The NHS needs high quality leadership to deliver high quality care for patients.

Leadership development is not an end in itself; it is about improving the service we deliver - it has a purpose.

The solution has to be to take positive action to ensure we get the diverse leadership talent we need

We need maximum creativity to drive up quality and we must release all the diverse leadership talent available.

We know that diversity is one key to success. CBI president Helen Alexander describes the most successful boards as those that are the most diverse.

We know from Erhardt et al in their review of corporate governance that diversity is positively associated with financial indicators of firm performance.

Such diversity prevents the likelihood of “group think”, which minimises conflict in order to reach consensus but can result in reaching hasty, irrational decisions because there has been no critical thinking, analysis or evaluation.

Hart, in his study of small groups and policy failure, identified group think as “one of the causes of major fiascos in foreign policy, large planning projects and strategic management”.

Is there a similar correlation between diversity and patient safety? A possible analogy may be the safety issues associated with the Challenger space shuttle disaster. While a physical failure caused the calamity, group think was a contributing factor, according to the presidential commission report into the explosion.

If we accept the need for diverse leadership and accept that the talent pool is not diverse enough, we need to ask why, and what should be done.

The answer to the first question is that it is a human response to appoint “mirror images” of oneself and so we end up with a very homogenous group of leaders.

And because of group think, the board or management team feels cohesive and likely to deliver results because they are “all going in the same direction”. For this, read “limited independent thinking” and reduced creativity.

The solution has to be to take positive action to ensure we get the diverse leadership talent we need.

We need to identify what groups are under-represented in leadership roles and give them the confidence and competence to take these roles on - although success in appointment must be down to merit.

A specific example is my work with the 12 allied health professions. Different clinical settings bring different perspectives and, while ensuring all clinical leadership programmes are now opened up to all clinicians is a step in the right direction, such an under-represented group as allied health professions does require positive action.

The allied health professions leadership challenges are aimed at raising their profile as leaders and provide them with the confidence to translate their clinical skills in analysis, diagnosis, problem solving and the ability to motivate, into leadership.

There is also the issue of clinical roles at board level that limit which professions can sit on the board. If we limit ourselves in such a way, what is the impact on improving the quality of patient care?

The solution is confident and competent clinical leaders, whatever their background.


1. Erhardt, N.L. et al, Corporate Governance: An International Review, Vol 11, pp. 102111, April 2003

2. Hart, P., Groupthink in government: A study of small groups and policy failure, pp318, 1990

3. Rogers, W.P., Report of the Presidential Commission on the Space Shuttle Challenger Accident, 1986

NHS Leadership Spring Debates: Positive action