Junior health minister Lord Darzi’s interim report on the future of the NHS highlights the importance of effective leadership and stable contexts for service improvement. It would be tragic if we missed this historic opportunity to make the best use of our current understanding of leadership and leadership development.
A recent HSJ survey understandably focused on middle management as the crucial interface between senior management and clinicians. That is often where boards point leadership programme developers too. My experience of running middle management development programmes is that the participants very soon let you know how their behaviours are being constrained from above.
Professor in leadership studies Beverly Alimo-Metcalfe suggests that the best leadership is rarely found at the top of organisations. It is distributed within complex systems, and the leadership required depends on the task and the stage of development of the organisations involved.
For example, Russell Mannion’s work on culture and performance in trusts highlighted the importance of a top-down style in the early stages – clarifying expectations, lines of accountability and performance management. But he foresaw negative longer-term implications for such an approach, suggesting that once the required performance had been achieved a shift to a more participative style may be required.
Increasingly leadership is seen less as something to be developed by creating better quality human beings and more as something that emerges from everyday interactions involved in achieving service improvement. Most of these interactions take place in teams.
According to the Healthcare Commission’s annual staff survey nine out of 10 health and social care staff say they work in teams. However, only four in 10 work in groups that meet even minimal criteria for effective team working. Aston Business School’s findings show that most of the health and social care workforce is working in “pseudo” teams in which staff are more vulnerable to dangerous mistakes and poor morale.
It is in these teams that effective leadership is needed. Research highlights how line management relationships affect key organisational outcomes such as motivation, morale and intention to stay in the job. It is perhaps unsurprising that Professor Alimo-Metcalfe’s research highlights “genuine concern” shown by immediate line managers as the factor that contributes most to organisational effectiveness.
This is not to suggest we neglect the importance of top teams. They have a key role in creating the right context and culture for service improvement. The Institute for Healthcare Improvement stresses that the most common reason for failure of large systems to change is the failure of senior leaders to function as an effective team.
The challenge for leadership development is to build improvement capacity within local systems of provision rather than churn out specially endowed heroes. It is about creating a social movement at a local community level. Rather than focusing on competency-based programmes aimed at particular groups, we need bespoke approaches shaped by local contexts which recognise that the action is in the interactions between local staff, managers and the other stakeholders that depend on them.
A neglected factor in team working is the importance of designing teams that encompass people who depend on each other to achieve a shared task. The same principle applies to developing leadership programmes. We need programmes that link leadership behaviour to the task at hand. They need to bring the people interdependent on each other to achieve that task together, wherever they are located and whatever their status in the system. This helps effective working within and across teams.
Such programmes also require a greater emphasis on developing positive relationships within and across organisations and out into communities. This is helped by practices that focus on what works rather than rubbing people’s noses in their deficiencies. It requires attention to the “soft stuff” of culture and the personal and positive meanings people attach to their roles. It also means we need to protect thinking time for busy staff, for example by establishing action learning sets or plan-do-study-act groups. Without such time, organisations will fail to turn events into the learning needed to create better futures.
As part of the Care Services Improvement Partnership’s response to this challenge we have established a new Learning for Improvement Network for Leadership and Teamwork Development. This provides a forum for sharing resources on leadership and teamwork, including training materials, and links to organisations that can offer support. The network formally launches at the national 21st Century Leadership conference on 16-17 April but mind maps containing a range of resources can be downloaded now at www.icn.csip.org.uk/leadership.
We have also launched a social networking site (www.leadershipnet-icn.org.uk) for people involved in designing, implementing and evaluating leadership and teamwork development interventions, including coaching.
Both networks are open to all and aim to provide complementary resources that support both people who offer training and advice and those who receive it. We aim to be a network “with attitude” about what constitutes effective leadership and team development, stimulating discussion and debate with a wide array of stakeholders.
We hope that people will use these resources to achieve a meaningful and productive exchange that lifts leadership and teamwork development out of the familiar silos to achieve a more integrated approach to local service delivery.
Professor Steve Onyett leads the Learning for Improvement Network for Leadership and Teamwork Development at CSIP Networks and is senior development consultant at CSIP-SW.