The peloton is the perfect leadership model for the NHS because it encourages competition to be the best while everybody works together, argues Clare Gerada

I attended an Empathy and Compassion in Society conference at Friends House in London in November last year. The conference talked about both leadership and how the lack of effective leadership has contributed to the problems we too often see in the NHS.

I was there because I am increasingly concerned that we are replacing the language of caring with that of the market.

‘The peloton style of leadership works for cyclists and with some imagination it can work for the NHS’

Group of bikes in a race

The conference was timely as just a few days later, the chief nursing officer published Compassion in Practice aiming to embed the six values of care, compassion, courage, communication, competence and commitment in nursing, midwifery and care giving.

This came just a few months after Delivering Dignity, a report by the NHS Confederation’s commission on dignity in care for older people was published, and the Care Quality Commission’s annual report.

All three publications point to a lack of compassion, which is leading to errors, poor patient care and worsening healthcare for the most vulnerable. The forthcoming Francis report into the Mid-Staffordshire Foundation Trust is also expected to raise similar issues.

Part of the pack

It has caused me to reflect that we now have the perfect opportunity to do things differently. I don’t mean in terms of NHS commissioning or service design, but to refocus on what matters most to patients − kindness, caring, compassion and, perhaps more importantly, how our leaders and leadership can become the vehicle for this.

Leadership, that ubiquitous word, is (rather like integration) touted as the solution to all the woes facing the NHS. The argument goes that if only there was more “disruptive innovation” led by “heroic” individuals who are willing to make sacrifices and march their army of managers and clinicians into a battle against waste and insolence, then we would have an NHS fit for the future.

My view is different. I feel it is time to rethink leadership. In the spirit of self-help author Anthony Robbins, I think we need to stop doing what we have always done and try something different. Perhaps it is time to try “peloton style” leadership.

‘In education there have been many attempts to promote distributional leadership and highlight how leadership emerges from a group’

A peloton is the main pack of riders in a road cycling race, with the riders at the front sheltering the rest of the pack from the wind. Taking turns at the head of the peloton allows the whole field to travel faster and for longer than any one rider could manage alone. No rider, no matter how strong, can win without cooperating with others.

Together the group focuses its attention on the epic task in hand (cycling a ridiculous number of miles) and deals with adversity (such as difficult weather conditions and terrain). This peloton style perfectly matches the idea that leadership is a symbiotic relationship between those who choose to lead and those who decide to follow.

No more heroes

The peloton style of leadership works for cyclists and I think with some imagination (and possibly without the lycra) it can work for the NHS.

What’s more, the peloton is the perfect model for the NHS to follow because it encourages competition to be the best while everybody works together to move the whole thing forward.

I am not the first person to champion this idea. In the field of education there have been numerous attempts to promote distributional leadership and highlight how leadership emerges from a group or network of interacting individuals.

‘We need to move away from an environment where micro-managers demand targets and collaborate little’

A report in 2011 by the King’s Fund called for recognition that the old “heroic” individual leadership model − the “turnaround chief executive” − needed to make way for leadership being shared across the care system, “from the board to the ward” and away from “pace setters”.

New environment

The hope that the NHS will be transformed by exceptional heroic leaders is unrealistic, unsustainable and rather misogynistic. The idea of a dominant, invariably male, leader perched on top of an organisational hierarchy is paradoxical in the complex, value-laden, now predominantly female NHS.

Binney et al, in their book Living Leadership, point out: “The identification of leadership with lone individuals standing apart and wrestling their organisations into shape paradoxically disempowers leaders and stops them doing their best.” Overburdening leaders and paralysing followers only leads to poor patient care and demoralised staff.

We need to move away from an environment where micro-managers demand targets and collaborate little. We need to move towards a peloton style leadership where boundaries of leadership are widened and where people work together to pool their initiative, talents, distinct perspectives, energy and expertise. In this environment, the outcome will always be richer and greater than the sum of their individual actions.

Leadership, as Roy Lilley has written in his blog, is about “creating the space for people to do the best job they can… creating opportunities to do the best job they can”. The peloton, with everyone involved working to the best of their ability for the good of the team, is the perfect example of this.  

Dr Clare Gerada is chair of the Royal College of GPs