, what is the impact on improving the quality of patient care?
The solution is confident and competent clinical leaders, whatever their background.
References
1. Erhardt, N.L. et al, Corporate Governance: An International Review, Vol 11, pp. 102111, April 2003
2. Hart, P., Groupthink in government: A study of small groups and policy failure, pp318, 1990
3. Rogers, W.P., Report of the Presidential Commission on the Space Shuttle Challenger Accident, 1986
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Readers' comments (4)
Anonymous | 8-Mar-2010 10:18 am
I am responding to this article in this week’s issue of the HSJ, which seeks to encourage debate on the merits of positive action in driving leadership capacity and capability. Nobody wants to feel that some are favoured more than others which is the risk of positive action initiatives. However, the current system for career progression is far from transparent and existing levers to drive quality in leadership capability e.g. appraisals & PDPs are not systematically and routinely used and followed through in the NHS and therefore it is very challenging to objectively determine the role that merit and enthusiasm has on career progression, or the performance of organisations in their willingness and ability to develop people’s leadership aspirations as these are not often captured.
In the absence of such transparency in development opportunities and an absence of accountability in organisations, positive action is an imperfect but necessary action towards levelling the playing field, contributing to the redress of disciplinary cases, bullying and harassment often in BME staff, giving hope to many who are living with the resentment and frustration of unfulfilled aspirations, but often do not have the opportunity to express this in a way that this will be heard and acted upon.
In short, the playing field is not level- any hope in this is currently misplaced, and continued rhetoric urging that it should be a level playing field does nothing to ensure that this is a reality, in the absence of robust accountability currently in place with other targets the NHS is required to meet. Let us also not estimate the role and power of networks in progressing one’s career. Networks are usually by nature exclusive as they are not available and accessible to all- further evidence that opportunities are not equally available to all.
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Richard Evans | 11-Mar-2010 12:43 pm
Will leadership "cream" rise to the top in the NHS? Experience says that this is unlikely or at best unreliable. There is too much in the way in terms of territorialism, lack of imagination and sheer obstructive practice.
"Positive Action"is necessary not only in selecting individuals for development to ensure diversity to match the society we serve and in allowing access to individuals from the full range of clinical backgrounds but also to ensure that those parts of the NHS which are mired with self-interested, incompetent middle management are dealt with in order to free the potential leaders that are being suppressed. Latent talent is there. Releasing and developing it is essential. Doing nothing about those who fear or (worse) actively manage against leadership talent is scandalous.
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Derek Mowbray | 18-Mar-2010 5:44 pm
I am sceptical about the notion that diversity is an antidote to groupthink - it may be, but a diverse leadership in the inhibiting culture will produce the same inward focus as a less diverse leadership. Groupthink is the blocking out of fresh information, a corporate closed mind, that needs prizing open. Once on the inside as part of the leadership, even a diverse leadership, the danger of groupthink exists.
This comes down to the fundamental contrast between people looking inwards (normally initiated by psychological distress) and people looking outwards (normally initiated by quisical confidence). Self interest dominates the NHS culture currently and this leads to inward looking self preservation and groupthink. Getting into the spiral of despair and changing it is complicated as those who lead are within the spiral of despair without, necessarily, understanding this because they are already suffering groupthink. The most likely force for change will come from the professional organisations, but they are finding it hard to remain professional in a hostile environment - and there cannot be anything more hostile than the Legal Services Commission halving fees paid up the year ago and approved by the Courts, for example, and now not being able to pay the March fees because of running out of money -an example of a government service not supporting professionals. The threats are real.
It is going to take some hugely robust and resilient individuals to bring a change to the groupthinking NHS - people with a passion for the highest standards of care to others, and people with a passion to make the NHS brilliant once more. Who these people are and how they can be motivated to act is the serious question.
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Anonymous | 26-Apr-2010 10:54 am
I do not agree that positive action is needed to allow diverse leadership talent from under-represented groups to grow.
Leadership is about inspiring confidence. NHS leaders therefore need to have a proven track record and clear-cut formal qualifications which demonstrate their ability to do the job they are being asked to do.
Giving under-represented groups in leadership roles "the confidence and competence to take these roles on" will not inspire the confidence of those being led and will therefore cause dissatisfaction and resentment.
Yes, by all means target minority groups in education, advertising and recruitment (which is likely to be a long-term project). However, appointment to senior leadership roles should only be based on solid evidence of the person's ability to do the job.
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