Three decades after Roy Griffiths’ report heralded the end of “consensus management” in the NHS, collaborative leadership is making a comeback, argues Pete Thomond
“If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge,” wrote Roy Griffiths to the secretary of state for social services 31 years ago, before the adoption of his report introduced general management to the NHS.
‘Griffiths inadvertently conflated the terms leadership and management – a trend that continues today’
“We share the report’s view,” said the government at the time, “that consensus, as a management style, will not alone secure effective and timely management action, nor does it necessarily initiate the kind of dynamic approach needed in the health service to ensure the best quality of care and value for money for patients.”
The effects of the report are still felt today. Everyone, it would seem, is talking about NHS leadership and management, from CQC inspectors and the King’s Fund to NHS England chief executive Simon Stevens calling for more diversity in healthcare leadership.
But while Griffiths identified the right problems, he was wrong in taking aim at “consensus management”. Yes, he observed the failure of consensus, but this does not make consensus wrong. It’s just difficult to do well.
His work inadvertently conflated the terms leadership and management – a trend that continues today. So let us set the record straight.
‘The “them” and “us” narrative disempowers many NHS organisations today’
First, we must stop mixing the terms leadership and management, and in particular, stop acting like one is somehow better than the other. The best organisations I’ve researched or advised make a clear delineation.
HSJ’s Future of NHS Leadership inquiry
Management is a function that coordinates the actions of people to accomplish tasks, goals and objectives, while leadership is focused upon defining a desired future state and enlisting the aid and support of others to go on the journey.
Conflating the terms, as the government did in 1983, has led to a failure to recognise their vital and complementary functions.
Second, we should be clear that today’s complex organisations need everyone to play a leadership role. In the NHS, we regularly hear the word “leadership” used to describe people at the very top of hierarchies, while the layers below are “management”, with the rest being “workers” or the “front line”. This labelling has to stop.
‘Griffiths saw an NHS that talked about consensus management, when in fact what prevailed was nothing of the sort’
Recovering academics and pedants like me prefer more precise language, but more importantly, this labelling underpins the “them” and “us” narrative that disempowers so many NHS organisations today.
Moreover, the type of devolved leadership that cutting edge chief executives want and need today requires collaborative visions and goals that are genuinely shared.
This speaks to personal and organisational leadership, which in turn requires a feeling of consensus that everyone has had their voice heard in the process of setting their objectives.
The consensus myth
Rather than being ineffective, consensus is needed in the health service to ensure the best quality of care and value for money for patients and carers.
‘The best leaders today are cutting through the treacle of internal politics’
I would suggest that Griffiths saw an NHS that talked about consensus management, when in fact what prevailed was nothing of the sort. Instead, he saw the illegitimate influence of the sharp elbowed garnering support for their ideas wherever and however they could.
This inadvertently creates unresponsive organisations at best, or a tyranny of leaderlessness at worst. The consensus style is not at fault; it’s the processes that leaders have used that undermine its strength.
The best leaders today are cutting through the treacle of internal politics and the slowness of consensus building workshops and focus groups using digital tools.
The power of cleverly deployed social media style technologies with the right process and strategies is empowering leaders to crowdsource solutions to problems, create new visions, agree goals and objectives and design plans of action, fast.
This not only occurs in a manner that delivers consensus, but also in a manner that empowers everyone to take a stake in the leadership of their own organisations.
Rather than centralising leadership, these chief execs are using such approaches to make power equitable and allow everyone their share.
Today, more than ever, with the right technological tools and, critically, the know-how, crowdsourcing and approaches like it can facilitate the kind of leadership the NHS is crying out for. The leaders I work with bring back “consensus” in a way that creates an ideas meritocracy, not a slow, political quagmire.
Pete Thomond is managing director of Clever Together