Leadership for what? by Brigid Russell

I am struggling with what leadership development in health and care is really for. While it might seem risky for someone who ‘delivers’ leadership development to admit to such a struggle, I want to share some critical questions I have about the purpose of leadership and how we approach its development.


So, my first question is: What do we really mean by leadership in health and care?

If we are going to address inequities across society, which have been further exposed by COVID-19, then we need people who are prepared to challenge what is done, and how, in the current health and care system. The challenges we face point to us needing leadership, which is much more collaborative and collective, exercised by people throughout the system.

To be clear. I mean leadership as a process, in which it is essential for many people to be involved from across communities, and from voluntary as well as statutory organisations. This means moving from ‘doing to’ and ‘doing for’ people to being alongside each other in understanding the wider determinants of health and finding better ways of shaping responses collectively. Responsibilities and solutions for health and care do not sit solely with those in formal positions of leadership. All of us, across society, have valid contributions to make to our health and care. What really matters is how we work together in making sense of the context, how we listen to and understand each other, and how we acknowledge and address the power differentials between us.

For collective leadership and collaborative working to work in practice, power has to shift from where it is currently held in formal structures to be shared by people in a local place, as well as across the system. Rather than ‘empowerment’, we need power to be genuinely relational, in spaces where we are alongside each other and work collaboratively as equals. This means being able to bring our strengths together in the most effective way, as well as understanding and valuing our differences.


That brings me to my second question. What makes us think that leadership is politically neutral in a system which is shaped by politics, and impacted by persistent inequities?

We need leadership with and for a social purpose, surely? It makes no sense to me to consider the development of leadership in public services out of context. Working in public services, we need to be aware of our personal ‘operating system’ and be ready to explore it critically.

What are our beliefs about social justice, equity, fairness, and social policy? How have our educational background, family upbringing, lived experiences, and professional development shaped our identities? We need to understand the prevailing ethos and values of the system within which we’re operating, and to be up for exploring how well our personal and these ‘corporate’ values are aligned.

Such critical reflection is at the heart of our personal and collective development, and we need to feel able and supported to bring it openly into our conversations about what is to be done, and how. Such reflective practice is an integral part of our work; we can be ‘works in progress’ together, perhaps.


My third question is: What are we seeking to develop through leadership development?

People with a set of leadership skills and capabilities and the knowledge to continue leading the current ‘system’? Or, people who are open to the possibilities of changing the system, ready to disrupt the status quo, embrace uncertainty, and work differently alongside communities? I believe it is the latter.

I find myself weary of the narrative around the ‘special’ qualities of leaders, even though we say we’ve moved away from the concept of leader as ‘super hero’. We have replaced ‘charisma’ and ‘heroic leadership’ with terms like humility and compassion, and yet we still seem to be looking to individual leaders in hierarchical positions of power. I just can’t peddle that interpretation any longer.

Rather than being mainly about the development of individual capability and capacity, it is more about developing collectively the kind of leadership needed, and shaping how it needs to be enacted collaboratively in practice.

I believe leadership happens in all of the connections and the relationships between us. It is not about specific expertise, technical knowledge, or hierarchy. It is about how we can be ourselves as well as connect with and listen to each other as people. It is emergent and relational. Such things as compassion, curiosity, humility, and empathy are the very human qualities which we all need to develop and nurture throughout our lives, for our relationships to work well. I don’t think it is about creating a special set of characteristics for this thing called ‘leadership’.


This brings me to my final question: Where and how does leadership development actually happen?

I believe that the real development of leadership happens in relationships, in community, and in the reality and messiness of live, collaborative work. It is about much more than formal ‘programmes’ of development.

Rather than be a passive learner of a fixed set of leadership attributes and seek to fit in to a ‘leadership role’, it is about developing self-insight. Learning in a space which feels psychologically safe, meaning that is ‘safe enough’ for us all to listen and learn with and from each other, and to share our strengths, weaknesses, beliefs, and assumptions.

It’s about being curious and questioning, surfacing our differences and learning from them, and contributing actively to what working collaboratively across the system actually needs to look and feel like. As a facilitator, too, it is about being alongside and open to learning, rather than being in the role of detached expert.

If the development of leadership isn’t stretching us to the edges of our practice, and making us feel uncomfortable about the status quo, then it really isn’t doing its job. It requires openness to learning and receiving feedback in the real work. And that is both hard and a critically worthwhile part of the work.


Leadership for what? Making a contribution to tackling health inequities, and enabling people to live healthier lives.

Brigid Russell

Brigid Russell is a coach and leadership consultant, working with people across public and third sectors in Scotland. She is strongly committed to a relational approach to coaching and development.  She lives in Stirling, and was recently bereaved when her husband, Jim, died of leukaemia in February 2020. Twitter @brigidrussell51

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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