How to Succeed as a Leader

Ruth Chambers, Kay Mohanna, Richard Jones, David Wall

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315357409
• Edition: 1
• Topic: Medicina
• Subtopic: Salud pública, administración y atención

This work includes Foreword by David Nicholson - Chief Executive, National Health Service of England. In the past, there has been too little emphasis and investment made in developing leaders in healthcare. People have become leaders without being prepared or trained or supported in the role. Individuals need to understand the context, the concept and models of good leadership, the practical steps to becoming a good leader, and how to sustain the various components of a well functioning and effective organisation, whether that is a large NHS trust or hospital department, a clinical group or practice team. This guide has been written by a range of writers from organisational consultancy and NHS backgrounds who are all experienced in developing and supporting leaders, planning and providing education, and change management. It is specially designed for independent learning, with answers to frequently asked questions, self-assessment exercises and helpful tips. "How to Succeed as a Leader" is ideal for all healthcare professionals in (or aspiring to) leadership roles. It also provides inspiration for academics and workplace educators, managers and leaders in government, strategic health authorities and workforce deaneries. 'There is constant reorganisation and a changing culture in our health service. Good leadership is essential to address the changes required and take others with you so that the service can function effectively. There has been an amateurish approach to leadership in the NHS in the past, where people have become leaders without being prepared or trained for the role or supported in it. This book is all about presenting you with a practical approach to becoming a competent leader, to prepare you to lead in a positive way and realise your responsibilities as a leader.' From the Preface.

Chapter 1

About leadership

Peter Spurgeon

Introduction

The NHS has experienced a prolonged period of upheaval; most notably in the form of seemingly constant structural change. The current focus upon new ways of delivering services associated with stringent financial controls and unprecedented job losses with yet further organisational restructuring is as great as any change experienced by the NHS to date. Previous failures or problems in the NHS are often blamed on a lack of leadership, whilst the demand for good leadership is said to be at a premium as the only way to cope with the present challenges.

The term leadership when used in this very general way can come to mean almost whatever you want it to mean, and is on the whole unhelpful to those who aspire to contribute through their own leadership capacity in a variety of roles. Here, we offer you some insight and understanding as to how leadership operates in a variety of contexts.

Ros Taylor, a business psychologist and author, emphasises the importance of the extent of infrastructure support for leaders so that they can be effective:

I have found the standards of leadership in the NHS extremely high. Leadership is about being comfortable putting yourself out in front, wanting to make a difference and having some answers about how to do that. It is not about organising your own diary or typing up memos. There are some fantastic thinkers in the NHS who end up doing mundane tasks because they don’t have a PA. The amount of stress this causes is immense.¹

Leadership: what do we know?

The literature on leadership is vast, running to millions of citations. Inevitably in such a prolific field the definitions used are variable. Clarity about just what is meant by the term leadership is lacking. There is a tendency to confuse the question: Who are leaders? with What do leaders do? The former approach leads to an unending series of lists of personal qualities that an individual, designated as a leader might possess. Sadly as you line yourself up against the list you will fall short. The paragon matching up to all the virtues described does not exist. If they did, they would be unlikely to be applying for a job where such lists are often to be found.

The reality is that you may possess some of these personal characteristics to some degree – but just how much of each do you need to be a leader? Since individuals do emerge as leaders with an almost infinite set of combinations of personal characteristics then your first conclusion must be that there are lots of ways in which people can lead and that no single universal set of characteristics is required. This is helpful in two ways:

1. as individuals we can all make a contribution as leaders in different ways
2. when reading the many descriptions of leadership it is entirely legitimate to choose a model that fits with your own personal make-up or chosen model of leadership. No proposed model is right. But elements can be adapted and grafted onto others to offer you an approach to being a leader that is comfortable and compatible with your own individual resources.

The fascination with leadership in a personal capacity is in part a recognition of the interpersonal nature of leadership, i.e. how we as leaders have an impact on others. It also reflects a key distinction between management and leadership. Management requires a degree of rationality and is aimed at efficiency. Leadership by its nature is more affective in that it is about generating follower-ship, by inspiring, motivating, energising or convincing others that the direction or goal identified is worthwhile and appropriately demanding of their commitment.

The glaring weakness of the personal characteristics approach, even beyond clarifying which characteristics are needed, is that it does not really offer any insight to the aspiring leader as to what leadership involves in terms of activities or behaviours. Therefore the second overall question to emerge around leadership is, What do leaders actually do? This behavioural approach typically leads to a set of leadership competencies or behaviours which taken together represent the repertoire of actions an individual can take. The Leadership Qualities Framework (LQF) recently developed specifically for the NHS is an example of this approach.² The LQF and competencies are discussed as a specific aspect of leadership in Chapter 5.

Although the number of competency frameworks is growing with the risk of creating confusion about their relative merits, the competency approach has two particular advantages:

• although the language of competency frameworks often looks different there is frequently a great deal of underlying overlap in what competencies are being described
• even when particular competencies seem to be demanding, they are accessible to the individual and offer the prospect of being acquired through appropriate training and development opportunities.

A third way that some people think about leadership is to define it in terms of outcome such that if a unit or group is successful then they must by definition have experienced good leadership and vice versa. An example of this is the published study conducted by the Hay Group.^3,4 The overall conclusion of the study was that effective ward management led to fewer drug errors, higher patient satisfaction and lower staff absenteeism and turnover. Whilst the differences reported in some of these areas was substantial it is worth noting that ‘effective and poor-performing managers were identified by analysing results in three areas for the 12 months before the study. These were: the number and severity of drug errors, the frequency and nature of patient complaints, staff turnover and absenteeism.’ Thus the product or outcome is itself used to define leadership. The study also reported that the more effective leaders used a greater variety of styles of leadership ranging from coercive, to democratic to coaching styles.⁵ The real point is that effectiveness is associated with being able to link a leadership approach to the nature of the problem and people involved.

We see many examples of leaders being defined by outcome in various sectors and also the fallacy of the approach. Successful companies by definition must be effectively led but when leaders are recruited to a new setting they often fail. The lessons about leadership would seem to be that:

• it is fundamentally about influencing others
• each individual can make a contribution as a leader in an enormous variety of ways based on their personal attributes and the style adopted
• the setting, context and nature of the people being influenced make a great difference to what is classed as effective leadership.⁵

Top tips

• Be aware of the context in which you exercise leadership – its history and values.
• Understand the task so that it is apparent what type of leadership might be needed and should work best.
• Develop your own self-awareness so that you can build on your strengths, and develop a style that suits you.
• The best leaders can adapt their leadership style to the needs of the situation.
• Leadership can be offered at all sorts of levels in the organisation and there is a need to create room for both individuals and the organisation to flourish.
• Leading is a complex matter, so recognise the contributions made by those around you.
• Recognise and encourage talent. To do so should not be a threat but will make you a better leader.
• Be clear about your focus and what you are trying to achieve as a leader.
• Be willing to communicate to others what is happening and how you are going to do it over and over again.
• Get feedback from others as to the leadership style that you commonly use – how well it seems to work in your everyday work and leadership roles. This might be informal feedback or structured from a multisource feedback exercise (see Chapter 3).
• Become familiar with the various approaches to leadership – read all about them and reflect on what suits you and your circumstances.^2,3,4,5
• Try to protect time for your development as a leader. Be strict with yourself about prioritising your learning in the midst of all your other commitments and pressures. Negotiate with your employers or colleagues for time out, and funding for pursuing training activities.

Frequently asked questions and answers

Q. I have recently joined a new practice as a GP partner. Overall the practice has survived rather than been successful. I sense people looking at me to lead improvements but I am not really clear how to go about it. What approach should I take?

A. This is a context whereby someone is expected to provide leadership because of their seniority and expertise but where they have probably had little or no training in the skills of leadership. It is partly an issue of confidence, i.e. feeling that it is reasonable for you to start suggesting what should change and how staff should go about things. It is also an error to believe that there exists some prescriptive guide to leadership that will tell you what to do. The most likely way to be effective as a leader in this setting is to believe in yourself in establishing a lead in a way that feels comfortable and most like your own preferred style. But be aware of the reaction of others and be sensitive enough to adapt your approach if it is triggering difficulties.

Q. How do I decide if I have leadership qualities?

A. The key is a combination of self-awareness and self-insight – know what you are like, what your strengths and weaknesses are – and then link this to some kind of feedback. The feedback can be derived from many sources – from trusted colleagues who can tell you how you are seen by others; from a psychometric profile carried out by someone competent to give you sensitive feedback and guidance as to how you might develop certain skills; or by attending a formal course that offers you insight into the models of leadership that exist and allows you and other participants to practise some leadership behaviours. Then you can reflect how this works out in real life when you try them out back in your workplace.

Interactive exercise: compare yourself with effective leaders

Ideally this exercise should be carried out with two or three colleagues. You should list:

1. three examples of leadership behaviour that you have experienced that you believe made a difference to the outcome in a particular situation. Make sure the list is of behaviours, not personal characteristics
2. identify three people who you believe have leadership capacity. Describe what it is about them that defines them as leaders.

Compare the types of information obtained from the two tasks and then consider whether you behave in ways like those described in (1) or possess characteristics such as those described in (2). If not, th...