Effective Healthcare Leadership

Melanie Jasper, Mansour Jumaa, Melanie Jasper, Mansour Jumaa

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781119267195
• Edition: 1
• Topic: Médecine
• Subtopic: Soins infirmiers

Effective Healthcare Leadership integrates theory and practice to distil the reality of healthcare leadership today. It addresses the context and explores strategies for leadership and examines the leadership skills required to implement and sustain developments in healthcare. Section one examines the contemporary context and challenges of healthcare leadership. Section two offers opportunities through the CLINLAP/LEADLAP model to see how modern management ideas, tools and techniques are used effectively in leadership development. Section three examines the role of leadership in implementing change and improving practice in different contexts of care. The final section explores future challenges in leadership.

Section One
The Challenges of Leadership in Healthcare

1
The Context of Healthcare Leadership in Britain Today

Melanie Jasper

Introduction

Avery’s textbook on leadership (Avery 2004) attempts to draw together the many and varied perspectives and theories that have developed as our (capitalist) societies become more fluid and rapidly changing than at any other period in history.

The speed of change on multiple fronts seems to be pushing humankind to the limits of its adaptability. People have no sooner adapted to one change than the next one is upon them, bringing more uncertainty and complexity. The challenge is for leadership to operate under rapidly mutating circumstances, which requires a rethink of paradigms of leadership both in theory and in practice. (Avery 2004, p. 7)

The development of healthcare provision in Britain is a perfect example of this frantic need for increasing efficiency in service sector industries, where the traditional public service ethos is being influenced, and often replaced, by the ethos and ethics of business and the marketplace.

For many who have grown up in the post-war years of the welfare state, and who have spent their working lives in public services directed and run by it, this is an uneasy alliance of competing sets of beliefs and values. Alongside managerial concepts and strategies imported from successful business organisation runs a whole vocabulary that those working in health and social care are having to embrace and adapt to. As with many instances of social change, the reorganisation and adoption of new directions and challenges in healthcare is a political response to fundamental problems in sustaining the basic premises envisaged at the creation of the welfare state. British society is simply unable to continue to fund a state-financed healthcare system where demands on it are infinite, where the changing demography over the next 30 years will result in an increasingly elderly and dependent population and where the working population will generate insufficient taxation to meet demand. Hence, it is reasonable that government strategies are directed towards the fundamental premises of the welfare state, whilst at the same time attempting to introduce concepts from business and the marketplace to take it into a sustainable future, and to seek innovative approaches to funding healthcare, which under another name would be labelled ‘private sector’. As the Government White Paper The New NHS: Modern and Dependable (DH 1997, p. 8) identified:

It is clear there are tough choices facing the NHS. It has to improve its performance if it is to deliver the sort ozzf services patients need.

The context of leadership within the British National Health Service

In short, the New Labour Government created a vision of ‘a new NHS for a new century’ (DH 1997, p. 8), expanded in a number of governmental papers over successive years (e.g. DH 1998, 2000, 2001, 2002a, 2002b) and still progressing. The message in these was clear – that a central plank of governmental vision was the need for leadership as well as efficient management throughout all areas of activity in the NHS. As Liam Donaldson (2001), Chief Medical Officer, said:

Implementing this major programme of change will require active leadership at all levels in the NHS and an inclusive approach. If it is successful the pay-off for the patients and staff will be huge.

This is reinforced by Nigel Crisp, NHS Chief Executive:

We must lead change as well as manage it. We need leadership in setting out the vision and working with and through people to achieve it. We need excellent management in systematic and tested approaches to secure delivery and improvement. (DH 2002a, p. iv)

Leadership per se is a relatively new (and inclusive) concept for the British NHS. As a result there is a dearth of published material relating to its nature and content over and above that in government papers and policies. These, by their very nature, take a particular view of leadership, influenced by the vision and direction of healthcare delivery at the beginning of the new century. The concept of leadership adopted has to be set within the social, cultural and environmental context of its time. Outmoded notions of leadership equated with authority, traditional and hereditary power are not commensurate with the values espoused by the New Labour Government, seeking equality throughout society. Rather, the definition of leadership adopted needs to reflect the values inherent within the socialist paradigm, and reflect increasing participation in policy-making and decision-making at all levels within the NHS. This latter point is perhaps one of the most important – transformation of the NHS will not occur unless the majority of employees at all levels within it are empowered to lead in new directions and espouse the values inherent within the policies. To this end, a blueprint has been created through government policy; what is missing is exactly how this can be achieved, given the lack of an evidence base relating to effective leadership styles of the type envisaged within public services – the evidence does not exist for the very reason that this is wholesale change of a type never before witnessed in state-funded organisations.

However, a plethora of literature from successful businessmen (e.g. Charles Handy, John Harvey Jones, Geoff Smith), prominent leaders (e.g. Winston Churchill) and self-styled leadership gurus (e.g. Adair 1998, 2002, Bennis 1998, Goleman 1995, Goleman et al. 2002) has influenced the ways in which leadership is framed and conceived. Hence, there are many theories about leadership, and many theorists writing about it, but little solid work to link these to the realities of the challenges of leading a modernised NHS where little remains the same. Whilst we can draw lessons and wisdom from the insights and experiences of others, we desperately need to encourage and develop the vision and skills of those leading from the inside and at all levels of the organisation. Whilst we need to be aware of published (and publicised) notions and models of leadership, we also need to be able to critique and evaluate them, with a view to making intelligent selection of strategies and building upon models that have been seen to be effective.

A culturally specific concept of leadership

What is significantly different in the approach of the New Labour Government is that leadership is not regarded as the preserve of the powerful few, but as being a function of people’s roles throughout the NHS. Hence, the concept of leadership is key to the modernisation of the NHS and has been enshrined in the work of the NHS Leadership Centre, created in 2001 as part of the NHS Modernisation Agency (The NHS Plan, DH 2000). The Centre launched the NHS Leadership Qualities Framework in 2002 (NHS Leadership Centre 2003). The components of this framework (shown in Table 1.1) comprise 15 qualities, organised into three clusters of setting direction, personal qualities and delivering the service.

Table 1.1 Components of the NHS Leadership Qualities Framework.

Setting direction	Personal qualities	Delivering the service
Broad scanning	Self-belief	Empowering others
Intellectual flexibility	Self-awareness	Holding to account
Seizing the future	Self-management	Leading change through people
Political astuteness	Drive for achievement	Effective and strategic influencing
Drive for results	Personal integrity	Collaborative working

It can be seen clearly that these qualities reflect the values and beliefs inherent within the Government’s political stance. They reflect a ‘here and now’ snapshot of public values, which, it could be suggested, would be unrecognisable to both political and military leaders 50 years ago, and certainly are unlikely to be those identified by a different political party whose values derive from capitalism and the marketplace. The emphasis is on personal attributes and qualities, as opposed to traditional sources of authority and power or target-driven incentives derived from a business cultur...