Published: 07/03/2002, Volume II2, No. 5795 Page 26 27
The government is committed to a greater role for the private sector to provide and run health services. Speaking to the New Health Network in January, health secretary Alan Milburn said the management of local services experiencing persistent problems could be franchised 'not just to another public health sector organisation' but to 'some other external management team'. So how would private sector managers fit within an NHS organisation?
The issue of failing trusts raises questions about the quality of management and leadership in those organisations and whether such trusts should be taken over by private sector managers.
Research at Leeds University throws some light on these questions. The stereotypes of the private sector providing a 'sophisticated' and 'dynamic' model of leadership, and the public sector a 'traditional, unsophisticated, and quiescent' style, persist. Is this an accurate picture?
Last year we completed a large investigation of leadership in the UK. This involved 3,500 public sector managers, of whom 2,000 were in the NHS, and 600 private sector managers in manufacturing, finance, telecommunications and service industries.
The NHS managers were at the middle to top of their organisations and came from health authorities and acute and community trusts in England, Wales and Scotland.
We were looking at transformational leadership - the kind of leadership that increases motivation, performance and effectiveness, and gives the workforce a greater sense of efficacy.
1The dimensions of leadership seen as important by the two sectors were remarkably similar. These were concern for others; approachability; encouraging questioning and promoting change;
integrity, charisma and intellectual ability;
the ability to communicate, set direction, unify and manage change.
But in interviews with managers and professionals at all levels in the organisations, those in the public sector cited integrity much more often than their counterparts in private organisations. This may be regarded by many as unsurprising.
Public sector managers also seemed much more aware of the need to be sensitive to the organisation's various stakeholders. Despite the strongly held belief that the private sector acts as an example to the public sector in this regard, we obtained clear evidence to the contrary.
This aspect of leadership was mentioned with regularity by the managers and professionals we interviewed in the NHS and local government. It was far less frequently cited by managers in the private sector organisations.
Our research also looked at how effective managers in the two sectors were perceived as being. The valid measurement of managerial effectiveness, and leadership in particular, is a notoriously difficult subject.
Psychologists have long struggled to develop methods for accurately predicting future performance of individuals, or of their teams.
Recent literature, however, offers some suggestions.
US psychologist Robert Hogan has summarised the findings from the research literature.
2He says that a superior's rating of a manager's performance primarily reflects the manager's technical competency rather than the performance of their team, and that peer ratings are probably swayed by politics.
But subordinates' ratings of a manager's performance are reliably correlated with team effectiveness.He concludes: 'We believe subordinates' ratings are the best single way to evaluate a manager's performance.'
We obtained the anonymous ratings that individuals made of their immediate boss, and collected comparative data along the dimensions of transformational leadership, listed above, which are common to private and public sector managers.
In both cases, the ratings were anonymous, and were made by a roughly equal number of male and female managers. There were 2,000 respondents from the NHS and 400 from the private sector.
Managers in the NHS were rated by their immediate subordinates or by direct reports significantly more highly than their private sector counterparts in terms of interpersonal skills and intellectual ability and also on managing change and entrepreneurial approach - the dimensions strongly associated with the private sector.
A second facet of our research was predicated on the belief that, with appropriate help and guidance, many aspects of leadership can be learnt and developed.We developed two diagnostic instruments - one for use in the public sector, the other in the private sector - for assessing the behaviour and qualities of transformational leadership and proposing specific courses of action to increase a leader's effectiveness.
To test the validity of the transformational leadership questionnaire, we included 10 'leadership impact measures'.The respondent is asked to rate their immediate boss's leadership behaviour in terms of the effect of their actions and leadership style on a range of psychological outcome measures. Such measures are identified in the literature as having a significant effect on behaviour and performance, and include increasing self-esteem, motivation to achieve, job satisfaction, job commitment and reducing job-related stress.
Analyses of our data established clear predictive links between leadership scores on the 12 dimensions, and a positive impact on all of the psychological outcomes.Given our findings, it is important to recognise that low scores on the 12 dimensions of transformational leadership will have a deleterious effect on morale, cause de-motivation, increase job-related stress and decrease performance.
One implication of our results is to counsel caution in the adoption of a private sector style of management.Our findings also show the need for central government initiatives, such as the NHS Leadership Centre, and initiatives at regional and trust level.
The good news is that new resources have been invested in the NHS, though it will take time before this will deliver in terms of patient care. Let us not be tempted to revert to a more directive managerial style, which may achieve some short-term gains, but create even greater problems in the longer term, and at the cost of staff goodwill and health.
Clearly, one great need within the NHS is for more capacity within the workforce, especially among clinicians.However, another great need is for a skilled workforce to be managed - and above all to be led - effectively, efficiently, and with humanity, particularly at a time when considerable change has to be managed.
As noted, the kind of leadership that is required is transformational leadership, and the evidence we have gathered suggests this is most highly developed among managers who come from the public, not the private sector.
Beverly Alimo-Metcalfe is professor of leadership studies at Leeds University.
Dr John Alban-Metcalfe is a principal lecturer at Trinity and All Saints University College, Leeds.
REFERENCES
1Alimo-Metcalfe B, AlbanMetcalfe R. Heaven can Wait.
HSJ 2000; 110(5726): 26-9 2Hogan R, Hogan J.
Assessing leadership: A view from the dark side.
International J of Selection and Assessment 2001; 9(1-2): 40-51.
Key points
A study of private and public sector managers, including 2,000 from the NHS, revealed consensus on the qualities of an effective leader.
These included: concern for others, approachability, intellectual ability, communication skills, charisma and the ability to unite people.
Integrity was seen as particularly important by public sector managers.
Public sector managers were rated significantly higher by their staff than those in the private sector.
The results point to the need for caution in introducing private sector managers to the NHS.
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