Combining leadership skill and management capability

Chris Lake, head of professional development at the NHS Leadership Academy, explores why leadership and management are equally important – and why they can’t work in isolation.

Having spent twenty years in the business of studying leadership and developing leaders, there’s not a single definition of leadership, or even a set of definitions, that are nearly as coherent and unified as there are for management.

There are however some fairly coherent and consistent definitions of management. When we talk about management, most people would say pretty-much the same thing; it’s about planning, organising, commanding, coordinating, controlling and so on.

The NHS is strapped for cash and social care has had money stripped out of it. Performance is slipping, and the people within the service that I talk to, especially the middle management tiers, are saying morale is diving. It’s an old time adage that ‘morale has never been this low’ – right now, that might actually be true. Pressure, staff turnover and sickness absence are all going up and we’re at risk of patient care declining. In a climate where all these things are the norm, the usual response is to stay firmly ensconced in management territory. We need to balance the books and achieve a reduction in the deficit, so we hear words around the system like ‘grip.’

Three to four years ago, when stats were more palatable, we’d be more likely to hear words like compassion or care, but the pendulum has swung so far towards management that we’re at risk of damaging patient care.

What happened at Mid-Staffs was understood to be a failure of leadership, and within that, purpose. Did people working at Mid Staffs know why they were there? Was it to achieve Foundation Trust status? To make the books balance and hit targets? Or was it to care for patients? My point is that what happened at Mid-Staffs was a leadership issue, not a management one.

Different types of leadership
Henri Fayol listed five functions of management and Henry Mintzberg developed these into the ten roles of the manager. Both lists describe more-or-less the same territory. However, in leadership studies there exists a plethora of definitions and theories, many of which bear little relation to each other.

I’m not going to offer a definitive description of the leadership task – unlike ‘management, the field of ‘leadership’ is too broad to condense into an (over-) simplified list. However, I will offer that, when we are thinking and talking about leadership, it would serve us well to ask the question - ‘what field or scope of leadership are we talking about?’

Distant or strategic leadership: The aim here is to have a positive effect on the performance of a whole organisation. It’s about the top of the organisation; scanning beyond the organisation and developing and communicating the strategy. It’s about having an impact on the whole organisation and the people in it; many of whom you’ll never meet

Nearby leadership: This is about having a positive effect on the people you work with and alongside; it’s about people leadership, team leadership and peer relationships. It concerns what the Academy often describes as the fundamental question of what leadership: ‘What’s it like to be on the receiving end of you?’

Systems leadership: This is about working in service of the population that you serve, across and beyond organisational boundaries with other players in the system. These are people you over whom you have no direct ‘control’, you don’t share budgets, you report to different masters, and probably have different background and different cultures

Management and leadership are equally as important
One of the main drivers for our change to The Mary Seacole programme was the need for more practical management skills for up and coming and first time leaders. The need for more practical management skills at first line leader level was clear feedback from HR directors.

When first time leaders get into post they need core management skills in finance like budgeting and writing a business case, and HR fundamentals like annual appraisal, recruitment and selection, handling grievances and sickness absence. Management knowledge and practice for service improvement is also critical. And there are lots of tools to help drive up quality, consistency and efficiency and drive out unhelpful variation and repetition.

The size of the overlap between leadership and management is debatable and hugely subjective. For the NHS, almost all jobs require a good slug of leadership skill and an equal measure of management capability, because that’s the lived reality of most of the managers and leaders in our system – both clinical and non-clinical. We need to develop both.

How the Academy can help
Almost all of our programmes and tools develop management skills and leadership practice side by side. Yes, we’re the NHS Leadership Academy as opposed to the NHS Management Academy, but the content of our programmes, the learning outcomes, the development practice and the programme designs are based on what people in healthcare leadership positions really need: the skills, knowledge, attitudes and behaviours of both leadership and management.

So one day you’ll be learning about your impact on other people, or indeed organisations (leadership) and another you’ll be taught how to understand things like governance, risk, finance (management). We wrap all of these things together in a coherent programme of development – it complements people’s daily realities of being a manager/leader in their organisation and is much more impactful. After all, no one really does management in the morning and leadership in the afternoon.

Specific examples of overlap include: service improvement - this is a prime example of management and leadership working in harmony with one another. The management tools are there so that everyone knows what to do and the leadership approach engages people in doing it; and annual review - a good manager knows how to structure an annual review when they have someone sat in front of them and a good leader knows how to inspire them by articulating a vision that they buy into.

Our programmes – Mary Seacole, Elizabeth Garrett Anderson, Nye Bevan and the Aspiring Chief Executive in particular - pay attention to the fundamental questions of purpose, vision and values alongside giving the practical tools of management, whilst ever asking participants to explore ‘what’s it like to be on the receiving end of you?’ The job has to be done: be it ward manager, leader of an ambulance service, a department head in finance, or chief executive. And the job is both management and leadership.