Alternatively a despot who sees debate as decent and questioning as disloyalty - sometimes described as a strong leader often criticised for encouraging a macho management style. An organisation can only have one such leader. Yet increasingly it is recognised that transforming the NHS requires managers at every level in the organisation to show leadership skills to take responsibility, rather than to say ‘I’m only the message’. To be able to describe how things will look different in the future and explain the part their staff have in shaping that future, managers who understand the impact their behaviour has on others and who have good people skills are vital.

The NHS chief executive Sir David Nicholson recently spoke of the need for a new management style in his address to the Kings Fund Summit on Leadership. This came only days after the Institute of Leadership and Management (ILM) called for a more inclusive approach to management. In both cases the concern was that unless managers raised their game, the NHS would not deliver the biggest changes in its history.

Chief executives all too often don’t encourage and don’t get direct feedback on their own performance. We are all familiar with the unedifying sight of senior mangers “dancing around” their chief executive, meaning that they tell them only what they want to hear, filter out the bad news and wouldn’t dream of telling the boss that their focus on the big picture means they are missing some important detail or that their determination and enthusiasm is inhibiting people from asking legitimate questions for fear of appearing disloyal or not on-board.

The chief executive and their senior management team can model a more inclusive management style but they will need to do more than this to convince the wider staff group that imposed change and autocratic leadership is a thing of the past.

Changing the management culture throughout an organisation is a big task; it is not a one off exercise, it is a journey that will take years which of course is not what the board, the senior management team or those at the DH want to hear. However if you want to learn how one large, complex public sector organisation went about it then there is a detailed case example in Equipping managers for an uncertain Future published by Russell House.

Blair McPherson is author of numerous articles and several books on leadership and management