The NHS's masculine style misses out on female strengths, leadership experts argue. They want to see a new breed of 'hybrid managers' batting for the health service. Carol Harris reports

Brace yourself. The truth is that men and women are different.

In a new book, The X and Y of Leadership , two experts in leadership training define the different leadership styles of men and women and offer a hybrid model leader for the future.

Authors Liz Cook and Brian Rothwell draw heavily on their own and others' research to support their conclusions. Their findings suggest that institutions such as the NHS, apparently eager to break through the 'glass ceiling', have an attitude problem.

Male leadership, they argue, is risktaking, focused, task and action-oriented. It is concerned with vision, inventiveness, structure and form, competitiveness and challenging the status quo.

But the classic female style values dialogue and emphasises listening, coaching, interpersonal skills, appreciation of paradox, group working, multi-tasking, and appreciation of detail, Mr Rothwell and Ms Cook say.

They argue that part of the reason is chemical: men's brains have higher levels of serotonin and testosterone which makes them more inclined to take risks. Physiological differences give men better hand-eye co-ordination and spatial awareness. The two halves in their brains work alone and sequentially.

It is why most gamblers and derivative traders are men and why even in the sexually balanced world of gardening, only men compete to grow the biggest onions.

Women have fewer brain cells but use them more efficiently, the authors say. Their brains are physiologically better for listening, working intuitively and making connections.

Women therefore find it easier to accept an unstructured discussion with no clear conclusions; men want debates.

Women respond flexibly to their environment, say Mr Rothwell and Ms Cook, while men justify their actions through rules - no-ball and legbefore-wicket in cricket and the offside rule in football.

But during education and in career choices, the differences are only partly due to biology. Social and structural boundaries are also powerful factors and that is the NHS's problem.

Structurally, the NHS is in the 1970s, when the typical leader in the UK was male. The accepted paradigm was 'action-centred leadership', developed by John Adair at Sandhurst in 1964 and itself derived from the Second World War command and control model.

'The NHS, like most large bureaucratic structures, has substantial elements of command and control, part of a solid bedrock in masculine style - an environment that emphasises the 'only' way and the 'correct' approach, ' says Brian Rothwell.

'Paradoxically, its main purpose is caring, and the caring professions within it are predominantly female.

But the way those professions operate is not always female.'

Uniforms, he points out, are symptomatic of a heavily masculine style professionally and institutionally.

Liz Cook says: 'The NHS is still very hierarchical and archaic in its decision-making; it plays to the strengths of the traditional male style.

'So men predominate at senior levels and the organisation does not recognise the strengths of more typically female styles.'

In the UK during the 1980s, women progressed up the career ladder. They did so largely by imitating and emphasising a masculine style of leadership.

Power dressing, long hours and an emphasis on rules and order were the mark of the 1980s manager, male or female.

By 1990, the paradigm was becoming feminised: empathy, emotional intelligence, self-awareness and persistence became important. No quick fix, no checklists. Organisations were motivated by ethics, values and beliefs.

Principle-centred leadership was the thing. It meant leading from behind, making choices, not decisions, and '360 degree appraisals' - where a manager is appraised by their staff and colleagues as well as their own manager.

But for all that, women today occupy only 10 per cent of the top jobs in the UK, and the health service - despite a predominantly female workforce - has not given a lead.

Ms Cook and Mr Rothwell argue that two factors will dominate working lives over the next five years, making the in-built strengths of both sexes essential to success.

The first is speed: the worldwide electronic network transfers money at the rate of $40bn a minute so the gap between requesting products or services and receiving them has reduced markedly - and our expectations increased.

The other factor is connectivity.

Mobile telephones, voicemail, e-mail and the Internet mean that people are routinely connected beyond barriers of time and distance. 'We must have permission and encouragement to be ourselves, ' says Mr Rothwell.

'We need to appreciate how the opposite sex works and acts in situations; our own way of looking at the world is not the only world available to us. We need to use differences when the situation requires, to identify our own shortcomings and use the strengths of those around us.'

Ms Cook says: 'We need speed and connectivity, we need people to show initiative, we need flexibility and the capacity for urgent action.'

Individuals in the NHS regularly demonstrate these qualities but the institution does not value them, even though to do so would make life easier, says Mr Rothwell. 'The move to community-based services is part of a new, holistic approach. The more female style will be better structured to deal with this.'

The NHS must be better connected to the outside world, better at dealing with paradoxes, more flexible and able to use flattened structures internally and externally and to act quickly.

Patient complaints are another example: those focusing on procedure are less likely to be resolved than those in which the complainant feels they are being listened to and action follows rapidly.

Patient involvement will become more important, Mr Rothwell says. 'As in local authorities, the quality of decision-making has a lot to do with the level of involvement of the people who are represented.'

The more service users are involved, the better the quality of services.

Family-friendly policies and other staff initiatives are good but 'the hybrid leader in the NHS will have to deal with what is still a deeply hierarchical structure', Ms Cook says.

She argues that the best way to develop tomorrow's leaders is demonstrably to encourage and value diversity through to the top levels of the organisation. That way, the NHS will ensure services are of the highest quality.

'We can be different and equal, ' Mr Rothwell concludes.

Cook L, and Rothwell B. The X and Y of Leadership . Published by the Industrial Society,£14.99.

A woman's place is. . .

Women now occupy more than half of all 'administrative manager' posts in the NHS, according to the most recent figures issued by the Department of Health.

Though the official statistics give no breakdown by seniority, they show that women hold 52 per cent of such jobs compared with 79 per cent of the health service's nonmedical workforce as a whole.

By contrast, figures compiled by the Institute of Management show that women form 51 per cent of the UK workforce, 18 per cent of managers and 3.6 per cent of directors.

There are 10 women among 600 FTSE 100 company executive directors.

At the beginning of the 1990s, 7.9 per cent of managers and 1.6 per cent of company directors were women.

NHS Hospital and Community Health Services Non-Medical Staff in England: 1988-98. Institute of Management