Effective People

Leadership and Organisation Development in Healthcare, Second Edition

Stephen Prosser

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315357775
• Edition: 2
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

'In these pages you will find a rich mixture of the best in leadership and organisation development practice and theory, based on a lifetime of studying and applying the principles of why some healthcare organisations succeed and why some fail.' This inspirational book analyses the attitudes and disciplines which make people and the organizations for which they work more effective, more productive and generally more successful. The author, who has experience of working in healthcare and manufacturing and with senior civil servants, and is also familiar with key academic literature, sets out a highly practical combination of practice, theory and policy applicable in a wide variety of healthcare situations. Now revised, including an entirely new chapter on being patient-focused, this remains an invaluable resource for health service leaders and future leaders including managers, clinicians, policy makers and academics.

Disciplines

CHAPTER 1

Leadership

In today’s dynamic world, the business environment is constantly changing. It is driven by the economic situation – both global and domestic advances in technology, changing markets, regulatory change and fierce competition. Never has leadership – and continuity of leadership – been more important.¹

This is some claim from George Cox, recent Director General of the UK’s Institute of Directors, and he is not alone. Acclaimed leadership writers, Rob Goffee and Gareth Jones, writing in the wake of the 2009 financial crisis believe:

As we struggle through the most serious economic crisis since 1929, it’s clear that we do not yet know what the business landscape will look like when we do finally emerge from the recession. What we do know, however, is that leadership is more important than ever and organisations that are well led have much more chance of surviving these turbulent times.²

Recognition of the existence and importance of leadership has been around since the dawn of time: the Old Testament discussed it, as did the Icelandic sagas and the Greek and Latin classics. Confucius and Plato were interested in leadership, and the Odyssey even advised leaders on maintaining their social distance: ‘The leader, mingling with the vulgar host, is in the common mass of matter lost’.³ Despite this longevity in the practice of leadership, Cox, Goffee and Jones may well be right. Leadership may never have been so important, and in recent times the prominence given to it, in an ever-burgeoning and unprecedented literature, seems to support this claim. Organisations realise that effective leadership will provide them with a competitive edge over rivals and help to continue the transformation of their organisations.

In healthcare, there is widespread recognition of the importance of leadership for the provision of effective services. The website of Donald Berwick’s influential Institute of Healthcare Improvement (www.ihi.org/ihi) is replete with examples of the impact of leadership on effective patient care, not least as evidenced through work on patient safety including the prevention of avoidable deaths. In England, the health services chief executive has established and will chair a potentially powerful National Leadership Council on the premise that:

Leadership is the vital ingredient that can make all the difference to the quality of care that our patients experience. Great leadership, which focuses on improving services for patients, will help transform the NHS.⁴

Whether there is evidence of a link between leadership development and positive patient experiences will be considered later in this chapter.

The UK Government saw leadership and management as such an important issue that in 2000 the then Secretaries of State for Education and Employment and for Trade and Industry established the Council for Excellence in Management and Leadership, the aim being ‘to develop a strategy to ensure that the UK has the managers and leaders of the future to match the best in the world’. The Council took to its task with relish and set out a compelling vision statement (the realism of which will be judged soon) to underpin its recommendations:

By 2010, the UK will be seen as a world leader in developing and deploying management and leadership capability for the twenty-first century.

Across many sectors of the economy major international companies continue to invest in the development of their existing and future leadership talent, as evidenced in books such as Fuller and Goldsmith’s The Leadership Investment – How The World’s Best Organizations Gain Strategic Advantage Through Leadership Development.⁵ Although the widespread interest in leadership is commendable, there is a danger that certain managers will see leadership – or possibly have already seen it – as the latest panacea for all of their problems. Where that happens, leadership is in danger of becoming merely the latest fad. These managers will be tempted to believe that ‘If only we had the right type of leadership in this organisation most of our problems would be solved and most of our challenges would be met’, and they say it with the same simpering optimism that greeted the last managerial panacea they discovered.

This growing interest in leadership is reflected in the ever-increasing number of books published on the subject (and the books, no doubt, are feeding the frenzied interest in leadership), and the volume of reports from Government departments and professional bodies examining and recommending the need for more leadership to drive forward the public and private sectors. I am more than willing to declare my belief that effective leadership is critically important in all organisations, whatever sector they may occupy. However, I am also concerned (for reasons I shall elaborate upon in other chapters) when I see the subject of leadership being treated superficially and as the latest ‘quick fix’ to solve an array of organisational or specific healthcare needs. As I write these words (in 2009) I have on my desk a brochure from a well-known UK health-related institution inviting me to attend a conference session where I will be able to learn how to: adapt my leadership style to drive large-scale change; develop a commercial culture of innovation and transformation; and ensure change has positive outcomes for both staff and patients. Some claims for a session programmed to run from 10.10 to 10.40! There is rarely such a thing as a quick fix in an organisation and for leadership to take its proper place and help the organisation to prosper, leadership must be understood properly and practised effectively.

Andrew Pettigrew, the distinguished academic and analyst, provided balance with regard to the place of leadership within an organisation in an article entitled ‘Does leadership make a difference to organisational performance?’ Pettigrew contended:

…although leaders are important and leader effects are quite crucial, we shouldn’t concentrate our attentions on leaders alone. Indeed, my belief about the links between innovation, change and performance is that we should think about fixing the system, and not just the people. This is not to rule out the significance of people, but it does mean looking at a wider set of factors in assessing why things do change and why performance goes up and down … easy assumptions about leadership effects should be avoided, especially given the tendency to over-attribute them. But you can’t make the contrary conclusion – to say that leaders have no effect. The problem is to balance out the competing explanations.⁶

WHAT IS LEADERSHIP?

I can’t tell you what it is, but I know it when I see it.

Supreme Court Justice’s much publicised (and possibly apocryphal) comment about pornography

Leadership is a complex subject, yet its complexity does not prevent many people from wanting to reduce the whole subject to a user-friendly definition of no more than six or seven words. They want a simple, easy-to-remember, slogan-type definition that will sum up the subject in as few memorable words as possible.

Leadership cannot be understood by such simplistic methods. It is necessary first of all to understand many different perspectives on the subject, and secondly, to comprehend the many complementary activities that impact upon its practice. I like very much Keith Grint’s⁷ demonstration of this complexity in his description of four quite different ways of understanding leadership:

➤ Person: is it WHO ‘leaders’ are that makes them leaders?

➤ Result: is it WHAT ‘leaders’ achieve that makes them leaders?

➤ Position: is it WHERE ‘leaders’ operate that makes them leaders?

➤ Process: is it HOW ‘leaders’ get things done that makes them leaders?

It is only when someone has examined leadership comprehensively that they can begin to declare an understanding, and even then they may feel that their studies have merely skimmed the surface. However, I would not want to carry the point of leadership complexity as far as leadership guru Warren Bennis in his description of the depth of leadership studies:⁸

So there are two kinds of subjects that we academics tackle. Some, like fly-fishing or English seventeenth-century poetry, can be plumbed to their depths. Others, like leadership, are so vast and complex that they can only be explored.

Even if he has a point (although my English-language colleagues would dispute his reference to plumbing the depths of seventeenth-century poetry), the best application of his quote is to demonstrate to those who wish to reduce the subject of leadership to six or seven words that it cannot be explained in such a manner. I find that to develop a proper understanding of leadership it is necessary, in the first place, to start with the negatives and to describe in clear terms what leadership is not. Only then is it possible to move on to a positive description of leadership. Experience with vast numbers of healthcare managers and clinicians has taught me that there are typically five common misunderstandings about the subject of leadership. These are what can be called the ‘five negatives’ of leadership.

The five negatives of leadership

1 It is possible to provide a ‘bumper-sticker’ or ‘fridge-magnet’ explanation of leadership. This attempt to explain leadership usually starts with the words ‘Leadership is …’ and ends with some simplistic explanation that, quite frankly, leaves more questions unanswered than answered. There is no glib answer to the question ‘What is leadership?’, even though there is continual pressure on leadership experts to sum up their entire field of enquiry in a few well-chosen words. I have lost count of the number of times I have been asked this question. The most recent occasion was at an international healthcare conference and when I explained to the enquirer that a short answer was impossible he respected my position and understood that short simple questions do not always have short simple answers. Instead, we decided to have another glass of wine and discuss some other imponderables of life.

2 Leaders are only to be found at the top of the organisation. This is the second common misunderstanding. It is what I call the ‘Churchill and Mandela syndrome’, where people believe that someone can only be a leader if they demonstrate qualities akin to those of great men such as Churchill and Mandela and occupy a place near the top of their hospital chain of command. The error lies in the belief that leadership can only come from the top of the organisation, and a failure to recognise that leadership is practised at all levels in the organisation, from the hospital ward or the GP’s surgery to the oak-panelled boardroom. To think otherwise is to miss the leadership contribution made daily by a large percentage of nurses, doctors, porters and others in the organisation, in small acts that are often not classified as leadership, but which their colleagues recognise as indispensable. To confine leadership to the rarefied stratosphere of the senior people in the organisation is not a surprising error when one realises that the early studies of leadership, conducted between the 1930s and 1950s, did just that. They concerned themselves with the great man or trait approach and tried to identify the distinguishing qualities or characteristics that exemplified great leaders. The studies showed that there was no single set of such characteristics or traits, but the preoccupation with studying the great men – and, latterly and rightly, great women – has lasted and is still reflected in books being published today.

3 ‘Tell me what I need to do to be a great leader! This is a very tempting invitation! However, it is almost impossible to do this without an in-depth understanding of the individual who is making the request and of the part of the health service in which they work … The nature of effective leadership depends on a variety of factors, and although it is possible to give a set of general pointers, genuine and helpful advice can only be given after there has been a period of diagnosis. I will say more about this later.

4 Leaders are born, not made. Ask any parent or schoolteacher and they will be able to provide evidence to substantiate a claim that leaders are born, not made. Leadership qualities can be seen in children at an early age, and many children seem to have a natural inclination – a gene – that makes them able and willing to lead others. Sometimes it appears as an ability to ‘boss others around’, which is often not the most attractive of qualities, but unquestionably there is something that sets some children apart as leaders from an early age. However, conceding that there is a genetic aspect to leadership is not the same thing as taking the view that because some people are born with a natural ability to lead, other people are doomed to be followers all their lives. Genetically inclined ‘followers’ can learn leadership skills and become effective leaders themselves. The analogy I use to make this point is taken from the world of tennis. I know that no matter how much I worked at it I would never have become another Pete Sampras or Roger Federer – I just did not have the natural athletic ability that top sportsmen need. However, I also know that if I had practised my tennis every day and been coached by a real expert, my serve and backhand would be very much better than they are at present. Training would have had a major impact on my tennis ability. It is exactly the same with leadership. You might never become the Federer of the leadership world, but your leadership performance can be enhanced dramatically.

As someone who has used that tennis example as a metaphor for leadership for many years, you can...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Preface to the second edition
• About the author
• Acknowledgements
• DISCIPLINES
• ATTITUDES
• Index