Wednesday, 30 May 2012

A new style of leadership for the NHS

A new style of leadership for the NHS:
Chris Ham summarises issues discussed at the Leadership and Management Summit and explores the challenges NHS faces
A new style of leadership is needed in the NHS in which leaders engage staff, patients and partner organisations to improve patient care and health outcomes. That is the message of the King's Fund's latest report Together we can, and it was a message strongly endorsed by the chair and chief executive of the NHS commissioning board at our leadership summit on 23 May.
The question, however, is whether they mean it, and even more important, can they deliver it.
There are three reasons for the scepticism. The first is the emphasis on a 'pace-setting' style that has, in some cases, improved patient care through the use of targets and performance management. Why should NHS give it up if it has proved so effective?
The second reason is the ability of old dogs to learn new tricks. The chief executive of the NHS, David Nicholson, was refreshingly honest at the leadership summit in 'fessing up that his own style is an extreme example of pace-setting. Like many chief executives he does not find it easy to adopt a more engaging approach because, quite simply, old habits die hard.
The third reason is the challenge of maintaining high standards of performance while implementing the biggest organisational changes in its history. The risks involved are huge and it would be understandable for leaders to want to keep a tight grip on finance and the quality of patient care during the transition.
The chair of the NHS commissioning board, Malcolm Grant, was clear that now is the time to break with old habits. He emphasised that the board is sincere in its desire to let go and to allow space and opportunity for managers and clinicians to innovate and excel. This won't happen overnight but the aim must be to move towards improvements in patient care being led bottom up within a clear national framework.
Both Grant and Nicholson underlined the need for the NHS to work with local authorities and other partners to develop more integrated care to meet the needs of an ageing population in which chronic diseases are increasingly prevalent. Our report argues that for this to happen leaders must be able to work across boundaries and services.
The view of the King's Fund is that public sector leaders have a choice. They can either adopt a fortress mentality in which they focus on the interests of their own organisations and survival in a hostile financial climate. Or they can work with their partners to use resources as effectively as possible, even if this means relinquishing a degree of sovereignty.
The first option is understandable, but the second is essential in the straitened circumstances that will cast a long shadow over public services for the foreseeable future.
Chris Ham is chief executive of the Kings Fund. For more coverage of the Leadership and Management Summit, please see our Today in Healthcare blog and interview with Jan Sobieraj here. Guardian Professional. 

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