Leadership In A Changing Environment Nhs Management Essay

leading In A Changing Environment Nhs worry EssaySpending on the NHS has risen from 447m a year to 96bn fore reallyplace the last 60 years (Ham 1997), nearly a 10-fold increase later adjustment for inflation (Hawe 2008). In 2000 the Labour government initiated a architectural plan of investment of 7% bud under photograph increases for 7 years that was unprecedented for any(prenominal) healthc be system (Department of Health 2000). However, Andrew Lansley the naked as a jaybird health secretary, recently announced that the NHS budget would continue to rise above inflation in the orgasm years, but sign al st atomic number 18d that the NHS may need to make more than savings than the antecedently announced 20bn in efficiency cuts, a move health experts draw as extremely ambitious and unions warned could befool a de immenseating aim to on hospitals (The Guardian, 2010).The government say it is necessary to make savings on much(prenominal) a scale because of the squeeze in public spend. So the NHS, with a budget of 100bn amounting to a fifth of total public spending will oblige to do more with less.The individuals charged with steering the NHS with this period of relative famine will no doubt be required to display all the qualities of full(a) leading in score to tuck the demanding financial and strategic scraps that face the organisation. But what atomic number 18 those qualities? How be they cosmos developed indoors the NHS, and be they even the right qualities requisite to produce effective lead in an organisation as difficult and demanding as the NHS?This report starting linely takes a critical look at what might constitute good healthc are leaders with reference to the on-going NHS leading Qualities Framework (NHS Institute of Innovation and Improvement, 2005) and presents an alternative to the individual surface of seeing leading as a set of distinct private qualities, capabilities and/or behaviours. Some of the theo retical and methodological failinges of the individua leanic near shot are exposed in an attempt to challenge the circularize up potpourriula for good leaders, and argue that in the increasingly tough economic climate that the NHS has to fit in, a current style of leaders is required to meet the challenge of delivering high quality healthcare whilst balancing the books.Secondly we look at the type of organisational variegate over in facilitating this modernistic approach to leadership. Established works of ending alter are summarised and analysed to see if they might fit within this spic-and-span approach to leadership.Finally the author discusses his possess ain style of leadership in light of the findings and attempts to apply theory to practice within his own work milieu. leadinghip in the condition of the NHSThe NHS employs more than 1.3 million good write out spread across hundreds of organisations.Leaders of NHS organisations need to provide strong, stra tegic leadership for their organisation composition be held to account by topical anaesthetic uncreated Care Trusts (PCTs), Strategic Health Authorities (SHAs) and new(prenominal) regulatory bodies for across the country and locally set objectives.The execution of instrument of these organisations is dependant on the performance of clinicians who are often leaders in their own right, and due to the nature of their barter are expected to work under a great deal of autonomy.This is a problem that the NHS has been struggling with over its entire history. In 1983 the butt aced-up government of the time commissioned the Griffiths Report, which was a key trigger to the increment of focal point and leadership in the NHS.In the report, Roy Griffiths famously said, If Florence Nightingale were carrying her lamp by means of the NHS today she would be searching for the mountain in charge.(Griffiths, 1983). The report is shell known for recommending that general motorcoachs be int roduced into the NHS.During the 1980s, hospitals began to integrate the medical exam profession into the management structure. In the early 1990s, until now, with the introduction of the internal market, managers and leaders were tasked very clearly with balancing the books.This distort uped in managers becoming stereo personad as bean counters, a popular descrypoint still held by many a(prenominal) (Kings fund, 2009). It was important past that the publication of Lord Darzis NHS Next Stage Re gain in 2008 (Doh, 2008) shifted the commission from general management onto the need for more clinical leadership.Clinicians are beingness asked to subscribe to increasing involvement with the management agenda and take business for the delivery of services locally.As a result of this increased experience of a need for high quality leadership to deliver the NHS conception (Doh, 2000) in 2009 the Chief Executive of the NHS, David Nicholson, established, and currently chairs the N ational leaders Council (NLC). The Council has v main work streams Top Leaders, Emerging Leaders, Board Development, Inclusion, and Clinical Leadership. This phylogeny represents a switch from where commonwealth were left to work out their vocation options for themselves, to a more nurturing environment, with a greater counseling on tide over to both individuals and organisations.The Leadership Qualities FrameworkThe document that underpins the development of leaders by with(predicate) the (NLC) is the Leadership Qualities Framework which has a number of applications and builds on the increasing speech pattern in management recruitment, development and education on nurturing individual point of reference traits in leaders, with the sole advise of producing a set of abilities and transferable skills that sens be apply in a variety of situations and contexts. Through this approach, NHS organisations apply to produce conformable leaders, able to work across a confluence of intricate environments and systems typical of a healthcare organisation. The term leadership is applied then to those who come outingly possess the abilities deemed necessary to lead, such(prenominal) as discourse, tribe management, decision making and problem-solving. This dominant approach focuses on individual individualisedised qualities for leadership development and is the latest in a long kris of efficiency frameworks that have emerged in the last 50 years.The history of strength frameworksLeadership thinking has developed substantially over the last 50 years. The idea of individual character traits that started with Stogdill (1950) soon expanded into other schools of scene with McGregor pioneering the behavioural approach (1960) and Fiedler the contingency school (1967). These ideas were added to by Hersey Blanchard (1977) with situational leadership and fire with transformational leadership (1978). All these approaches focus on leadership as a set of qualiti es imbed in the individual and can be horizon of as competency approaches. at that place focus is on leaders who dissemble others inspire people push through transformations get the job through have compelling, even gripping visions stir enthusiasm and have personal magnetism (Maccoby, 2000).The NHS Leadership Qualities Framework is the latest such tool that adopts the individualistic approach with a focus on 15 core personal characteristics such as self-belief, empowering others, in tell apartectual flexibility, political astuteness and integrity. These personal qualities are doubtless important but do non probably tell the whole story of what makes a good leader. Sanderson (2002) makes the point that management is more likely a mo of complex contextually-situated interrelations, thoughts reiterated by Mintzberg in 2004 who suggests that our view of leadership is more likely to be an over-simplification of a vast pussy of environmental selective information compressed into a hardly a(prenominal) key people. So what are the major criticisms of competency models such as the LQF, and how might such a model have to adapt to ensure that the National Leadership Council produces the right kind of leaders inevitable for the future(a)?Weaknesses of competency approaches to leadershipThere are at least five areas where the competency approach could be seen to be flawed (Bolden et al, 2006). Firstly it can be seen to be reductionist in the awareness that it reduces the management role to its constituent separate sort of than seeing it as a whole (Lester, 1994 Ecclestone, 1997). Secondly, the competencies that are listed as prerequisites for good leadership are often generic with no explanation of the nature of the task or situation (Swales Roodhouse, 2003). Thirdly, that focusing on personal traits may reinforce stereotypes active leadership quite than challenge them (Cullen, 1992). Fourthly, that non enough attention is given to the subtle qualities such as the honorable and emotional elements of leadership that are difficult to quantify and measure (Bell et al. 2002). The fifth and final main criticism of competency frameworks is that their content forms part of an approach to education that aims to train individuals to improve their performance at work or else than develop more general cognitive abilities (Grugulis, 1997).If we accept the above weakness as legitimate, then it does cast doubt over the validity of competency frameworks such as the LQF to really select and develop leaders. Salaman (2004) suggests that these frameworks may actually be confusing the issue when he states thatThe problems it promised to resolve are not capable of resolution and its promise consisted largely of a sleight of give-up the ghost whereby organizational problems were simply restated as management responsibilitiesWeaknesses specific to the LQF allow the occurrence that the initial research on which it was built was taken from intervie ws with Directors and Chief Executives rather than observation of good leadership in practice (NHS Leadership heart and soul 2005). Also the qualities being promoted such as awareness, self-belief and integrity may be admiral in their own right but do not necessarily automatically lead to effective leadership. Bolden et al (2006) lists the characteristics as (a) a just aboutwhat persecutory list of oughts, and (b) suggest that the characteristics still do little to get effective leadership done. One may be visionary, communicative and middling and still find leadership to be elusive. This then is the great enigma clubhouse within the competency approaches that while they aim to highlight the skills that may be needed in certain situations, it is highly unlikely that people will encounter the exact same set of circumstances in their own practice because of the inherent complex nature of work life. Also, that while providing prescriptive solutions to problems may increase cons istency, they may stifle any master though in the leader wanting to apply their own ratiocination to the problem.The characteristics of the LQF seem then to be then a description of the qualities found in people in the top jobs rather than the prerequisites for leadership. The difference in viewing these traits as descriptive rather than prescriptive cannot be underestimated. much(prenominal) descriptions however tend to oversimplify and may prove to be of special, applicative value within the climate of complexity, interdependence and fragmentation that arguably characterizes multi-disciplinary organizations such as the NHS (Blackler et al., 1999). Additionally, individuals are likely to try and define themselves according to the incorporated language found within competency frameworks to legitimise their role rather than seek new ways of working and improving their practice (Holman Hall, 1997). passing back to Sandersons earlier point that management is more likely a conseq uence of complex contextually-situated interrelations, we can see how in a medical setting such as in a busy outpatient subdivision the needd outcomes can wholly be achieved as a consequence of quadruplicate staffing/patient/organisational/medical occurrenceors working in synergy. Successful leadership in this sort of environment is not likely to be the result of any one individual, but a result of all the characters aptly playing their respective parts. Marx (1973) suggests that we should not focus on a few key individuals when toil more or less to explain leadership in an organisation, because if we do so there is the danger that individuals become pigeonholed as either leader/ partner and the nuances of the group interactions as a whole become lost. He last describes the leadership focus on a few key people as an illusion. Using the earlier example of a trip to the outpatient part there is no point looking for a leader end-to-end the care serve well, as responsibility p asses amid various individuals, especially if you include the initial referral from the GP and follow up staff such as home armed service after the visit.Beyond individual competenciesSo if tralatitious competency frameworks, including the Qualities Leadership Framework are flawed, how can a view of leadership based on contextual factors better steer the future of leadership development within the NHS?Building on the initial thoughts of Marx in 1973, Bolden et al (2006) develop the argument that leadership is an organic process that is an ongoing, ever underdeveloped situation that individuals find themselves in whilst interacting with others. Leadership can come and go depending on the relationships that people have with each other and is inextricably linked to the token environment of the time. Like power, leadership is an internal relation, perpetually in-tension and subject to a myriad of meanings, values, ideals and discourse processes (Alvesson, 1996). One of the implic ations of reclassifying leadership in this way is that good and effective leadership cannot now be taught, only experienced by others.Sandberg (2000) interviewed assembly line workers and concluded that finding purpose at work led to appropriate competencies arising naturally. He proposes that by salty in dialogue to clarify a workers purpose leads to better outcomes compared to presenting them with a list of competencies to achieve. Within the outpatient department example it is likely that the unified sense of purpose will bind the individual players, creating an environment that facilitates the emergence of supreme behaviours when required.In light of the increasing economic constraints that health organisations have to expire within, it would be wise to promote leadership as potentially fond to all by placing more emphasis on personal autonomy. perhaps then this re-conceptualisation would go on a shift not only in how leadership is researched, but also in how it is recogni sed, rewarded and developed within the NHS. very much speaking the NHS demand to cast its net a bit wider when trying to define good leadership. It means opening up leadership from quintuple angles, searching its humiliated details, minor shifts and subtle contours (Dreyfuss Rabinow, 1982) to see it in the context of its environment.Bringing about organisational channelizeIn light of our proposal that it would be wise to promote leadership as potentially accessible to all by placing more emphasis on personal autonomy, there needs to be a way that leaders can disseminate this farming within their organisations. As many health organisations are built on strict hierarchical chains of command it is inevitable then that many organisation will have to go through some form of shade throw to embrace new ideas and practices. Many people working in health organisations will be familiar with organisational vary of some sort. But most would associate organisational neuter with shift s in management structures or indeed the creation/removal of whole new organisations. When morphologic change is implemented it is usually with the intention of act asing about change to meet wider goals such as introducing stronger leadership, achieving financial balance or heading a previously unmet service need. There is however an alternative, the option of attempting to change the market-gardening within the organisation to meet these same goals.There are a vast range of models for understanding organisational culture change which were reviewed by brownness in 1995. His extensive review of the literature identified five main models comminuted in Box 1.Lundbergs model, based on earlier scholarship- motorcycle models of organisational change emphasises outside(a) environmental factors as well as internal characteristics of organisations.Dyers model, posits that the perception of crisis in conjunction with a leadership change are required for culture change to occur.Schein s model, based on a simple life-cycle framework posits that assorted culture change mechanisms are associated with different stages in an organisations development.Gagliardis model, suggests that only additive culture change can properly be described as a form of organisational change.A composite model, based on the ideas of Lewin, Beyer and Trice, and Isabella provides some insights into the microprocesses of culture.Box 1 Five Models of Organisational Culture Change (Scott et al., 2003, adapted and derived from Brown 1995).No model is comprehensive enough to be said to be the definitive blueprint for change processes, but the merits and weaknesses of each are briefly listed in turnLundbergs model trope 1 Lundbergs organisational learning cycle of culture change (Lundberg, 1985) and reproduced in Brown (1995).Lundbergs model (1985) recognises the presence of ninefold subcultures that operate within organisations, and at each stage there are various internal and external conditi ons that need to be met in order to move round the cycle and for change to occur. It is not possible to go into all the detail that surrounds this model, but Lundberg describes the numerous precipitating events that can lightness change (otherwise known as the trigger events) before describing the types of strategies employed by leaders and the different forms of action planning required to bring about change.Critics (Scott, 2003) suggest that the model is rather mechanistic, failing to fully acknowledge the energy and uncertainty between cause and effect in organisational life. It also fails to address the political forces (doctor-managerial tensions) within organisations, or recognise the influence of key individuals and groups in facilitating and resisting culture change (Mannion, 2010).Dyers cycle of cultural evolutionFigure 2 The cycle of cultural evolution in organisations (Dyer 1985) and reproduced in Brown, (1995).Dyers model (1985) suggests that a crisis paves the way for a culture breakdown within an organisation, which in turn leads to the emergence of new leadership. A power struggle ensues whereby the new leadership has to assert their dominance over the old leadership by being seen to resolve the conflict between to two parties. To aid with this transition the new leadership introduce new values, symbols and artefacts into the organisation to banish the old organisational history. bare-ass people are recruited who support the new values and so the new culture is sustained.One advantage of Dyers model over many other theoretical models is that its two essential conditions for cultural transformation crisis and new leadership are relatively easy to identify and test in organisational settings. There is also a particular focus on leadership in organisational culture and change. However Scott (2003) again criticises the model for oversimplifying the change process, pointing out that the roles of the absolute majority of individuals in an organi sational culture are de-emphasised in favour of a focus on innovative leadership. Mannion (2010) mentions that Dyers model also fails to ask a of the essence(p) and rather obvious question about the causes of crises in organisations.Scheins Life bicycle ModelFigure 3 Growth stages, functions of culture, and mechanisms of change. Reproduced from Schein (1985) and reproduced in Brown, (1995)Scheins life-cycle model of organisational culture change (1985) suggests that organisations undergo the three distinct stages of birth and early growth, organisational midlife, and organisational maturity.In the early birth and growth stages the organisation battles with its identity, characterised by revolutionary change and possible challenges to the leadership from individuals from the old culture.The midlife phase is characterised by deeply embedded values that need be brought to the surface through organisational development to bring about change. Other factors that can precipitate change d uring this stage however are new technology, scandals (such as the Bristol heart surgery tragedy/Harold Shipman) and the gradatory drip feeding of new ideas by the leadership described by Quinn as Incrementalism (1978).The final mature stage implies that change would come substantially to this type of organisation. In fact the opposite is true, and companies may have to go through large turnaround projects to detour from their well established courses. Leaders are also more likely to need to use tyrannical strategies for change when more subtle approaches have failed to produce results.Gagliardis modelFigure 4 Gagliardis model Cultural change as an incremental process (Brown 1995)Gagliardi (1986) agues that rather than seeing old cultures as totally re dictated by new ones, the old ones are merely built upon to incorporate the new values. Leaders will ascribe success to the new ways of doing things despite the fact that the new process might have no connection to that particular outcome.This model of cultural change is interesting because it embraces the fact that gradual change can happen over time, and that the way that this happens can often be as a result of the way that successful leaders proportion the reasons behind the organisations success to previous decision making, even though those decisions would have made little or no effect on the result.The complex model of Lewin, Beyer and Trice, and IsabellaFigure 5 Understanding organisation culture change three related domains (reproduced from Roberts and Brown (1992)The final model of organisational change discussed by Brown (1995) is a compilation model based on the ideas of Lewin (1951) as modified by Schein (1964), Beyer and Trice (1988) and Isabella (1990). Essentially the model describes the three stages of learning as freezing- clinging to what one knows, unfreezing exploring ideas, issues and approaches and refreezing identifying, utilising and integrating values, attitudes and skills with t hose previously held and currently desired.The framework is very general and applicable to any type of organisation and to any aim within an organisation. However the model (much like Lundbergs in model 1) paints a very mechanistic picture of change, and it does not recognise the often agonised transitions that can to take place moving between the three stages.This type of planned change model is not without its critics, and Garvin (1994) argues that change cannot occur from one stable state to another in the turbulent business environment that exists today. Bamford and Forrester (2003) suggest that the planned approach assumes that all parties are in arrangement on their goals and direction and this is rarely the case. Hayes (2002) highlights that some organisations may have to change initially for environmental reasons but have no desire to define the end state. It serves then as a fairly limited descriptive tool, and does not attempt to inform as to whether any change programm e has been successful or not.In contrast to planned change, emergent approaches see change as less reliant on the manager (Wilson 1992) and less prescriptive and more analytical in nature (Dawson 1994). Dawson claims that change must be linked to developments in markets, work organisation, systems of management keep in line and the shifting nature of the organisational boundaries and relationships. There is therefore more emphasis on bottom-up action rather than top-down control in commencing and implementing organisational change. habituated the need for NHS managers to harness the cooperation of professional staff and work across complex organisational boundaries, emergent approaches are often well suited to achieving change because the role of senior management shifts from a controller to a facilitator.Personal responses to leadershipIn having to reflect on my own leadership style I am immediately presented with a dilemma. The objective of this paper was to deconstruct the est ablished models of leadership (including the NHS Leadership Qualities Framework) and adopt a new approach to leadership that incorporates the situational context and other social factors. I refer back to Dreyfuss Rabinow, (1982) who encourage us to open up leadership from multiple angles, searching its small details, minor shifts and subtle contours to see it in the context of its environment.There are at least five major weaknesses to this individualistic approach which have been discussed at length already, so I will not reverberate myself here. But essentially by subjecting myself to these established competency frameworks I would undoubtedly be shoehorning myself into a set of constructs that would probably do little to help me establish how surpass to operate in my individual working environment. To take this thought one step further I would say that the best leaders are therefore the individuals most able to analyse their environment, adapt their interactions and self actua lize within that environment appropriately.In light of the fact that NHS organisations are moving from large highly structured institutions to smaller stakeholder organisations with multiple players, the skills most required to lead will most probably be relational and persuasive. Perhaps then ones ability to interact with others according to model of relational proximity best describes the leaders of the future. This model lists the values needed for effective relationships such as focusing on the quality of the communication process, maintaining relationships, breadth of knowledge, use and abuse of power and valuing similarity and difference. I am again however again inclined to see this model as too prescriptive, and as Bolden mentions earlier lists the characteristics as (a) a somewhat persecutory list of oughts, and (b) suggest that the characteristics still do little to get effective leadership done.As a manager working in a primary quill Care Trust I am able to see first han d how the general move towards decentralisation with greater autonomy does seem to be creating a paradox within the organisation. The combined effects of outfit organisations splitting away from their provider arms and an increasing move towards an open market has created a more mechanistic approach towards commissioning and providing services. This seems to slug against the other central directive of rest flexible to meet local need.Effective leadership for me then and I suspect all working a healthcare environment is to somehow thread the needle by employing on the one hand a mechanistic approach that satisfies the performance management demands from monitoring bodies, while at the same time remaining flexible enough to respond to the changing healthcare marketplace.Concluding remarksThis paper has set out to demonstrate that the existing emphasis on developing leadership through competency based models such as the Leadership Qualities Framework is a flawed. Less emphasis needs to be placed on individual leaders and more attention paid to the environmental and situational factors that encourage leadership to thrive. The NHS is an organisation dependent on responsible divided leadership. It would not be accurate to attribute its successes and failures to the few as that tie-up is likely to be an over-simplification of a vast pool of environmental data compressed into a few key people.Organisational culture change was discussed as a vehicle for introducing new approaches to leadership and the five main models of organisational change as reviewed by Brown in 1995 were summarised and discussed. None of these models were found to comprehensively describe the change process and most could be accused of being rather mechanistic, failing to fully acknowledge the dynamism and uncertainty between cause and effect in organisational life (Scott, 2003).The mixed messages distributed by insurance makers centrally add to the confusion within healthcare, requesting tha t workers are both centrally accountable and at the same time expected to work flexibly and autonomously. The argument being then, that it is not possible (or even preferable) to maintain one leadership style in this context.Further research it seems is required to deepen our understanding of ideal environmental factors that allow leadership to blossom through bottom-up emergent processes as opposed to imposed top-down structural changes and rigid concepts of what constitutes good leadership.