Leading from every seat in the NHS

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As part of the Academy’s two year story, we have asked a range of people from across health and social care to share their own stories and experiences of what leadership means to them.

We have some of the finest leaders in the world in the NHS.

They show values based leadership while making tough clinical, financial, operational and ethical decisions every hour of every day. As you read this, how many of you immediately looked up to the people in top roles in the service? Who are these modern Supermen and Wonder Women flying past in heroic leadership mode? As you scan the empty skies, shaking your head muttering about the rarity of pigs in flight, I would suggest that you are looking in the wrong direction.

I am talking about the leaders that are all around us, the people we follow. They sit in our clinics, visit patients in their homes, operate in theatres and dwell in offices across the country. Think about them – the district nurse you admire who is pioneering integrated working with social care colleagues with a wary team; or the psychiatrist introducing co-consulting for vulnerable teenagers to reduce their risk of further escalation in the forensic care system; or maybe the receptionist raising concerns about attitudes towards patients despite being the most junior member of the team. The idea that we need leadership at all levels – or as I like to say “from every seat” – in the NHS is gaining traction. It is part of the fundamental changes we will see as the NHS meets its toughest challenges for a generation.

In the recent 2015 Challenge Declaration, the NHS Confederation and partners representing managers, doctors and patients set out that:

  • The needs of the 21st century population are different, with a focus on ongoing care and support
  • This means services will have to be redesigned radically
  • Which will take leadership, which will have to operate across the system and be values based because decisions will be tough
  • The leadership will need to enhance the culture so that staff are engaged in their organisations as this will deliver better outcomes for patients; and a culture where the patient is part of the team
  • This will need workforce reform, with new skills, more holistic and generalist support and people able to work across traditional boundaries
  • Technology will be fundamental to supporting all of the above
  • Which all must be delivered within a tough financial climate

At the heart of this is a leadership challenge unlike any other we have faced. We need a distributed leadership model where traditional heroic models are discarded. One where leadership is promoted at every level. As a front line Chief Executive, I know that building a culture like this takes time, an unwavering focus on values and purpose and the profile that means it always supports people trying to deliver care. I also know that my role was in setting the parameters and culture for this to succeed. Getting this wrong could wreck years of work in just a day. Getting it right will secure the NHS for another generation.

So if you are looking for leadership role models and examples, look all around you. Spot the great examples and celebrate them. They will be all with the porter or paediatrician, finance accountant or forensic psychiatrist, OT or children’s community nurse, ambulance driver or anathetist, HR lead or haematologist. You may even want to take a good look in the mirror.

4 thoughts on “Leading from every seat in the NHS

  1. I agree, you find the leadership in the most unexpected places. This week I witnessed a fantastic piece of work to inform the future model of children’s and young people’s services from young people. This important work will lead us towards a much better commissioning & provider response.

  2. Exactly what we need.. Empathic and distributive style of leadership is needed for engagement that is fundamental to change . NHS reform was supposed to be disruptive in nature to ensure spontaneous development – green shoots after a forest fire – top down approach delivered by power of official position is fundamentally in conflict with the reform objective . A hybrid model is best to balance creativity and anarchy of unregulated freedom .. It’s the little people who are the big people in NHS.

  3. Hi Rob
    This is a fantastic write with just the absolute and on the spot points. ‘Leading from every seat’ is fundamental. Give that sense of responsibility and ownership of leading to everyone is key. Exclude ‘they’ & ‘us’ which is a generic culture that is devicise and counter productive in NHS. When we manage to eradicate ‘traditional’ heroic leadership more junior leaders will step on board and take an active part of their leadership role for the benefits of patients. Leadership will not have boisterous people who not only hinder others to practice thier skills and protect their leadership peripherals for damaging meaningless self recognition but they will be inclusive.
    You are right this takes a long time and when done wrong can be damaging and when done right ‘secures’ a generation.
    My questions are what do organisations do to change to this new culture? How do they sustain it and how do they know it is a better thing to do than the previous ‘heroic leadership’. Can it be shared across? If so how?

  4. Dear Rob well written Blog but unfortunate reality is that NHS still appoints many leaders with wrong values. In a target driven culture sadly there are many bullying leaders. As you rightly say we do need value based leaders. Leaders whose only value is to put patients at the heart of everything they do and value their staff. Happy staff and happy patients. We need leaders who inspire, motivate and provide culture and climate where every staff want to do their best, have a great sense of belonging and feel integral part of the organisation. But sadly NHS doesn’t train clinicians to be leaders and nor it appoints value based clinicians as leaders. Many medical leaders are appointed without any leadership training and there is 360 feedback to many leaders and leaders are not performance managed. One has to look at many Whistleblowers plight and also BME staff feeling about NHS and the way they have been treated. BME staff are 3 times more unhappy. Time is right for leaders to show the leadership which our patients deserve, staff expect and NHS needs. Of course there are many great staff with amazing leadership and NHS must appoint these clinicians as leaders. Good leaders make more good leaders. Leaders who are kind, compassionate and caring towards staff and patients is what NHS needs.