Can best practice leadership save the health service?

Weak leadership and management are considered to be a significant cause of poor organisational performance. The health service’s continued struggle to develop leadership could be a major factor behind the reports of NHS hospitals that are considered to be ‘failing’ could be handed over to private sector managers. So as health secretary Andrew Lansley looks set to announce new measures that will affect trusts’ financial health, it is time for better leadership, but what can be done?
Given that priorities lie with delivering a comprehensive set of services on a day-to-day basis, with teams at all levels having headcounts challenged, it is no surprise that there is often little funding left over for training and development in leadership skills. However, this short term thinking, especially where what funding there is often gets allocated to senior positions, can see the problems being compounded. If this attitude is allowed to persist, there is the danger that the health service will continue to make the same incorrect assumption as many private and public sector organisations: that leadership and management skills are only required above a certain level. In the day-to-day workplace, however, whether you are talking about the shop floor or the ward, leadership and management is taking place all of the time.
If weak leadership and management are a significant cause of poor organisational performance, does that mean that health organisations should be investing heavily in their leadership and management development? Not exactly, because the issues are more complex than simply to do more training.

Key questions
There are several key questions when considering the impact of leadership and management development on organisational performance. Has development improved the capability of leaders and managers? (Do they know how to perform effectively and how to put this knowledge into practice?)
How significant is this enhanced managerial capability compared to other externalities in determining organisational performance? (Are leaders and managers able to apply what they have learnt? How much do factors like the government policy or technological change limit the effectiveness of managerial decision-making?)
The evidence is well summarised in the report ‘The Development of Management and Leadership Capability and its Contribution to Performance: The evidence, the prospects and the research need’.
It suggests that the first relationship – between leadership and management development and capability – is clearer than the second – the impact of leadership and management development capability on organisational performance. This is simply because so many of the factors shaping the latter are down to externalities. However, that doesn’t mean that we have no idea, and organisations that don’t make sure that they are maximising the impact of their investment in leadership and management development may well be wasting much of their money.

Effective development
The first, and most important step, is to ensure that a leadership and management development programme is designed to ensure that leaders and managers are more capable of performing their role. The three key factors that need to be considered are: the quality of the development programme; the strategies for ensuring learning transfer; and the level of organisational commitment and support.
There are so many dimensions of quality in the design and delivery of a learning programme, but a good quality programme will incorporate some form of assessment of learning need – what needs to be learnt – leading to clear and agreed learning outcomes. Clearly the people, learning materials and other resources used need to be able to deliver these outcomes to these learners, and the programme needs to be designed to use these resources effectively to achieve the agreed outcomes. Furthermore, there is little point in going to all this trouble if no effort is made to assess whether or not the learning outcomes have been achieved.

Learning transfer
Part of the programme design should be to ensure learning transfer. Learning transfer is the process by which what has been learnt is transferred into the workplace. Without careful attention to this aspect of the programme there is no guarantee that individual performance will be changed. There are two broad dimensions to learning transfer, ‘hugging’ and ‘bridging’.
‘Hugging’ means making the learning experience more like the ultimate applications. To achieve this, development should address the realities of the working environment, be practical and encourage learners to use their own work tasks and problems as part of the learning process. Incorporating techniques into the programme like coaching (which takes learning into the workplace and focuses on application in specific work contexts), Action Learning Sets (which bring the workplace to learning, addressing workplace problems) and work based learning and assessment (to engage earners in practical tasks to stimulate and apply their learning), will help to encourage ‘hugging’.
‘Bridging’ is all about making conceptual connections between what’s learned and other applications. Development should not consist of fragmented elements of learning, but should be fitted into a broader picture to enable greater understanding. This doesn’t preclude using short, focused learning activities, but requires those leading the development to fit it into the larger picture.
It is clear that to achieve this, a dialogue between those delivering the training and those commissioning it is essential. The resources devoted to initial diagnosis, making sure that the programme is well designed, and to assessing the effectiveness of the programme in achieving the learning outcomes, is all money well spent.
Furthermore, the support of the organisation is critical. This means that line and senior managers are committed to the programme and actively engage in ensuring that it works. This can mean using line managers and technical specialists as mentors to support learners or creating systems to provide 360o feedback to managers. This will help them translate learning into action and make L&M development part of organisational strategy.

Improved organisational performance
It’s a lot easier to be prescriptive about what it takes to ensure that L&M development improves capability than it is to say how this will affect organisational performance. The Institute of Employment Studies’s report ‘The Comparative Capability of UK Managers IES for the SSDA’ says: “The approach to management development emerges as of significantly greater importance than the amount of development which takes place. The clear message is that smarter working, such as embedding development within an overarching strategy of the organisation, reaps dividends.”
Furthermore, the IES report concluded: “The management and leadership development that contributes most clearly to performance is that carried out in or close to organisations, and for managers and leaders who are in or entering posts.” So, if you want Leadership and Management development to have an impact on your organisation’s performance, don’t rely on what happens to be available locally, but treat it as part of your organisational development strategy and commission programmes that directly address your needs.

ILM is the UK’s largest L&M qualification awarding body by far and we have made every effort to ensure that the characteristics outlined above can be built into programmes offered by our 2,000 centres worldwide. ILM has taken advantage of the opportunities offered by the new Qualification and Credit Framework (in England, Wales and Northern Ireland) to enable its centres to create flexible, tailored programmes that incorporate the features that ensure that the investment made L&M development is translated into enhanced capability and, as far as it is possible, into improved organisational performance.
Furthermore, by offering qualifications for all levels of management, from team leaders to chief executives, there is consistency in the principles and practices that are being learnt. By making sure that every manager in the organisation has a similar understanding and a common vocabulary for communicating with others, the organisation can have greater confidence that its investment in leadership and management development will produce real returns.

David Pardey is the senior manager, research and policy for the Institute of Leadership and Management (ILM).

UK Competitiveness: moving to the next stage Michael Porter & Christian Ketels, DTI Economics Paper 3: 2003
The Development of Management and Leadership Capability and its Contribution to Performance: The evidence, the prospects and the research need, John Burgoyne, Wendy Hirsh and Sadie Williams, DfES Research Report RR560: 2004