Take me to your leader

What makes a successful leader in our highly complex healthcare organisations? Can you be a good leader without being a manager? Or a good manager without being a leader?  
    
The interplay between management and leadership skills has long been a matter of debate, but now the drive to improve management skills is clearly being replaced by a far more sophisticated approach to developing NHS leaders at all levels.
    
Earlier this year, health minister Lord Darzi and NHS chief executive David Nicholson announced the setting up of a new National Leadership Council to help nurture the next generation of NHS leaders. The former BBC director general Greg Dyke is one of five ‘patrons’ who join 25 core members and 14 fellows in this latest attempt to turn ad hoc arrangements into a coherent drive.  

A leadership culture
Improving leadership across the health service was a key commitment within ‘High Quality Care for All’, Lord Darzi’s review of the NHS. The plan is that the new Council will be responsible for building a strong culture of leadership across the health service. This will include:

• Gathering intelligence and evidence
• Setting standards 
• Taking a strategic role in commissioning leadership development programmes 
• Ensuring that leadership capacity is improved across the NHS.

To emphasise that this is serious, the Council will be a sub-committee of the NHS Management Board. NHS chairs and chief executives have been appointed part-time leads for the priority areas: clinical leadership, top leaders, board development, emerging leaders and inclusion.
    
NHS chief executive David Nicholson commented: “We are extremely lucky to already have fantastic leaders throughout the NHS. But if we are to realise our vision of an NHS that puts quality at the heart of everything it does, we need to embrace more leaders from all levels in the service and from a wider range of backgrounds.”
    
He continued: “The NLC will champion the new priority being attached to leadership in the NHS, to ensure that the system supports high quality leadership and to challenge it where it does not.”

Leadership development
At the same time, the Department of Health has published new guidance for talent and leadership planning aimed at encouraging strategic health authorities to design their own leadership development plans. By July, SHAs will be expected to have assessed the state of talent and leadership across their area and set out measures for fostering talent at a regional level.
    
All this Department of Health activity is reinforced by the creation of a new NHS Leadership Awards Scheme to champion leadership and quality throughout the NHS. The awards are for leader, quality champion, innovator, change leader, mentor, partner and an award for inspiration.
    
The idea is that you nominate one of your peers if they have shown outstanding leadership in these areas, and you have until 15 May to do so.
    
In Wales the NHS is well ahead of the game with its Care to Lead programme run by the National Leadership and Improvement Agency for Healthcare, with the aim of supporting existing leaders and developing leadership talent. This is seen as crucial in meeting the challenges of the strategic change agenda and deliver the service change and development. A range of programmes is designed to support the development of current leaders, board development, succession planning, clinical leadership and e-development and technology.

A top priority
At this year’s nursing summit, organised in January to generate and capture discussion about the key issues facing the profession, time and again developing leadership skills emerged as a top priority. Participants argued that the change needed to improve the quality of the patient experience could only come about by the emergence of effective clinical leaders who had the skills and the vision to transform patient services.
    
The medical profession has its own leadership concerns. When medical education was reformed with the introduction of the Foundation programme, it included competences for a range of leadership and management outcomes including team working, time management, communication, and managing and improving services. It is too soon to assess the impact of this but the doctors of the future should be more skilled at managing people and leading change.  
    
The stalwart work of the British Association of Medical Managers over the years has helped to make the concept of management respectable among doctors. BAMM runs Fit to Lead, which sets out a structure for medical leadership and management. Underpinned by a set of national standards, Fit to Lead measures the knowledge and skills already in place and defines a learning and development journey unique to each doctor on the programme. The Fit to Lead approach means that the overall needs of both individuals and the NHS can be met through personalised development programmes, leading to Certified Medical Manager (CMM), Advanced Medical Leader (AML) and then to BAMM Fellow.
    
An excellent summary of the changing face of the trust medical director role is included in one of the NHS Confederation’s recent papers on the future of leadership. It makes the point that if doctors are to be attracted to senior management roles, more effort should be made to communicate the positive aspects of the medical director role to junior doctors.

The Leadership Challenge
The allied health professions have also taken this on board and a special Leadership Challenge initiative is being launched by the chief health professions officer at the Department of Health to focus on these key professionals, who are often overshadowed by the larger groups in the workforce. The winning team from each regional Challenge will compete for the national accolade in June.

Through participation in the Challenge events, the aim is to provide AHPs with the opportunity to test their transferable skills in a range of business scenarios and to raise the profile of AHPs as transformational leaders throughout health and social care.
    
At the nursing summit, we heard first hand about the real enthusiasm with which the NHS Institute for Innovation and Improvement’s Productive series has been received by ward managers and clinical staff. Using the principles of Lean Thinking and Six Sigma it enables leadership teams to reduce waste and variation in personal work processes. It starts, for example, with the reality of the ward layout and the way staff move around it in order to devise ways to deliver care more effectively and efficiently.
    
One of many publications in the series is the Productive Leader aimed at helping managers to filter out time wasting activities and free up time to make the decisions that matter. The programme has been developed over a two-year period in co-production with NHS executive teams in acute hospital trusts, primary care trusts and mental health trusts.    
    
It features a combination of facilitated and self-development modules, supporting teams to identify improvement in high impact areas such as e-mail management, meetings and workload management.

Sourcing new talent
The Gateway to Leadership programme, now run by the NHS Institute, has been around since 2002, with the aim of sourcing new talent from the private, other public sectors and third sectors to the NHS, designed specifically to take the best senior management talent and enable them to progress to the highest levels within the NHS. It is recognised that the NHS needs to widen its managerial skills base at senior levels, taking the skills and experiences of senior leaders outside of the NHS to complement the strengths of existing management teams. So far, 160 managers have joined the NHS via this route. We do not know how many have stayed.
    
It has been a stock-in-trade for management trainers to draw a distinction between ‘management’ and ‘leadership’ but in the NHS at least the distinction is extremely blurred. A thoughtful paper from the NHS Confederation in its Future of leadership series, entitled Reforming leadership development… again offers the new Council the challenge of examining the system issues which prevent good leadership in the NHS and make the top jobs unattractive.
    
The Confederation is asking its members to engage in debate on such matters as how we get a more diverse leadership community and what are the incentives to ensure that all organisations take this issue seriously. At least 20 years of exhortation to develop leadership skills has not yet – apparently – embedded it in the culture. Perhaps less national direction and more local initiative and entrepreneurialism could foster the leadership culture more effectively than Greg Dyke and his merry band. We shall see.

Developing courses
Meanwhile at GateHouse we continue to develop our courses to meet changing needs in health and social care. One size does not fit all. A large mental health trust, for example, has recently signed us up to deliver our two-day New Manager course four times a year to scoop up their newly promoted staff and newcomers before they fall into bad habits or adopt role models that are not the best.
    
They see this as a valuable supplementary to their main leadership development programme, which by its very nature can’t encompass everyone who could benefit from it. And they have also identified a specific and crucial skills training need: How to have difficult conversations. All four hundred front line managers will have a day’s training on this key skill over the coming year.
    
We tell this story because sometimes you can begin to unlock talent, develop confidence in managing and inspire leadership by giving a person some ‘tricks of the trade’ in an area where they don’t know where to start.  

GateHouse is the training division of Chamberlain Dunn.

References:
NHS Institute for Innovation and Improvement  www.institute.nhs.uk
Productive Series;  http://www.institute.nhs.uk/quality_and_value/productivity_series/the_productive_nhs_leadership_team_-_making_time_to_lead.html
www.come2life.nhs.uk/gateway.
    
The ‘Inspiring Leaders: leadership for quality’ talent and leadership guidance is available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_093395
    
Wales National Leadership and Improvement Agency for Healthcare
http://www.wales.nhs.uk/sitesplus/829
Care to Lead www.caretolead.tv  
    
British Association of Medical Managers www.bamm.org.uk
Fit to Lead www.fittolead.co.uk
    
NHS Confederation briefings: Future of leadership
Reforming leadership development… again
Developing NHS leadership: the role of the trust medical director
www.nhsconfed.org/leadership

For more information
Contact Alison Dunn
Managing director
GateHouse
Tel: 020 8334 4500
Web: www.GateHouseCourses.com