The NHS plan promised a change in the quality of leadership. Carole Doherty reflects on the practicalities of achieving that ambition

What is leadership and how can it be developed? The NHS plan promised 'a step change in the calibre of NHS leadership' and there is no shortage of interest in the subject.

Competition for the King's Fund national nursing leadership programme is intense - there are around 250 applications for 20 places. The course is designed to develop future nurse leaders by emphasising personal impact and learning through experience.

The two-day interview process includes a standard interview, observed group work, essays and a presentation. The course consists of eight modules and a series of action-learning sets over two years.

Self and leadership was the theme of the first module. Participants were asked to consider 'tame' problems - those with solutions - and 'wicked' problems - those to which there were no easy answers and no easy way of measuring success.

The NHS is characterised by 'wicked' problems such as infinite demand and finite resources creating conflicting priorities and conflicts of ethics. If the NHS aims to deliver the greatest good for the greatest number, for example, it will most likely be at a cost to individual patients.

Another wicked problem is political shorttermism. The NHS is like a tree blown in the wind of the political ideology of left and right, and politicians tend to distance themselves from difficult issues about resource allocation. All this makes for a complex working environment where frontline staff can find themselves blamed for organisational failings.

And then there is the most fundamental question of them all: how do we measure success?

The King's Fund course invites participants to think about these problems and the leaders' role in building an organisation where staff can create the warmth and energy to nurture new possibilities through the contradictions. Knowing one's personal values and beliefs is essential as this gives the framework through which the individual can relate to others in the decision-making process.

During one module the group deliberated on personal identity through the experience of nursing. We discussed the significance of having 'nurse' incorporated in job titles if the individual is a manager. The discussion highlighted the invisibility of nursing, except at times of recruitment crises, and its resonance with women's traditional role. Stereotyping of nurses as angels or battleaxes persists, leading to poor understanding of the variety and complexity of the job.

Another part of the course, which took place out of doors, involved dividing the group into teams and giving members the task of collecting as many clues as possible, each having money attached, within a set time. I went searching, with another participant, for the most distant clues that carried the largest reward. We used a mobile telephone to communicate the clues to the team members back at base. But communication failed and none of the hard-earned clues counted. Mastering communication is probably the single most important determinant of success in leadership.

The task was intended to be competitive and we rose to the challenge. Is there a place for competition in the NHS? During the Thatcher years, the imposition of the internal market encouraged competition within the service. Now, partnership and co-operation are the buzzwords.

Arguably, competition serves a purpose in creating a shared identity.

Identity and diversity are at the heart of effective leadership, and the course encouraged thinking about their interaction, which is so often the cause of conflict. It presented eclectic opportunities for learning how these concepts can be harnessed by effective leadership to create the conditions in which the best in human nature can thrive. If, as health service staff, we choose to look outside our own borders, we can learn much from the experience of other people managing wicked problems of a different hue: and thus one can learn about oneself anew.

As the poet TS Eliot said: 'We must not cease from exploration and the end of our exploring will be to arrive where we began and know the place for the first time. '