Guest blogger:
Karen Lynas, Head of Delivery/Deputy Managing Director at NHS Leadership Academy
“With the NHS facing huge challenges in emergency, acute and primary care, finances squeezed and a new commissioning landscape to navigate, now is the perfect time to invest in developing leaders.”
What is the thing you wish you had known before you took the job you’re now doing? If you could write a letter to your younger self about how to prepare for it, what would it say? Would it be about the skills and knowledge you needed but didn’t have − and didn’t know you needed until you started? Or about the people you would be working with and how you needed to learn a bit more about yourself to manage them well and positively? Would it be about the energy, enthusiasm, tenacity and resilience you were going to need? Maybe it would concern how to network better? Or perhaps something else entirely.
We have such a diverse range of leadership roles in the NHS that understanding the role you are about to move into can be difficult; preparing for it even harder. The truth is we haven’t yet done what most industries do routinely and what many FTSE 500 companies describe as one of their “differentiating success factors”: provide structured development to spot, nurture, train and support leaders in their organisations to prepare them for their next role.
If you are really lucky, your organisation will do this − and there have been some excellent regional initiatives supporting people in transition. But the NHS has never put industry-wide, sufficiently resourced, high-quality leadership development in place − a system that would prepare people for their next role rather than help them once they’ve moved. Until now.
Be prepared
The leadership role is complex at every level. Getting it right is tough and getting it wrong is disastrous to the people who most need our support. So the NHS Leadership Academy is attempting to change that. We have put together five national core programmes, from entry level to the most senior leadership roles in the service.
Open to all those working in health and care and NHS funded care, these programmes exist to help prepare you for your next leadership role, and successful completion leads to an award that demonstrate your readiness to do the job.
I know the questions you’re asking. So what? Why now? Accident and emergency departments are bursting at the seams, nurse staffing levels are under real pressure, GP surgeries are packed, elderly patients are stuck in hospital because social services are under pressure, finances are constrained and the squeeze is getting tighter.
Why choose now to take people away from their jobs to develop their leadership potential? What’s the benefit of investing all this money?
The answer is these challenges make it precisely the time we need to do it. This work isn’t a distraction from solving the problems we are all currently facing − it is a big part of the solution. We have a whole new architecture being led in many parts by people new to the role and struggling to find their way through what they have inherited − they need support, wisdom, knowledge and experience.
A simple solution
We have staff working in provider organisations who truly can’t continue to do more of the same − just harder and faster, while getting those around them to do the same. They need new solutions, new skills, new knowledge and new ways of leading, engaging and motivating others.
If the NHS is to survive as a service that meets the changing needs of our population, then it also needs to change to meet its own needs. I don’t think we should expect those leading our services, at whatever level and from whatever profession, to be able to do that without real support and development. That includes learning from the best in the service, from other industries and from other health systems. It includes looking at their challenges with new eyes and fresh ideas; rethinking how the way they lead can liberate and engage the people who work with them.
It is this kind of radical thinking and support that will contribute significantly to moving us from where we are now to a safer, more sustainable, more effective, response and innovative NHS.
So let’s not leave it to chance anymore − moving into a job you think you might know but have never been properly developed to do. Where you are expected to have all the answers when you barely know the right questions, or absorb through osmosis all you should know about the impact your leadership has on others. And whether that is good, bad or indifferent.
You deserve to be supported to learn with others about how together we can start to change the way we work right across the system. Invest in your staff and they’ll look after the rest − it’s that simple.
(This article was originally published on the Health Service Journal website on 20 May 2013.)
The Open University 
Hi Karen, I love reading about the NHS because it is such a fantastic concept with great people but is appears to be stymied by invariably getting itself wrapped around the axle of being unable to effectively mix management and leadership.
I am in the process of writing a book about leadership lessons as a leadership practitioner, some of which is very personal and is inevitably biased. However, one aspect I have always felt we have got wrong in our large public organisations (and I work in one) is that of structures and the impact on behaviours and culture. I have cut and paste a draft piece from my book to try to highlight what I mean, hope it is of some interest or stimulates debate.
Regards garry
Turn it upside down. Every organisation I have worked in, every handover of post briefing pack, and every presentation I have attended that involves a briefing about a department/company, includes a hierarchical diagram. They have all shown the CEO, or equivalent, firmly at the top and the workforce at the bottom. To me this is a complete anathema and runs wholly against that oft cited sound bite of ‘our people are our greatest asset’. I am sure the CEO feels very valued and respected but how would you feel if you were a member of the workforce? You spend your day working to deliver the output and you are always at the bottom! I would suggest the reason an organisation thrives and exists is through its output which is delivered by, the salesperson, the production worker, the doctor, the teacher. The CEO has a vital part but if he or she wasn’t there for a period of time would the production stop, the answer is no. Take away the teacher and children don’t get taught, the doctor and patients don’t get better, the production worker and no products are produced therefore no profit. I would offer that if you turn the hierarchical diagram upside down, placing the workforce at the top, it results in up to 999 people (in my case) feeling important not one, and it helps to stimulate supportive organisational cultures and behaviours. Moreover, it clarifies who is supported and who are supporting. This doesn’t mean the latter group isn’t important but it does allow leaders to keep focussing on output and effect. This is particularly relevant in those often precious environments of the central office or headquarters where there is a pervasive feeling of self- value and importance, by dint of the proximity to the ‘power’ of the organisation (I have worked in them and been just as guilty). Truly ask yourself how much of the effort of a central headquarters team is directed outwardly and upwards and not inward and supporting of those who are delivering the organisational outputs? Furthermore, is the prevailing attitude one of ‘I must support those who are delivering the organisational output’ or is it one of expecting the workforce to support them in their outward facing efforts with requests for information. My experience is that the answers are most headquarters effort is focussed away from the delivery end and the prevalent attitude is that headquarters are there to be supported. The result being there are normally two disconnected organisational elements, the workforce and the headquarters personnel, when they should be working together and focussed on organisational output. As a minimum this causes tension and wasted effort however at its most extreme you end up with an Enron situation or Staffordshire NHS Trust situation. At Enron the leadership and headquarters staff ended up creating a cloud cuckoo land self licking lollipop. The overarching focus at Enron was on share value which, alongside some pretty unethical leadership, which helped foster a move away from focussing on the core business of finding and selling energy to manipulation of figures and markets within the headquarters, and ultimately the collapse of the organisation. Whilst in Staffordshire the CEO admitted that the Trust had moved to focussing on statistics not on patient health. I would offer that a genuine belief in ‘turning it upside down’ may have helped to prevent the gradual drift away from core activities that occurred in both environments. Just sticking with the NHS for a moment, and I know I am beginning to sound like an apologist for the organisation, but I do think makes a fantastic leadership study. It is interesting to review the response to the criticism by the outgoing Head of NHS, at the UK government over their interference and negative impact on delivering the NHS mission and transformation. The Department of Health stated:
For too long the NHS was run as a top-down system. We believe that it should be able to operate independently, making the decisions and changes that patients really need. That’s exactly why we introduced our reforms, to put doctors and nurses in charge and set up NHS England, to deliver the high quality health service patients expect’.
This all seems very laudable but when you consider the statement it appears that the DoH, a politically led ministry, recognise the problems of a ‘top down approach’ and then go on to outline how, they at the top of the organisation ‘have introduced our reforms’. Whilst the DoH and government have stressed the need to reduce targets which stimulated some 260000 data returns in 2010, there is still appears to be a lack of clarity, and agreement regarding the mission of the NHS . Is it to provide data for patients to have choice, or is it to put the needs of patients first? If the latter, which I feel it should be, then focus on that, I suspect most people want a local service that delivers a decent level of care and one which delivers fixes the problems, or eases the problem where this isn’t possible. I recently had a significant period of treatment which just about broke or stretched all the NHS target times on the advice of the medical staff. Had they applied the targets my time in treatment would have been much longer and the likelihood of complications would have been much higher, guess which advice I was happier with! It should also give us faith that the NHS does have leaders who are prepared to make a decision even when it goes against extant policy and guidance.
If you really focus on the fact that ultimately the organisation exists to deliver the organisational outputs, otherwise it would not exist or survive, it results in a different organisational culture. Shareholders and external stakeholders are important and as a leader you need to be aware of their influence but it doesn’t matter if you are Shell, Oxfam, or the military, without the respective, discovery and exploitation of energy, provision of charitable aid, or the successful prosecution of operations, the organisation will wither and perish.