Effective Healthcare Leadership E-Book
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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Effective Healthcare Leadership integrates theory and practice to distil the reality of healthcare leadership today. It addresses the context and explores strategies for leadership and examines the leadership skills required to implement and sustain developments in healthcare. Section one examines the contemporary context and challenges of healthcare leadership. Section two offers opportunities through the CLINLAP/LEADLAP model to see how modern management ideas, tools and techniques are used effectively in leadership development. Section three examines the role of leadership in implementing change and improving practice in different contexts of care. The final section explores future challenges in leadership.
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Seitenzahl: 504
Veröffentlichungsjahr: 2016
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Table of Contents
Cover
Title
Copyright
Foreword
List of Contributors
Introduction
Section 1: The Challenges of Leadership in Healthcare
1: The Context of Healthcare Leadership in Britain Today
Introduction
The context of leadership within the British National Health Service
A culturally specific concept of leadership
Transformational leadership – the latest trend?
Leadership in nursing – a case study for healthcare
Small steps – giant strides
Leadership is about influencing what happens tomorrow today
2: What is Leadership? A Critical Overview of Frameworks, Models and Theories
Introduction
Significant leadership approaches from the early twentieth century to present day
Leadership, power, style and culture of the organisation
Understanding leadership particularly in nursing and in healthcare
A more realistic model for understanding leadership situations
Conclusions
3: What is Effective Healthcare Leadership? A Case Study of the NHS in England
Introduction
What is the goal of effective leadership in healthcare in England?
The nature of the stakeholder relationship
Managing within an environment of trust
How effective is healthcare leadership currently perceived?
Who or what could sustain effective healthcare leadership and when?
Summary and conclusions
4: Strategic Leadership for Healthcare Management
Whole-picture leadership
Vision, goals and targets
Changes to the scenery of healthcare provision
Training for strategic leaders
Diversity
Transparent behaviour through the management code
Creating the environment
Intervention and risk
The recipe for success
5: Healthcare Governance Through Effective Leadership
The challenges of leadership for healthcare governance
Setting leadership in the context of modernisation: key drivers
Defining the terms healthcare governance and leadership
Demonstrating the complementary and integrated nature of healthcare governance and leadership
Making it happen
Conclusions
Section 2: Using the CLINLAP/LEADLAP Model for Effective Healthcare Leadership
6: The CLINLAP Model – A Model for Nursing Management and Leadership Development
Introduction
A multiperspective modelling approach to leadership development in nursing and healthcare
The CLINLAP model’s assumptions
How the CLINLAP model was developed
Why strategic leadership now?
Specific clinical goals – stages 1 and 2 of the model
Explicit clinical roles
Operationalising the model through the five strategic questions
Finding answers to the five strategic questions
The final stage of the model – implementing high quality service/care
What are the findings and lessons learnt from these activities?
Why the CLINLAP model approach?
Advantages of the CLINLAP model
Disadvantages of the CLINLAP model
Sustainable healthcare performance
Facilitating the clinical leadership process
The environment for CLINLAP
Summary and conclusions
7: Implementing the CLINLAP Model – A Case Study of Policy Change in Managing Deliberate Self-Harm
Introduction
Background
Application of the CLINLAP model in effective care processes
Conclusions
8: Leadership Through Group Clinical Supervision
Introduction
What is clinical supervision?
Why was this project needed?
What are leadership and management?
How can group clinical supervision facilitate leadership/management development?
Towards a new definition of group clinical supervision
Why the CLINLAP way?
Research aim and questions
Methodology
When can research and development become an empowerment process?
Project activities
The context of the district nurse’s world prior to group clinical supervision
Content and processes of group clinical supervision
Project outcomes
Management and leadership skills for supervisors of group clinical supervision
9: Leadership for Evidence-Based Practice
Introduction
The context of the study – the Finnish healthcare system
The terms of reference of the study and the research questions
A focused literature review
Project activity including methods and processes
Rationale for collaborative inquiry
A small case study – the hallmark of the ‘Finnish way’
Key findings of the inquiry
The new nurse leader as stakeholder manager and strategic planner for EBP – a felt need for change and acting on that change
A high quality R&D activity – could this approach be applied elsewhere?
Conclusions and recommendations
10: Leadership for Emotional Intelligence
Introduction
What is meant by resources and capabilities for leadership in emotional intelligence?
What is emotional intelligence?
Why develop emotional intelligence competencies and capabilities in nursing and healthcare?
The leadership necessary for the development and sustaining of necessary emotional intelligence resources and capabilities
Conclusions
Section 3: Strategies for Making a Difference in Healthcare Leadership
11: Leading Change in Primary and Community Care
The challenges of the shifting focus of healthcare delivery
Leadership and the policy framework
Leadership in primary care
Clinicians in strategic leadership roles
Multiprofessional leadership training – service development and commissioning
Shifting boundaries and changing practice – inter-agency leadership training and development
Conclusion – the changing roles of nurses and healthcare professionals
12: Leading an Older Persons’ Outreach and Support Team Through Transformational Leadership
Introduction
Transformational leadership
Key principles for authentic transformational leadership
Learning to lead
Starting with the vision
A self-managed team in a complex organisation
Dealing with adversity
The growth factor
Quality control
On reflection
Back to the future
13: Leadership for Practice Development
Introduction
The nature and purpose of practice development
Influence of leadership on practice developement and change
Leadership roles in practice development: transformational leader, facilitator, practice developer
Reflecting on the influences of leadership and approaches to practice development in action: the realities of practice
Conclusions
14: Leadership in an Interprofessional Context: Learning from Learning Disability
The challenges of working in an interprofessional context
The challenges of interprofessional practice
Leadership approaches used in this study
Origins of transformational leadership roles
The participants
The research process
The conceptual framework for practice
Exploring the concepts and practice characteristics
The framework in practice
Learning to apply the framework
Example of practitioner use of the framework
Outcomes from using the framework
Fitness for purpose: a role in transforming services?
What can be learnt for learning disabilities practice?
Conclusions
Section 4: Challenges for Leadership in the Future
15: The Challenges for Leadership in the Future
Introduction
Challenge one: gaining hearts and minds – the challenge of culture change
Challenge two: leadership-for-all
Challenge three: overcoming traditional boundaries/barriers
Challenge four: education for leadership
Conclusions
Index
End User License Agreement
List of Tables
1: The Context of Healthcare Leadership in Britain Today
Table 1.1 Components of the NHS Leadership Qualities Framework.
2: What is Leadership? A Critical Overview of Frameworks, Models and Theories
Table 2.1 The ‘history’ of leadership theory from the early twentieth century to 2004.
Table 2.2 Practical visible leadership and the politics of strategic learning.
3: What is Effective Healthcare Leadership? A Case Study of the NHS in England
Table 3.1 A SWOT analysis of the NHS in England, showing its strengths and opportunities mapped against its resources.
5: Healthcare Governance Through Effective Leadership
Table 5.1 Features of healthcare governance.
Table 5.2 Comparing and contrasting governance and leadership.
6: The CLINLAP Model – A Model for Nursing Management and Leadership Development
Table 6.1 SWOT analysis of the surgical ward showing its strengths and opportunities mapped against its resources.
7: Implementing the CLINLAP Model – A Case Study of Policy Change in Managing Deliberate Self-Harm
Table 7.1 Application of the CLINLAP model using management and leadership concepts.
Table 7.2 Stakeholder analysis.
Table 7.3 The Phillips and Jumaa Quality of Information Matrix applied to information on Osprey Ward. PARTNER (The Open College 1992) stands for precise, adequate, reliable, timed, needed, economic and readable analysis of quality of information.
9: Leadership for Evidence-Based Practice
Table 9.1 Summary of the project methodology.
Table 9.2 Synthesis of the outcomes of the study (Jumaa 2001.
Table 9.3 Effective leadership for implementing EBP through the LEADLAP model (Jumaa 2003).
11: Leading Change in Primary and Community Care
Table 11.1 Nursing leadership skills and attributes.
13: Leadership for Practice Development
Table 13.1 A comparison of the two world views of practice development – technical and emancipatory practice development (PD). (Adapted from Manley & McCormack 2003)
14: Leadership in an Interprofessional Context: Learning from Learning Disability
Table 14.1 Evaluation of the theory using Fitzpatrick & Whall’s criteria.
List of Illustrations
3: What is Effective Healthcare Leadership? A Case Study of the NHS in England
Fig 3.1 How the NHS and its organisations are organised (source: www.NHS.uk). (Crown copyright is reproduced with the permission of the Controller of HMSO and the Queen’s Printer for Scotland.)
Fig 3.2 Isikawa’s fish bone (cause and effect) diagram and the LOOP Factors Framework (Jumaa 2001) used to make sense of a ‘fear of litigation’.
5: Healthcare Governance Through Effective Leadership
Fig 5.1 NHS Leadership Qualities Framework.
Fig 5.2 Key components of clinical governance. [Adapted from McSherry & Pearce (2002) with permission from Blackwell Science; sources DH (1998), McNeil (1998), RCN (2000), Roland & Baker (1999), Scally & Donaldson (1998) and Sealey (1999).]
Fig 5.3 Healthcare governance in the NHS. [Adapted from McSherry & Pearce (2002) with permission from Blackwell Science.]
Fig 5.4 Harmonising the key qualities of healthcare governance and leadership.
6: The CLINLAP Model – A Model for Nursing Management and Leadership Development
Fig 6.1 The CLINLAP/LEADLAP model (Jumaa 2001).
7: Implementing the CLINLAP Model – A Case Study of Policy Change in Managing Deliberate Self-Harm
Fig 7.1 The taken-for-granted aspects of Osprey Ward, using the Cultural Web.
9: Leadership for Evidence-Based Practice
Fig 9.1 Framework for making sense of the project activities (Jumaa 2001).
14: Leadership in an Interprofessional Context: Learning from Learning Disability
Fig 14.1 The conceptual framework (McCray 2003a).
Guide
Cover
Table of Contents
Begin Reading
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Effective Healthcare Leadership
Melanie Jasper
Mansour Jumaa
© 2005 by Blackwell Publishing Ltd
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All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.
First published 2005 by Blackwell Publishing Ltd
Library of Congress Cataloging-in-Publication Data
Jasper, Melanie.
Effective healthcare leadership /Melanie Jasper and Mansour Jumaa.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-14051-2182-8 (pbk. : alk. paper)
ISBN-10: 1-4051-2182-3 (pbk. : alk. paper)
1. Health services administration–Great Britain. 2. Leadership–Great Britain.
[DNLM: 1. Health Services Administration–Great Britain. 2. Leadership–Great Britain. 3. Evidence-Based Medicine–organization & administration–Great Britain. 4. Models, Organizational–Great Britain. 5. Organizational Case Studies–Great Britain. W 84 FA1 J39e 2005] I. Jumaa, Mansour. II. Title.
RA971.J37 2005
362.1’068–dc22
2005005882
ISBN 10: 1-4051-2182-3
ISBN 13: 978-14051-2182-8
A catalogue record for this title is available from the British Library
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Foreword
Donald H McGannon wrote that leadership is an action not a position. I agree with this statement wholeheartedly. The National Health Service (NHS) is changing rapidly, it is now as concerned with health promotion and well-being as it is with sickness and curing. It is becoming truly patient led and everything we do as professionals is increasingly being measured by the impact it has on patients.
Today’s NHS needs good leaders to ensure that services are delivered to a consistently high standard and are developed to meet the needs of individuals whilst not losing sight of the needs of the wider population. These leaders must be able to captivate, motivate and inspire their colleagues in order to respond effectively to the ever changing demands of healthcare.
This book explores the content and processes of leadership within today’s NHS. Rather than being another textbook about the theory of leadership, it looks in depth at existing practice in clinical settings across the health service and identifies the key ingredients for and features of successful leadership.
I was particularly interested in the chapter identifying service challenges and how management and leadership techniques are used to solve them. By focusing on how the nursing profession has developed leadership strategies to deliver on the government’s modernisation agenda, it is clear that nurses have been at the forefront of delivering many health reforms and policies.
Leadership is the art or process of influencing people so they willingly and enthusiastically move towards the achievement of a goal. The book rightly, in my view, concludes that strategic leaders are not superhuman with a clearer picture of the world than anyone else. Rather, they successfully create the right environments and understand their people to achieve successful out-comes.
Good leaders are aware of their strengths and weaknesses as well as those of others; they take responsibility for their actions and those of their teams; are able to set a clear direction of travel; use sound evidence to support decisions; keep their knowledge base current; and, through deploying all of these things, achieve and maintain the respect of colleagues across and beyond the organisation. Through the work they do on a daily basis and from the leadership they have shown in delivering on healthcare reforms, it is clear that many nurses already have a substantial range of these skills. For those looking to further develop their management skills and expertise, this book will be a valuable and inspirational resource be they nurses or other healthcare professionals.
Professor Chris Beasley CBE
Chief Nursing Officer
Department of Health
List of Contributors
Dr Jo Alleyne, Principal Lecturer in Nursing and Healthcare Management, School of Health and Social Sciences, Middlesex University, London
Jo is the current Chartered Management Institute’s Programme Director for the Institute’s Approved Centre at Middlesex University. She devised and successfully applied a model of Group Clinical Supervision as part of her doctoral studies, through a co-operative inquiry approach, which used focused management and leadership interventions. She is an RCN and National Association for Teachers in Further and Higher Education (NATFHE) activist, a member of the RCN Education Forum and the negotiating secretary for the Middlesex University NATFHE branch. She is Chair of the Health Educators Forum. Jo combines her management and leadership knowledge and skills to support her teaching and research and to contribute towards effective negotiations in her trade union activities.
Dr Nadia Chambers, Consultant Nurse for Older People, Southampton University Hospitals NHS Trust
Nadia qualified in 1982 and gained extensive experience in medicine and care of older people. She has led both practice and service developments for older people, including influencing the development of a staff support system for victims of violence experienced at work, developing quality standards for care of the older person, developing the care of the older person in an acute medical assessment unit and developing a rapid access Transient Ischaemic Attack Service. In addition to this, her experience as a teacher in higher education has included innovative curriculum developments such as post-graduate studies in clinical governance and clinical leadership.
Christopher M.A.D. Gbolo, Charge Nurse, Mental Health, Barnet, Enfield and Haringey Health Care NHS Trust, London
Christopher is a charge nurse/team leader in the psychiatric intensive care unit in Barnet, Enfield and Haringey Health Care NHS Trust in north London. He trained as a psychiatric and general nurse in Ghana and migrated to the UK in 1999. He progressed in his nursing career and became a charge nurse by 2003. He studied at Middlesex University and obtained an advanced diploma in healthcare, ethics and law and an advanced diploma in health and social care management. He is currently studying to obtain a BSc Honours degree in nursing studies and a professional diploma at Middlesex University and Chartered Management Institute respectively.
Lindsey Hayes, Senior Fellow, Leadership for Primary Care, Royal College of Nursing Institute, London
Lindsey brings many years of knowledge, skills and experience as a community nurse, teacher and trainer to the world of leadership in primary care. Her passion for primary and public health developed when she was working as a health visitor in an inner city multicultural and ethnically diverse area. Then she chose to work with disadvantaged community groups, specialising in the homeless, a fairly unique health visiting role. Her interest in individual and group behaviours led her to undertake a period of ante-natal teaching and then go on to further education, where she managed and taught a large child care course in one of the most deprived inner London boroughs. Her passion for health and understanding of behaviour was further enhanced through counselling and more recently completing an MSc in health psychology. She is now Senior Fellow, Leadership for Primary Care at the Royal College of Nursing Institute in London.
Mark Hodder, Head of Organisational Development, Mid and West Wales (NHS Secondment from Centre for Health Leadership, Wales)
Mark is a training and development professional working to improve organisational and individual performance in NHS Wales through the implementation of the balanced scorecard approach to performance management. Mark gained his leadership experience as a Royal Air Force Officer developing and delivering officer training both in the UK and overseas. He is also a qualified performance coach, master practitioner of neuro-linguistic programming and hypnotherapist, skills that he uses to develop excellence in others.
Professor Melanie Jasper, Professor and Head of Health and Social Welfare Studies, Canterbury Christ Church University College
Having practised in the community as a midwife and health visitor for a number of years post-qualification, Melanie moved to the University of Portsmouth as a senior lecturer in 1990. She led the Masters curriculum and the Professional Doctorate in Nursing, as well as developing her academic field in critical reflection, reflective practice and reflective writing, until her appointment at Canterbury. She was appointed Editor of the Journal of Nursing Management in 2002, and holds an honorary appointment with Thames Valley University as Visiting Professor in the Adult Nursing subject group.
Helen Julu, Senior Practitioner, Health Visiting, London Borough of Enfield
Helen trained as a nurse in Uganda and migrated to Great Britain in 1983, elevating her nursing career to the level of a Ward Sister by 1998. Her ambition carried her further and she obtained an Honours degree at the University of South Bank in Specialist Community Nursing Public Health/Health Visiting in 2000 and an advanced diploma in Management in 2003 with the Chartered Institute of Management and Middlesex University, London.
Dr Mansour Jumaa, Chartered Manager and Executive Coach, Chief Emeka Anyaoku R&D Centre for Work Based Learnig and Leading. Anyaoku Centre, West Sussex
A Florence Nightingale Foundation Scholar in Evidence-Based Practice in Healthcare and Nursing Management, Academic Group Chair (Healthcare Management), and former Chartered Management Institute Programme Director at Middlesex University, London. Mansour is now a Chartered Manager and Executive Coach at the Anyaoku Centre, West Sussex. He is the first nurse, the first West African, the first Nigerian and the first black person of African origin resident in the UK to be awarded Chartered Manager status, the hallmark of the professional manager. His award was based on his ability to use knowledge management processes for performance improvement within organisations. Mansour has over 30 years of experience within the NHS and the higher education sector in the UK. Since 1987 he has taught, facilitated and supervised management and leadership courses from doctorate and masters levels to single study days at many universities in the UK – the Middlesex, the London School of Economics, and the Universities of Sussex, Surrey, and Wales in Swansea. He is committed to widening management and leadership access to first- and middle-line managers, particularly managers from black and minority ethnic communities. It is for this reason that he has established L4T – Leadership For Today (www.leadershipfortoday.com).
Dr Ilkka Kunnamo, Editor-in-Chief, EBM Guidelines, Finland
Ilkka, a specialist in general medicine, wrote his doctoral thesis in the field of paediatrics. Since 1986 he has worked as a general practitioner at Karstula in central Finland. He developed the idea of Evidence-Based Medicine Guide-lines (www.ebm-guidelines.com) and has served as its Editor-in-Chief since 1988. He is the author of about 30 research papers. He has been involved in several projects in primary care computing and medical informatics. He is a member of the Editorial Board of Clinical Evidence (BMJ Publishing Group, London) and the core reviewer group of BioMed Central.
Stuart Marples, Former Chief Executive, Institute of Healthcare Management, London
Although Stuart has now moved on in his career, at the time of writing he was Chief Executive of the Institute of Healthcare Management. The Institute is the professional body for managers working in healthcare. He is also a Fellow and Companion of the Institute. His 38-year career has been mainly in the NHS, including a long period as Chief Executive Officer of a large NHS Trust. He is a Business Studies Honours graduate and NVQ assessor and verifier. His personal interest is in management.
Dr Janet McCray, Principal Lecturer, Portsmouth Institute of Medicine, Health and Social Care, University of Portsmouth
Throughout her career, Janet has always maintained a connection with learning disability services. This has been broad, ranging from leading one of the first community care projects in North West England in the 1980s to taking forward the validation of the first joint prequalifying programme in nursing and social work in the learning disability field in the 1990s. Recently she has explored further practice roles in the field, gaining her PhD in 2002, and from this developing a conceptual framework for practice. At present she is beginning further testing of the framework and exploring its potential as a leadership tool.
Robert McSherry, Principal Lecturer, Practice Development, School of Health and Social Care, University of Teesside, Middlesbrough
Rob’s current post is Principal Lecturer in Practice Development at the School of Health and Social Care, University of Teesside, Middlesbrough. His long-term aim is to develop and strengthen practice development within the School of Health and Social Care, local community and NHS Trusts locally, regionally and nationally. Rob has facilitated and supported the advancement and evaluation of many innovative practice developments by focusing on the promotion of multiprofessional collaboration and teamworking in delivering evidence-based practice. Rob’s main concern is seeing research being utilised at a clinical level, whereby nurses, midwives, nurse specialists and other allied health professionals are equipped with the essential skills and knowledge to aid this process. Rob has shared and disseminated his work on practice development in three key areas – practice development, healthcare governance and evidence-informed practice – nationally and inter-nationally through publications, conferences, consultancy and workshops.
Paddy Pearce, Head of Healthcare Governance, Hambleton and Richmondshire Primary Care Trust
Paddy is the Head of Healthcare Governance for Hambleton and Richmondshire Primary Care Trust and is responsible for the integration of clinical and corporate governance. He trained as an RGN, practised in orthopaedics and has established clinical audit, clinical effectiveness and clinical governance in secondary and primary care trusts. Paddy holds a BSc (Honours) in Professional Studies in Healthcare and an MSc in Social Research Methods. He is a Health Care Commission Clinical Governance Reviewer and Cochrane Reviewer.
Janice Phillips, Service Manager for Learning Disability Services, Glen Care Organisation, Epsom, Surrey
Janice was a ward manager with the North London Forensic Service when she wrote her chapter. She has a specialist interest in risk assessment and risk management, and also self-harm and suicide. This has led to a number of clinical practice publications, where she has sought to challenge and test current clinical thinking, based on her own interpretation and application of research findings within the clinical environment. Much of her development in the clinical arena has been driven by clinical-based problem resolution, which has identified the need for a systematic strategy to improve the management of staff, resources and information systems.
Gülnur Salih, Patient Advocate and Language Interpreter, Camden PCT Advocacy and Interpreting Services, St Pancras Hospital, London
As a Health Advocate, Gülnur has worked for the NHS for 13 years, under-taking a range of duties providing help, advice and support for patients from the Turkish communities. She has established and run health education groups for Turkish communities and also devised and delivered training on Turkish culture to clinical and non-clinical staff. Achieving management and leadership qualifications has given Gülnur a new perspective on healthcare provision, which has allowed her to extend her effectiveness and interactions with patients and other health and social care staff. She has recently been seconded to work on a project involving healthcare provision to children and will be undertaking work to do with public consultation of the recommendations.
Theresa Shaw, Chief Executive, Foundation of Nursing Studies, London
Theresa Shaw is the Chief Executive Officer of the Foundation of Nursing Studies (FoNS), a small charity committed to supporting nurses to lead and develop innovative ways of working that improve patient care. Theresa successfully combines her role of charity manager with that of practice development facilitator, a role she believes is key to enabling development and research in practice. Prior to joining FoNS 6 years ago, she had been working in the NHS for 17 years. Her experience spanned clinical nursing, education and practice development, and whilst her clinical expertise lies in cardiothoracic nursing, she has worked with a variety of nurse-led teams. Theresa is currently undertaking the Doctor of Nursing Programme at Nottingham University, with specific focus on the impact of practice development.
Alyson Wadding, Senior Lecturer for Leadership Development, School of Health and Social Care, University of Teesside, Middlesbrough
Alyson is a Senior Lecturer for Leadership Development, responsible for leading the development and delivery of multiprofessional leadership programmes for all health and social care staff. She is a registered practitioner in the use of the Myers Briggs Type Indicator and is experienced in using this tool for individual and team leadership development. She is a registered feedback facilitator and trainer for the NHS Leadership Qualities Framework 360-degree diagnostic tool for leadership development and has integrated this framework into the design of leadership programmes. She is a licensed facilitator of the Leading an Empowered Organisation Programme, with a wide range of experience of delivering this programme to various groups. Alyson is also experienced in providing mentorship to clinical leaders in practice.
Introduction
Several certainties can be taken for granted when considering healthcare in Britain today. We can assume that there will be a population generating an ever-increasing demand for healthcare, founded within developments in medical science. These developments arise from the need, within an affluent Western society at least, to move from a front-line service where emergency and acute care is paramount, to a demand-led service providing access to secondary and further care for long-term and enduring conditions, and services beyond life-saving, such as preventive and palliative care. Many of these latter services arise from changes in perceptions of quality of life and perceived ‘rights’ of access within a publicly funded organisation; for instance, the demand for reconstructive surgery, organ transplant, termination of pregnancy and infertility treatment.
Another assumption that can be made in Britain, for the near future at least, is that there will be a publicly funded National Health Service (NHS) that is free at the point of delivery, providing healthcare to the majority of the population. As a public service this is subject to political whim and the blunt instrument of a general election every four to five years, resulting in a certain lack of stability, consistency or long-term focus in terms of priorities, structure and direction. Arising from this is the assumption that resources for the NHS are not infinite but limited through the Exchequer and public taxation, and allocated through recourse to political priorities, albeit those arising from a detected and quantifiable need.
Finally, and key to the successful delivery of healthcare, are those who provide the services – the people at the centre of the organisation. In order to be effective at both an organisational and an individual level, they need effective and efficient leadership.
The purpose of this book therefore is to explore both the content and processes of leadership within the British NHS today. The intention was not to create yet another textbook about leadership – there is already a vast selection of these available, providing different perspectives on how to achieve successful leadership in myriad settings and circumstances. Rather, the intention of this book was to consider the NHS today through the reality of what is already happening and explore the features of successful leadership through where and how it is happening.
Hence, although theoretical perspectives are provided throughout the book, they are inextricably linked to the context in which they are presented. There is no neat boundary between theory and practice; there are no ‘off-the-peg’ solutions. Rather, we present a series of chapters, in Sections 2 and 3, which focus on individual problems and utilise a selection of management and leadership strategies to solve them. These nine chapters are drawn from real-life case studies across England and one from Finland, where practitioners have used strategies arising from different theoretical starting points to effect change in their areas of service. They are not presented as perfect examples – rather they describe and demonstrate the need for intelligent flexibility and critical thinking in order to utilise the tools and resources available to work through and solve problems in order to improve services for their users.
The brief provided to our contributing authors was to present an example of how a particular strategy for leadership was used to solve a problem within their practice. They were asked to consider the principles behind this approach and show, through their case study, how this had enabled them to solve their problem or move their practice forward. As leadership was the focus for these, this inevitably meant enabling other people to consider their practice and make a conscious decision to change it, thus facilitating practice development.
Section 1 – The Challenges of Leadership in Healthcare
These sections are, of course, set within the context of the British NHS at the beginning of the twenty-first century, and shaped by the politics of the ‘New Labour’ Government first elected in 1997 following 18 years of Conservative policies. The purpose of Section 1 of this book is to set the background and context for the focus on leadership within the restructuring and modernisation of the NHS heralded by the change in political focus and driven by the following:
the internal and external environment required for effective healthcare leadership
the critical success factors for managing strategic linkages between healthcare leadership activities and
the consequent challenges posed for effective healthcare leadership during the first decade of the twenty-first century.
Chapter 1 presents and explores the central tenets driving the Labour government’s policies, exploring in particular the significance of strategies for leadership within this by considering in-depth how one particular healthcare profession – nursing – has been facilitated to develop leadership strategies. Melanie Jasper concludes, in this chapter, that leadership as a central feature of the modernisation agenda is presented as everyone’s concern and not just a role of those charged with a management function. Chapter 1 therefore establishes the context for leadership set at governmental level, within which the rest of the chapters in the book are located.
Chapter 2 presents a critical overview of theories and perspectives of leadership over time. Leadership theories, Mansour Jumaa contends, will always be set within the political, economical, sociological and technological structures existing at the time. This chapter provides a useful summary for readers who want a ‘potted history’ of the ways in which ideas and styles of leadership have developed over the past 50 years. Leadership styles do not happen by accident, rather they emerge in response to cultural imperatives within a specific sociotemporal context. This chapter identifies these trends and how they have, at various times in the history of the NHS, been adopted for use.
Chapter 3 builds on this foundation by considering what effective leadership means in the NHS today through five strategic questions. These questions explore the goals of leadership, its location and how effective it is perceived to be. Finally, the chapter considers what pathways would be preferred for leadership, who and what could sustain it and when it could be sustained.
Intrinsic to all perspectives on leadership is the use of emergent concepts, which are part of the presentation of initiatives as ‘new’ (where some might cynically consider that nothing is new, rather that old ideas are repackaged and resold in another temporal context). The identification of these concepts provides the structure for this book, as we wanted to see them in action. Two of these concepts, strategic leadership and healthcare governance, apply generically across the NHS and are therefore part of the context within which leadership development is perceived. The conclusion of this chapter, according to Mansour Jumaa, is that the new NHS is on the way to a full recovery, a view shared by both patients and staff within the NHS. This chapter also confirms that leadership is in a state of flux and that irrespective of perspectives taken to describe or define this concept, it is about relationships, and it has undergone a series of transformations over the 100 years of modern management.
Chapter 4 considers strategic leadership as the ‘ultimate unbounded problem, full of complexity and uncertainty, where cause and effect can be difficult, if not impossible, to see clearly’. Mark Hodder and Stuart Marples explore the need for creating an environment where strategic leadership can work, identifying issues of diversity, influencing people, identifying a management code and embracing transformational leadership styles as key concepts within this. They conclude that ‘strategic leaders are not superhuman with a clearer picture of the world than anyone else. Rather they have created an environment and an understanding of their people that allows success to take hold’. This is very much the message promoted by Government rhetoric, and exemplified in the individual case studies in the next two sections.
Finally, we end this section with a consideration of the strategies for leadership required to ensure effective healthcare governance. Rob McSherry, Alyson Wadding and Paddy Pearce suggest that ‘leadership development must be linked to both personal and organisational aspirations where clearly defined measurable objectives impact on performance for modernisation and service improvement’. Using case studies to illustrate their argument, these authors explore the drivers for modernisation and service improvement, and define, compare and contrast healthcare governance and leadership in order to demonstrate their integration. In common with many authors in this book, they identify transformational leadership as the most effective style to achieve the Government’s agenda for change.
Section 2 – Using the CLINLAP/LEADLAP Model for Effective Healthcare Leadership
This section is driven by the work of one of the editors of this book, Dr Mansour Jumaa; it presents the CLINLAP/LEADLAP model and how this has been developed and used in a variety of healthcare and nursing practice contexts. It:
explains and demonstrates that leadership is a process of
living as learning
, a process of sense-making in a community of practice
presents a full exposition of the CLINLAP/LEADLAP model and its applications in various contexts for strategic nursing management performance in management and leadership activities
proposes that, through the CLINLAP/LEADLAP model, leaders become the pathway travelled in order to enter the world of the community of practice and the external broader communities that sustain and keep them going. It demonstrates how, through a well structured model, such as the CLINLAP/LEADLAP model, the complexity of healthcare leadership activities and processes could be ‘reduced’ to observable and repeatable actions. Such an approach will always help to plan, implement and sustain effective service delivery.
In Chapter 6, Mansour Jumaa presents the CLINLAP/LEADLAP model, which he developed while he was a Principal Lecturer (Healthcare and Nursing Management) and the Programme Director of the Chartered Management Institute Accredited Centre at Middlesex University in London. The CLINLAP/LEADLAP model is both wide-ranging and specific. The essence of the model iterates around at least four main areas of responsibility and accountability, namely:
Specific goals – deciding what is to be achieved in the collective interest and planning to put the decisions into action to meet most of the stakeholders’ expectations.
Explicit roles – good decision-making processes about the agreed specific goals and about who does what with the available resources so that patients, clients and/or customers are pleased with the available services.
Clear processes – ensuring that the best is being done in terms of effectiveness and efficiency to keep on target for the agreed specific goals.
Open relationships – implementing agreed specific goals through partnership and collaborative working with other stakeholders.
This is followed, in Chapter 7, by a case study illustrating the model’s use in facilitating policy change within a clinical practice environment, presented by Janice Phillips, Helen Julu, Gülnur Salih and Chris Gbolo. Janice was a ward manager with the North London Forensic Service when this chapter was written. Helen is a Senior Practitioner, Health Visiting, with the London Borough of Enfield. Gülnur was a Patient Advocate and Language Interpreter within the NHS, providing help, advice and support for patients from the Turkish communities. Chris is a charge nurse/team leader on a psychiatric intensive care unit in Barnet, Enfield and Haringey Health Care NHS Trust in north London. They conclude, in this chapter, that current managers are expected to implement strategy, influence change and meet stakeholder expectations, and that the CLINLAP model can assist strategic thinking without neglecting clinical practice. This is contrary to beliefs that the creation of such a ‘toolbox’ can imply that management is just a series of ‘tricks’ that anyone can perform.
Chapter 8 presents the use of the CLINLAP/LEADLAP model in group clinical supervision for managing change in district nursing practice. Dr Jo Alleyne co-writes this chapter with Dr Mansour Jumaa. Dr Alleyne is the current Programme Director of the Chartered Management Institute Accredited Centre at Middlesex University in London and has devised and successfully applied a model of Group Clinical Supervision as part of her doctoral studies, through a co-operative inquiry approach, which used focused management and leadership interventions. This inquiry concluded that the challenge for practitioners wishing to apply the group clinical supervision approach will be achieved when ‘good nursing’ is accepted as being synonymous with ‘good management’.
Chapter 9, written by Mansour Jumaa, Dr Ilkka Kunnamo, who developed the idea of Evidence-Based Medicine (EBM) Guidelines (www.ebm-guidelines.com) in Finland and has served as its Editor-in-Chief since 1988, and Melanie Jasper, presents the results of a post-doctoral study1 that explored the leadership successes of the ‘Finnish way’ to evidence-based practice by general practitioners in Finland. It illustrates, using the LEADLAP model for analysis, how the problem of tackling healthcare delivery to a diverse population, geographically and culturally, was implemented successfully. The main lesson from this study is that survival in the workplace of the future demands that the nurse, midwife, health visitor and all other healthcare practitioners become capable of converting their many years of tacit knowledge to explicit knowledge for the benefit of their organisations, professions and themselves. This was the main strength behind the success of the ‘Finnish way’.
The final chapter in this section, authored by Mansour Jumaa, considers the use of emotional intelligence as a leadership strategy. The chapter concludes that the emotional intelligence attributes required are practical and rooted in everyday activities. They are feelings: awareness; ownership; identification; discrimination; acceptance; choice; transmutation; expression; control; and catharsis.
Apart from using the CLINLAP/LEADLAP model, these case studies have in common the need for ordinary people to lead their teams in solving problems in their everyday practice. This section focuses on the ways in which everyone can utilise leadership skills and management tools available in order to be involved in leading small parts of their own, others’, professional and service development. Whilst these may be seen as minute cogs in a very large wheel, it is a combination of all of these initiatives that will be contributing to change in our health service, improving patient care and leading towards the future. These case studies are clear examples of New Labour’s strategy of leadership at all levels within the health service that will ‘make a difference’ for the NHS and the people it serves.
Section 3 – Strategies for Making a Difference in Healthcare Leadership
Section 3 provides a collection of case studies driven by the notion of transformational leadership. If any one theory of leadership has achieved dominance within New Labour’s modernisation policy it is this one. Using the features of idealised influence, inspirational motivation, intellectual stimulation and individual consideration, transformational leadership seeks to win the hearts and minds of those being led to effect wholesale changes owned and developed by those involved in them. We are beginning to see the devolution of the power to effect change across far more levels of the NHS hierarchy, as well as dissemination to more professional groups. The chapters in this section illustrate this policy effectively, showing the effect of collaborative rather than competitive working within services. They are driven by the concepts of primary and community care, transformational leadership, practice development and interprofessional working. This section:
considers different enactments of transformational leadership
presents four case studies illustrating how transformational leadership can work in practice
identifies how leadership can occur at all levels of the health service hierarchy.
In Chapter 11, Lindsey Hayes, working within the Royal College of Nursing as a senior fellow in leadership for primary care, explores the leadership skills required to influence the development of primary and community care services strategically, ensuring that the views of all healthcare professionals are clearly articulated and that their voice is heard. She presents features of the Primary Care Leadership Programme, concluding that ‘central government expects professionals to embrace change, challenge existing professional boundaries and reflect on existing practice to enable change to happen’. Training for healthcare leadership must therefore take place within the context of change in both the health and social care domains.
Just such an example of change is presented through the work of Dr Nadia Chambers, who has undertaken one of the new Nurse Consultant roles introduced by the Government. Working with a multidisciplinary team, she instigated an older person’s outreach and support team, negotiating the delicate boundaries and shifting sands of enabling and facilitating interprofessional teamwork in order to provide a service responding to the service users’ needs. The results and evaluation of the initial pilot project enabled a successful bid to be made to the Department of Health, securing full funding for a further 2 years for the project.
In Chapter 13, Theresa Shaw, Chief Executive of the Foundation of Nursing Studies, suggests that ‘whilst practice development needs effective and supportive leadership it also has the potential to enable the development of leaders’, and she goes on to consider the role of leadership in practice development. In presenting five case studies she identifies the flexible nature of styles of leadership within different roles and considers the features and advantages of each.
Finally, in Chapter 14, Dr Janet McCray presents a grounded theory model of how interprofessional working can be facilitated. Arising from a learning disabilities perspective, Dr McCray suggests that recent policy changes have resulted in a ‘role shift for community-based RNLDs [Registered Nurses for People with Learning Disabilities], where leadership skills and teamwork facilitation roles are increasingly at the forefront of their practice across the boundaries of health and social care’. As a result she concludes that RNLDs are in a prime position to facilitate interprofessional working, presenting a model of how this can be accomplished. She suggests that ‘in highlighting the attributes needed for contemporary interagency teamwork, with reflection as a central element of change, the tool acts as an iterative mechanism for all those who wish to develop their skills as transformational leaders further’.
These chapters demonstrate that responsibility for change and development is indeed filtering down through the hierarchical ranks of the NHS, as more and more people are being charged with leading developments within their own services. New roles and new responsibilities are located within those charged with providing the services rather than those managing them. Leadership is no longer the purview of the few, a fact that recognises the increasing levels of academic preparation for those working within the NHS, and seeks to utilise the knowledge and skills developed as a result.
Section 4 – Challenges for Leadership in the Future
This section consists only of Chapter 15 written by Professor Melanie Jasper. It anticipates the challenges that need to be addressed if the Government’s vision of ‘leadership-for-all’ is to become a reality in the next decade. Four challenges are discussed: gaining hearts and minds – the challenge of culture change; leadership-for-all; overcoming traditional boundaries or barriers; and education for leadership. Melanie Jasper concludes that this final chapter has been a personal reflection and deliberation on what the future of leadership within the NHS means to her; this involves recognising and valuing the importance of the individual at all levels, and providing leadership within a culture that maximises the talents of all those individuals.
Melanie Jasper and Mansour Jumaa
1
This post-doctoral travel study was possible through a Florence Nightingale Foundation Scholarship sponsored by the St Mary’s Hospital League of Nurses, London, UK.
Section OneThe Challenges of Leadership in Healthcare
1The Context of Healthcare Leadership in Britain Today
Melanie Jasper
Introduction
Avery’s textbook on leadership (Avery 2004) attempts to draw together the many and varied perspectives and theories that have developed as our (capitalist) societies become more fluid and rapidly changing than at any other period in history.
The speed of change on multiple fronts seems to be pushing humankind to the limits of its adaptability. People have no sooner adapted to one change than the next one is upon them, bringing more uncertainty and complexity. The challenge is for leadership to operate under rapidly mutating circumstances, which requires a rethink of paradigms of leadership both in theory and in practice. (Avery 2004, p. 7)
The development of healthcare provision in Britain is a perfect example of this frantic need for increasing efficiency in service sector industries, where the traditional public service ethos is being influenced, and often replaced, by the ethos and ethics of business and the marketplace.
For many who have grown up in the post-war years of the welfare state, and who have spent their working lives in public services directed and run by it, this is an uneasy alliance of competing sets of beliefs and values. Alongside managerial concepts and strategies imported from successful business organisation runs a whole vocabulary that those working in health and social care are having to embrace and adapt to. As with many instances of social change, the reorganisation and adoption of new directions and challenges in healthcare is a political response to fundamental problems in sustaining the basic premises envisaged at the creation of the welfare state. British society is simply unable to continue to fund a state-financed healthcare system where demands on it are infinite, where the changing demography over the next 30 years will result in an increasingly elderly and dependent population and where the working population will generate insufficient taxation to meet demand. Hence, it is reasonable that government strategies are directed towards the fundamental premises of the welfare state, whilst at the same time attempting to introduce concepts from business and the marketplace to take it into a sustainable future, and to seek innovative approaches to funding healthcare, which under another name would be labelled ‘private sector’. As the Government White Paper The New NHS: Modern and Dependable (DH 1997, p. 8) identified:
It is clear there are tough choices facing the NHS. It has to improve its performance if it is to deliver the sort ozzf services patients need.
The context of leadership within the British National Health Service
In short, the New Labour Government created a vision of ‘a new NHS for a new century’ (DH 1997, p. 8), expanded in a number of governmental papers over successive years (e.g. DH 1998, 2000, 2001, 2002a, 2002b) and still progressing. The message in these was clear – that a central plank of governmental vision was the need for leadership as well as efficient management throughout all areas of activity in the NHS. As Liam Donaldson (2001), Chief Medical Officer, said:
Implementing this major programme of change will require active leadership at all levels in the NHS and an inclusive approach. If it is successful the pay-off for the patients and staff will be huge.
This is reinforced by Nigel Crisp, NHS Chief Executive:
We must lead change as well as manage it. We need leadership in setting out the vision and working with and through people to achieve it. We need excellent management in systematic and tested approaches to secure delivery and improvement. (DH 2002a, p. iv)
Leadership per se is a relatively new (and inclusive) concept for the British NHS. As a result there is a dearth of published material relating to its nature and content over and above that in government papers and policies. These, by their very nature, take a particular view of leadership, influenced by the vision and direction of healthcare delivery at the beginning of the new century. The concept of leadership adopted has to be set within the social, cultural and environmental context of its time. Outmoded notions of leadership equated with authority, traditional and hereditary power are not commensurate with the values espoused by the New Labour Government, seeking equality throughout society. Rather, the definition of leadership adopted needs to reflect the values inherent within the socialist paradigm, and reflect increasing participation in policy-making and decision-making at all levels within the NHS. This latter point is perhaps one of the most important – transformation of the NHS will not occur unless the majority of employees at all levels within it are empowered to lead in new directions and espouse the values inherent within the policies. To this end, a blueprint has been created through government policy; what is missing is exactly how this can be achieved, given the lack of an evidence base relating to effective leadership styles of the type envisaged within public services – the evidence does not exist for the very reason that this is wholesale change of a type never before witnessed in state-funded organisations.
However, a plethora of literature from successful businessmen (e.g. Charles Handy, John Harvey Jones, Geoff Smith), prominent leaders (e.g. Winston Churchill) and self-styled leadership gurus (e.g. Adair 1998, 2002, Bennis 1998, Goleman 1995, Goleman et al. 2002) has influenced the ways in which leadership is framed and conceived. Hence, there are many theories about leadership, and many theorists writing about it, but little solid work to link these to the realities of the challenges of leading a modernised NHS where little remains the same. Whilst we can draw lessons and wisdom from the insights and experiences of others, we desperately need to encourage and develop the vision and skills of those leading from the inside and at all levels of the organisation. Whilst we need to be aware of published (and publicised) notions and models of leadership, we also need to be able to critique and evaluate them, with a view to making intelligent selection of strategies and building upon models that have been seen to be effective.
A culturally specific concept of leadership
What is significantly different in the approach of the New Labour Government is that leadership is not regarded as the preserve of the powerful few, but as being a function of people’s roles throughout the NHS. Hence, the concept of leadership is key to the modernisation of the NHS and has been enshrined in the work of the NHS Leadership Centre, created in 2001 as part of the NHS Modernisation Agency (The NHS Plan, DH 2000). The Centre launched the NHS Leadership Qualities Framework in 2002 (NHS Leadership Centre 2003). The components of this framework (shown in Table 1.1) comprise 15 qualities, organised into three clusters of setting direction, personal qualities and delivering the service.
Table 1.1 Components of the NHS Leadership Qualities Framework.
Setting direction
Personal qualities
Delivering the service
Broad scanning
Self-belief
Empowering others
Intellectual flexibility
Self-awareness
Holding to account
Seizing the future
Self-management
Leading change through people
Political astuteness
Drive for achievement
Effective and strategic influencing
Drive for results
Personal integrity
Collaborative working
It can be seen clearly that these qualities reflect the values and beliefs inherent within the Government’s political stance. They reflect a ‘here and now’ snapshot of public values, which, it could be suggested, would be unrecognisable to both political and military leaders 50 years ago, and certainly are unlikely to be those identified by a different political party whose values derive from capitalism and the marketplace. The emphasis is on personal attributes and qualities, as opposed to traditional sources of authority and power or target-driven incentives derived from a business culture.
These qualities are considered to be a ‘set of key characteristics, attitudes and behaviours that leaders should aspire to in delivering the NHS Plan’:
setting the standard for leadership in the NHS
assessing and developing high performance in leadership
individual and organisational assessment
integrating leadership across the service and related agencies
adapting leadership to suit changing contexts
benchmarking – by enabling the development of a database on leadership capacity and capability
The framework is the result of a consultation exercise with NHS Chief Executives and Directors of all disciplines and ‘sets the standard for outstanding leadership in the NHS’ (www.nhsleadershipqualities.nhs.uk). It is considered to have the following applications:
Personal development
Board development
Leadership profiling for recruitment and selection
Career mapping
Succession planning
Connecting leadership capability
Performance management
Jean Faugier (2003), project director of the NHS Modernisation Agency’s national nursing leadership project, suggests that ‘effective leadership should embrace cultural, social, economic and organisational challenges and changes if it is to play a part in improving patient care’, and suggests that this is reflected in three themes:
developing and strengthening nursing leadership
breaking down the boundaries between professional groups
national nursing leadership programmes and the developing work of the NHS Leadership Centre.
This recognises that change, and leadership for change, is multifactorial, emphasising the need for wholesale, organisation-wide refocusing, rather than dependence on individual change. Government strategies, to this end, identify strategic, organisational, managerial and educational elements of the modernisation of the NHS, and task ‘leadership’ as the mechanism by which these will be effected.
There is further emphasis on the notion of interprofessional collaboration and development, particularly across both health and social care settings, and between primary and secondary care. Indeed, central to the vision of effective healthcare services premised upon local needs is the movement of funding to primary care services from secondary care and the strengthening of the role played by Primary Care Trusts in the new-look NHS (DH 1997, 2000).
