The new NHS leadership challenge

Citation

(2009), "The new NHS leadership challenge", Leadership in Health Services, Vol. 22 No. 1. https://doi.org/10.1108/lhs.2009.21122aab.002

The new NHS leadership challenge

Article Type: News and views From: Leadership in Health Services, Volume 22, Issue 1

Keywords: Healthcare strategy, Leadership development, Performance management

Developing new leaders is a strategic decision not an HR one, argues Chris Roebuck, and line managers should get started right away

The organisational world poses challenges for all leaders, but leaders in the NHS face additional challenges that complicate their role. The next stage review and current health service objectives give an urgency and new direction that adds to this.

Delivery of a world-class service to customers for any business is not easy, but where there are safety issues, high media exposure and tight external control of funding it is even more difficult. Add to this ethical and practical issues around improving the quality of human life and it is easy to see why a leadership role in the NHS can be one of the most challenging.

So it is not surprising that sometimes it is difficult for the health service to attract leaders from outside and that it must develop leaders internally. This is not a bad thing: evidence shows there is less risk of failure with internally developed leaders than externally sourced ones.

The next stage review, the current strategic focus on leadership and the time taken to fill some leadership roles confirm that growing new leaders inside the health service is vital. Only through effective leadership will the next stage review be implemented successfully. But there is substantial latent talent within the NHS that needs to be identified and developed, which is potentially being missed.

Those at senior level now have an opportunity to transform the service. It will not be easy – many commercial organisations have tried this and failed. The NHS finally has the chance to show that it can be as good, if not better, than the private sector. So why does the public sector often fail in growing leaders and improving performance? Primarily because doing this is often seen only as a human resources responsibility. Even when a chief executive takes an interest, the end result is still that the vast majority of line managers do not know they need to develop talent and improve performance day to day. Also they don’t know how to or don’t care. So even when the top 10 per cent of managers are doing it, if the other 90 per cent are not, then it won’t be successful.

To be successful, change must be driven by the chief executive and senior management, facilitated by HR and delivered by every line manager across the organisation every day. This is a strategic organisational leadership objective not an operational HR one. It is not just about putting in place a few initiatives to develop new leaders – that totally misses the point. It’s about a fundamental change in culture and attitudes across the organisation.

Everyone must be enabled to be the best they can, talent must be identified in a transparent way, then must be developed and made mobile across the health service, where this adds most value. In addition, clinicians must be encouraged to move into leadership roles if they wish. Otherwise substantial and highly relevant skill, knowledge and leadership capability are wasted.

While this development of clinical leaders is complex, it is achievable with the right systems and culture. The health service must also reflect the communities it serves to enable it to deliver the care those communities need. Although this takes more planning, resources and effort, it’s the only way to become world class.

There are many traps along the way. Over-complex systems are often put in place with the emphasis too much on process not output. There are endless debates about what leadership means and leadership behaviour is minutely dissected.

This all uses up precious time and demotivates line mangers as it takes their time away from growing new leaders and helping their teams get better. The whole thing then stagnates due to apathy and cynicism.

Staff engagement is vital. In an average private sector organisation, about 20 per cent of the workforce gives 100 per cent effort (they are the engaged), 60 per cent of workforce gives about 70 per cent effort, the neutral workforce, and the bottom 20 per cent, the disengaged, actually degrade the performance of the people around them. The NHS may not be much different - so the potential for massive improvement is there today, it just needs to be released. This staff engagement is vital to successful implementation of the next stage review and the other NHS objectives. To deliver this, HR is the key facilitator. A strong, professional HR function is vital for success.

Leadership is not about complex behavioural mapping, it is about getting people to perform at their best, measuring what gets done, seeing how it is done and by ensuring people are fully engaged. A well-trained line manager can increase someone’s performance by about 40 per cent through inspiring and engaging them. So senior clinicians in clinical roles are leaders just as much as those in management and have to have these skills developed.

In addition the health service, despite its complexity, has one key factor that no commercial organisation has: it has the deep belief everyone has in the importance and value of what they do. This gives the service an emotional engagement from staff that is greater than any commercial organisation could hope for. Combined with good leadership, this is the key to making the NHS world class. It is about creating an environment where everyone is looking for talent, where every leader gets their people performing at their best, where everyone with talent can develop those talents to the full and where being the best is part of day-to-day work.

For more information: www.nhscentreforinvolvement.nhs.uk