'Changing people's behaviour when they have been in the same job for years is one of the hardest things to do. Safer patient initiative teams now think less in terms of 'why won't he do that for me?' and more in terms of 'how can I get him to do that for me?' '



The Health Foundation is field-testing a leadership theory that has been in circulation for a number of years.

'Shared leadership works on the principle that teams work together more effectively to deliver high quality patient care if all members assert their individual leadership qualities. This does not mean no-one takes ultimate control but, if the team leader has a day off or moves, that the team continues to work effectively. The days of naive reliance on a single hero who can supposedly solve everyone's problems are over.

This approach seems like common sense and other industries have embraced it successfully. So why are healthcare professionals struggling with this seemingly obvious solution?

One of the simple answers to why the NHS hasn't embraced shared leadership is because of time. One medical director recently told me: 'We're so busy, we just tell people what to do.'

However, there are also in-built cultural factors that are hindering its uptake.

Traditionally, hospital leaders are expected to provide all the answers. Equally, there is understandable reticence for more junior members of staff to question their senior colleagues if they feel their questions will be interpreted as negative. For example, one hospital involved in our shared leadership work has found that measuring respiratory rates after all operations can help reduce the number of crash calls. But it wasn't until the measurement technique was implemented that one nurse had the courage to say, 'I've always wondered why we didn't do that here.'

Influence colleagues

The clinicians and managers involved in our safer patients initiative have been learning how to influence colleagues and to make patient safety everyone's responsibility. Changing people's behaviour when they have been in the same job for years is one of the hardest things to do. Safer patient initiative teams now think less in terms of 'why won't he do that for me?' and more in terms of 'how can I get him to do that for me?'

Furthermore, the teams are encouraged to find their own solutions to problems and the team leaders are prompted to say 'how can I help you?' not 'how can I do that for you?'

I recently heard a nice example of this from NHS Tayside. A young medical student on rotation was encouraged to develop a better form for recording anti-coagulation rates. She stepped up to the challenge and tested the new form with her senior colleagues. They helped her to revise it and the result was a better form which she will now take with her to use in other parts of the hospital. She afterwards said that the experience had been unexpectedly empowering.

Making the culture shift to shared leadership cannot happen overnight. However, our teams have been working very hard over the past two years to make small but important changes. We are seeing tangible benefits for patients which confirm that leadership development is for all members of the team, not just for the senior management.

Stephen Thornton is chief executive of the Health Foundation