Letters

Published: 07/03/2002, Volume II2, No. 5795 Page 23

Derek Smith's review of Leadership at Every Level (Books, 24 January) crystallises many points about the perceptions of leadership requirement in the NHS which need further exposure and debate.

David Spratt's letter in the same issue ('No sign of 'risk taking' in the appointment of 'standard' managers') reflects a perception of leadership requirement which currently has little substantiation, but seems to fit well with a general perception that the NHS requires entrepreneurs and risk-takers.

In general terms, research in leadership attributes, skills and kindred matters tends to suggest that transformational leaders see their world in outcome terms, while managers (often exhibiting transactional attributes) see their world in process terms. There is ample evidence to show the NHS is process-driven with overt targets, some aims, but ambiguous purpose.

In its current manifestation, the NHS is not an organisation in which people with transformational characteristics can thrive, despite research evidence showing that staff identify a need for transformational leaders.

Derek Mowbray Business school Gloucestershire University