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What makes a good leader within the NHS?
In a time of constant change and upheaval, leadership has never been more important. John Yates, group director at ILM, discusses leadership at all levels and why support to leaders is critical
When it comes to effective leadership, the UK has a skills gap that spans all sectors with UKCES finding that 500,000 new managers are needed by 2020; and 46 per cent of employers struggle to recruit leaders overall. The public healthcare sector is no exception to this shortage either. In his 2015 review of NHS leadership, Lord Stuart Rose raised his concerns about the NHS not having the leadership capability to deal effectively with the changes demanded of the service.
Whether it’s changing the way that services are currently contracted, ensuring greater savings and efficiencies, or finding skilled professionals in a complex recruitment landscape – NHS leaders need to be able to work in a constantly shifting environment. More than ever before, we need leaders within the NHS that can face up to the challenge.
Sink or swim
We frequently hear that those with leadership responsibilities are not given development or support to learn the skills required for such a role. For example, clinicians in the health sector tend to be promoted into leadership positions because of their medical expertise and clinical experience. When promoted, they are expected to pick up leadership skills naturally rather than being taught best practice methods to manage others. This means that clinicians are thrust into leadership positions with the right medical expertise but not necessarily the leadership skills to manage and nurture staff. As highlighted in The King’s Fund report ‘The future of leadership and management in the NHS’, many clinicians in leadership positions experience a disconnect between their day job requirements and leadership expectations – not knowing how to strike a suitable balance.
This sink or swim approach to leadership, having to learn on the job, is often at the expense of those they are managing. We can all think of bad leaders we’ve had in the past – those who handled a conversation insensitively, or those who we doubted really listened to our concerns before providing an ill-fitting solution. In order for professionals to be effective leaders, training and development is required to help them hone skills such as active listening and empathy.
Leadership at all levels
When we discuss leadership development, it’s all too common to think in terms of training those at the top of an organisation. But actually, leadership skills are needed at all levels of an organisation – so we should be thinking about those starting their careers within the NHS right through to the senior ranks. Leadership requires negotiation, motivation, risk management and problem solving skills (to name a few) and whether entering a first line management role or leading an entire department - these skills will always be needed.
Learning doesn’t stop once a training programme is over either; leadership skills need to constantly adapt and develop. We now have an unprecedented four generations working together in the workforce – meaning that different leadership skills need to be utilised to accommodate differing generational expectations. Someone that entered the NHS workforce in the 1970s, for example, will no doubt have seen the significant changes it has gone through over the decades and have had to adapt their practices. So why should leadership skills be any different? Effective leadership styles that worked then are likely to be outdated now and need modernising to meet today’s workplace demands.
The only constant in the NHS is that change is a constant. Leaders need to be able to navigate change themselves, whilst helping others to understand where they fit and their role and responsibilities. A frequent complaint we hear from those working in the NHS is that it’s difficult to find who is responsible for a particular task or service, being passed from pillar to post as individuals cite that it isn’t their responsibility. Therefore each time change occurs, it’s vital that roles and responsibilities are revised within this to ensure they are still fit for purpose and clearly understood. Leaders must communicate this to their direct reports, helping them to understand where they fit and what their responsibilities are.
The NHS staff survey also found that only 43 per cent felt able to meet the conflicting demands on their time. Leaders play a key role in supporting employees in managing their time, by understanding what pressures they face and helping them break it down into essential and non-essential activities. What may seem like an urgent activity due to pressure from other stakeholders, may not be a priority in the leader’s eyes – so it’s important to know how employees are managing demands on their time.
One tool leaders frequently use to support employees in their daily working lives and career progression, is coaching. It’s a technique whereby the leader helps the employee to find a solution to their work problem that works well for them – rather than the leader imposing an answer on them. It is an effective way of teaching people how to problem solve and think differently in their approach to work, rather than relying on seeking answers from others. During times of instability and flux coaching techniques are useful, as it helps individuals to work out solutions for themselves rather than simply await further instruction.
South Staffordshire and Shropshire Healthcare NHS Foundation Trust (SSSFT) has created a culture of coaching across its hospitals. Through ILM accredited training in coaching, the programme reaches professionals from Shropshire to the Isle of Wight, helping them to build and lead effective teams of clinical and administrative staff. The trust has since seen a positive impact on both new staff joining the trust and on those transferring as a result of acquisitions.
Theresa Shaw, head of learning and development at SSSFT, comments: “As a trust, we wanted to build our teams and equip our leaders with the skills needed to manage transitions in the workplace. We wanted to empower employees to take ownership and responsibility, helping them to be more resilient in an ever changing trust. The programme has given them confidence in their skills and helped them to develop others too.
“We’re really proud of what we’ve achieved to date. In fact we are only one of three mental health trusts in the UK to receive a good rating in the Care Quality Commission’s (CQC) inspection report. Our investment in employee development has really helped to ensure that we have a productive and engaged workforce.”
Another challenge that cuts across the whole NHS sector is motivation. When taking into account cuts to funding, extended hours for GPs and strikes by junior doctors, it’s understandable that morale has been low in the NHS organisation in recent years. Trusts are having to hit targets for cost improvements with less and less resource, with services being stripped back. When staff are under more pressure than ever before to provide their patients with the quality care under strained resources, personal motivation suffers and there is a conflict with values.
Leaders play a crucial role in aiding motivation. Celebrating successes, encouraging staff to take control of their own careers, and helping them to source new opportunities to learn and develop are all ways that can help motivation. Wide geographical spreads often make this more challenging too, as professionals are rarely all together in one place. So it’s important for leaders to think about how to motivate a highly mobile workforce. Sending e-mails is one, often overused, tool - but leaders that make the effort to have face-to-face time can dramatically help to improve morale too.
The NHS Staff survey found that 14 per cent of staff hadn’t received an appraisal in 12 months, rising to 34 per cent for ambulance trusts. In order for employees to feel truly engaged in the workplace, they also need to be assured that they have a career and a future with the organisation. Leaders within the NHS can support this, by holding regular career conversations and formal appraisals.
Leaders at all levels within the NHS face ongoing transformation, which requires regular support to ensure they have the skills needed to navigate such a rapidly changing environment. Not only does teaching individuals’ leadership skills help them to manage their direct reports, but it also has a positive impact on patient care too. Using vital communication tools to manage daily work can be used across multiple stakeholders – helping them to manage work more effectively. We have incredible talent within the NHS; let’s see it flourish.