‘Command and control’ leadership still ‘has a place’, say top trust CEOs

They were speaking at a roundtable to mark the publication of the HSJ’s annual ranking of the NHS’s “top 50 trust chief executives”. The list, which is sponsored by KPMG, was topped by University Hospitals Bristol and Weston boss Eugine Yafele.

The judges had made a point of selecting those CEOs whose leadership appeared to mark a break from the more directive approach favoured by trust leaders in the past.

However, Mr Yafele told the roundtable: “I don’t want to demonize control and command. It has a place.

“The challenge of leadership is knowing which lever and which approach to use,” he added “There are times where you say, come on, guys, hunker down, this has to happen, and it has to happen now.”

Steve McManus, the chief executive of Royal Berkshire Foundation Trust, took “direct offence” to the use of the word “gentler” in the judges’ description of the new breed of trust chief executive.

He said he feared it sparked off a chain of association which ran “gentler to soft, soft to weak, weak to lacking accountability”.

Despite having been “on the wrong end” of “toxic and inappropriate” leadership” which had led him to question whether he had a future in the service, Mr McManus said there was still a “time to be directive”.

He pointed out that in the world of integrated care systems and provider collaboratives that might mean being “directive to our peer colleagues within a system. We’re all in this together now in many ways and we have to hold each other to account.”

Matthew Trainer, the chief executive of Barking Havering and Redbridge Trust, told the roundtable: “I don’t think command and control is inherently bad.” He said problems arose when leaders did not “delegate suitable authority” having made a decision.

“If you take a decision and say crack on with this, [but then] don’t allow them to make decisions without running them past you”, problems emerge, he said.

Frimley chief executive Neil Dardis said “command and control” and “compassionate leadership” could “come very much hand in hand”.

Birmingham Women’s and Children’s Hospital chief executive Sarah-Jane Marsh said it was “a complete myth”, that supportive leaders could not also be challenging ones.

“The people who are more supportive, [who] focus on the culture, are the people who are more likely to have proper difficult conversations and challenge [others]” she said. “Shouty” leaders, she added, tended to go “sliding on the surface” of an issue.

“Some of these people [the new breed of trust CEO] will be the most challenging people in the NHS, but they wouldn’t be necessarily going around and hitting tables or throwing things or various other things that one may have encountered.”