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Michael West: Collective leadership—fundamental to creating the cultures we need in the NHS

28 May, 14 | by BMJ

michael-westPositivity, compassion, respect, dignity, engagement, and high quality care are key to creating the cultures we need in the NHS. And, just as importantly, we must deal decisively, consistently, and quickly with behaviours that are inconsistent with these values—regardless of the seniority of people exhibiting them.

Yet in the King’s Fund’s most recent survey of NHS staff, two fifths of those surveyed felt that negative behaviours—typically incivility, aggression, discrimination, carelessness, brusqueness, and poor performance—were not being dealt with in a timely or effective fashion in their organisation. How then can we ensure that positive NHS cultures (with a focus on patient care) are encouraged, and inappropriate behaviours and performance are reduced?

In two reports published last week, the King’s Fund explains how. Overall, the most important influence on behaviours in NHS organisations is the culture—”the way we do things around here.” It was the key problem identified by both Robert Francis and Don Berwick in their reports resulting from the appalling failures at Mid Staffordshire NHS Trust. And the most important influence on culture is leaders in organisations—leaders from top to bottom and end to end. What they focus on, attend to, monitor, model, and reinforce (every interaction by every leader) shapes the culture of the organisation.

The NHS is facing challenges that require fundamental changes to the way care is delivered. Because of shifting demographics, new patterns of care needs, new treatment methods, increasing demands, and huge budget pressures the service must adapt on a scale never seen before. It will require leaders, within and across organisations, to learn to work together with a shared vision of providing care. This means greater integration between health and social care, and the involvement of other agencies—including housing, leisure, and education—in many instances. At the very least, leaders within healthcare organisations will have to ensure that  their activities and efforts are joined up so that patients have integrated, consistent, and coherent care.

We will not make sufficient progress by continuing to develop leadership in a piecemeal and ad hoc way. The King’s Fund argues that boards must develop a clear and powerful leadership strategy to nurture the NHS cultures we will need for the future. This will involve identifying the number of leaders needed in each area of the organisation over the next five years, making sure that leadership reflects the diversity of the staff and local community, and pinning down the skills, competencies, and knowledge leaders require to achieve the organisational vision—for example, improving compassion, equality, staff engagement or openness. It will also involve identifying collective leadership capabilities—how leaders work together to implement organisational strategies and to nurture cultures, which individual leaders working alone cannot accomplish.

Collective leadership means moving away from the dominant command and control, hierarchical, and pacesetting styles of many NHS leaders to quite a different leadership culture. It is a leadership in which all take responsibility for ensuring patient care and all are accountable—for example, by speaking up when they see unsafe or inappropriate behaviour, regardless of the seniority of the staff involved.

Collective leadership means leaders and teams working together across boundaries, within and across organisations, in the interests of patient care and community health. This requires us to change the way we think about leadership by seeing leadership as the responsibility of all—anyone with expertise can take leadership responsibility when appropriate.

Boards must also take responsibility for consulting with all staff and stakeholders (including patients and the community) to develop a strategy for leadership and for creating a leadership culture that ensures effectiveness. In these challenging times, collective leadership is the key to creating NHS cultures that deliver high quality, compassionate, and improved care for patients and communities.

Michael West joined the King’s Fund as a visiting fellow in September 2013. He is professor of work and organisational psychology at Lancaster University Management School, senior research fellow at the Work Foundation, and emeritus professor at Aston University. He was formerly executive dean of Aston Business School.

He is a fellow of the British Psychological Society; the American Psychological Association (APA); the APA Society for Industrial/Organisational Psychology; the Royal Society for the Encouragement of Arts, Manufactures, and Commerce; the International Association of Applied Psychologists; and the British Academy of Management. 

Competing interests: The author has no further interests to declare. 

This blog first appeared on the King’s Fund website here

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