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Great leadership needs strong support to flourish


By Dennis Bacon
21 June 2019

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The NHS can’t thrive without excellent leadership, and excellent leadership can’t prosper without support, says Dennis Bacon

Many healthcare leaders today feel understandably overwhelmed by the situation they find themselves in, as rising demand for services, scrutiny from regulators and a tsunami of new initiatives conspire to build pressure.

It’s a demanding and often isolated position to be in, one that requires key competencies, for example management and financial abilities, and attributes such as integrity, strong communication skills and the ability to listen, learn and lead.

The majority of those in leadership positions are in a senior role because they are regarded, hopefully accurately, as skilled and good at what they do. Most have also been part of the healthcare system for many years, which can be both an advantage and a disadvantage.

However, neither professional competency nor longevity in the job automatically makes for an effective leader – there is much more involved. When it comes to those who have worked in the NHS for a long time, there is a risk that this produces savvy senior managers who are successful at navigating a complex and fragmented system but unsuccessful at lifting, inspiring and connecting with their teams.

The system often unwittingly ends up creating leaders very much in the mould of those who have gone before them – despite knowing that simply maintaining the status quo is not the answer to making the health service fit and viable for the future. The NHS system is built around the concept of command and control, an approach that means reasons are frequently found not to do things differently or to innovate. It’s a system that’s risk-averse to the point of avoiding potentially transformative decisions because something might go wrong.

Once they reach senior level, many NHS leaders are in need of a different skill set, but find themselves without anywhere to turn for support in developing these skills. Much like football managers, NHS leaders need to be given time, as well as assistance, to acquire the right leadership skills.

Ideally, mentoring and transitional support should be available, but the scarcity of human resources within the health service currently makes this very unlikely. The NHS Leadership Academy is doing some good work in this area, but for me, a great deal of that work is predicated around frameworks that are voluminous, cumbersome and hard to navigate.

The fact that most NHS leaders have limited available time also means many of the ‘solutions’ offered today are unworkable and ineffective. Traditionally configured learnings sets, courses and seminars often only add to the feeling of being overwhelmed and struggling to cope.

It is now widely recognised that leadership and culture are two key and inextricably linked components in driving improvements in patient safety and satisfaction levels, operational effectiveness and innovation – and NHS leaders need support to be able to power this.

However, the fragmented nature of the NHS, combined with some occasionally very odd procurement practices, have led to a situation where there is little alignment between the leadership support programmes chosen by different parts of the health service. It has also meant that there is scant opportunity for the NHS as a whole to cohesively assess which measures are working and which are not. Current and future leaders need a more targeted and practical way to access support.

A key question to answer when it comes to examining the type of leadership support the NHS should be providing is which skills and attributes we need to teach our leaders to allow them to do their jobs to the best of their abilities and enable the delivery of excellent care. In addition to the knowledge and qualities mentioned at the beginning of this blog, this should also include visibility as a leader and having a people-centred approach.

Leaders need to be able to create an open and inclusive workplace culture that deals with discrimination, bullying and harassment head on. However, culture can never work well where inspired leadership is absent, and great leadership needs mentoring and support to flourish. NHS leaders would therefore benefit from support that is directly and inextricably linked to culture, to allow them to create a positive and thriving one.

Dennis Bacon is chief executive of Pulse, which specialises in creating positive workplace cultures in sectors including the NHS

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