Five thoughts from five years in the NHS; #5 – Leadership…

…a blog post about leadership in the NHS; this could easily have turned into one of the shortest posts I’ve done; there isn’t enough, what currently passes for leadership is woeful, we’re in crisis for the lack of it, we desperately need some, let’s get on with it; end of blog post and job sorted. But leadership, ah leadership, leadership, leadership, that old chestnut, like a scratched repeating record the need for it has become a crackling stuttering mantra echoing across the entire landscape of the NHS. Leadership appears to be the prime preoccupation of the great and good and apparently the desire of every underling and minion in the stifling hierarchical structures of the NHS is to be well-led by a great leader. We are told it’s the panacea we both need and want and just as in most areas of society where change is needed, everyone seems to be looking to someone else to deliver on it; Gandhi’s exhortation to, be the change in the world that you want to see, has not yet reached deep into the NHS. It seems that many talk about it, few really understand it and less practice it. So what does everyone mean when they talk about the need for leadership and bemoan the apparent absence of it?

invis-b2ap3_thumbnail_invisibleIf we use an oft-quoted, and difficult to better definition of leadership, namely that leadership is about setting the direction of travel and management is about addressing the speed of travel, then there is an elephant in our room that needs addressing, it’s a very large one in this particular case, but one that needs to be acknowledged and deeply understood before we can go any further. And it is that many of those we are encouraged to view as leaders or as being in positions where leadership is needed, the vast majority of those who occupy the highest positions in the various NHS bodies across the length and breadth of the land, are managers; very well-paid and sometimes very capable managers, but simply managers. They are not leaders, they have not risen to the positions they are in because they demonstrated great leadership, some have excelled in the practice of management, a practice within the NHS that does not offer much room for questioning or courage but amply rewards adherence to the ever-changing mantras of each new day, and they have been duly rewarded for this. It would not have paid them to be leaders or demonstrate leadership, and they would not risk all they have achieved to become anything more or do anything other than the management role that has rewarded them; it is just not in their interest. We are awash with able skilled managers, unfortunately they are held up as leaders and much of what they do is passed off as leadership. Sure, many of them can fly a desk with the skill of a stunt pilot, speak with conviction, manage diaries with aplomb and some can navigate a spreadsheet like a seasoned explorer; just whisper the words “corporate governance, integration or implementation plan” into their ears and some go weak at the knees (show them a new matrix and some will faint); but they are not leaders.

And this is not a criticism or a slight, I am not talking about a separate race of different inherently bad people, it is simply an observation about the way systems of performance and reward are structured in the NHS and the wider Public Sector…it is just not a place in which there is much tolerance or room for true leadership; how could it be when the direction of travel and the targets to chase, often arbitrary and meaningless, are set by others? True leadership is seldom rewarded, often punished, and many a “successful” publicly funded career has had to be built on the principle of chasing the target and missing the point.

You manage things you don’t manage people, you lead people, you don’t manage them…the emergence of the knowledge workforce, an increasingly educated workforce of well qualified often experienced people has not yet been fully acknowledged by many in the NHS. The management principles of Taylor et al, are no longer the best way to manage situations and deal with people in a knowledge era and a world of uncertainty and unbounded complexity. Managers apply the wishes of those above and leaders challenge, question and shape the thinking of those above. Leadership is about creating the conditions in which things can happen, and the best generals, if that’s not an oxymoron, are those who shield their troops from harm and avoid battles at any cost, not turning left, right or forward at the whim of those in an ivory tower. Management in the NHS and wider Public Sector appears to have become the unquestioning application of objectives and measures from on high without taking any responsibility for what the unchallenged application of these may ultimately lead to. Managers are passive, they see the world unfolding around them and they don’t think, “I was part of creating this, my behaviour is shaping this”, they simply say, “that’s the way things are” and continue doing what they are doing”…like hapless actors, starring in a play that pays well with an unhappy ending, a play, who’s script and depressing finale, they do not even see they had a hand in shaping. Another truism that has not yet landed in the NHS is that we are where we are now because of the decisions we made in the past. Management and leadership in the NHS appears to encourage responsibility without accountability. I have yet to come across a senior Public Sector manager who has put their hand in the air and said, “the mess we are in now is partly down to me”…but I live in hope.

leap-downloadDo you remember that child at school who was always doing stupid things and then being asked by the teacher why they did them, the reply would often be, well Sir, Tom told me to do it and everyone else was doing it and so I did it, but I wouldn’t have done it if they hadn’t been doing it…I remember my teachers response to this, and I imagine your teacher used the same riposte, if they jumped off a cliff would you follow them? This old analogy seems to sum up the current world of NHS Management and Leadership, like Lemings in suits, we continually and unquestioningly find ourselves jumping off the edge of spurious challenges, “because everyone else is doing it”.

This is not me saying that we in the NHS are not intelligent; many of us are. As Darwin observed, those species that survive and thrive are those that adapt most readily to their environment. The question is, does the environment, the systems and structures we attempt to operate within, enable the cleverness and intelligence that undoubtedly exists to be applied and serve the public purse in the best way possible, i.e. with altruistic intent for the greater good…the answer is self-evident. And yes, there are exceptions, I have had the pleasure of meeting some and working with them, and as with all exceptions, they only serve to highlight the issue even more definitively. Just think for a moment of the titles we give to those who demonstrate leadership, “edgewalkers, disruptive innovators, boat-rockers”…we have even managed to normalise the use of the term “whistleblowing” as an acceptable way to describe truthtelling. I wonder if something has gone wrong when we use such terms to describe people whose only crime is having a moral compass?


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