Better leadership for health and care (first meeting)
This was the first of two meetings, and the topic was ‘if we don’t like command-and-control leadership methods in our health and care systems, what are the alternatives?
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Nick Sinclair spoke first. He is the Director of the Local Area Co-ordination Network, the founder of the New Social Leaders network, and a thought leader for the Better Way leadership strand.
As Nick explained, in recent months in the Better Way we have been exploring a style of leadership which places high value in building positive and productive relationships, in nurturing power and accountability in others, in listening closely to others and engaging in the reality of people’s lives, and in acting in collaboration with others.
Luan Grugeon was our second speaker. She is a Board Director of NHS Grampian, and Chair of Aberdeen City Integration Joint Board, with a background in the third sector.
Luan described how ‘conversational intelligence’ can be a foundation for a different kind of leadership, less about command-and-control and more about building relationship, trust and collaboration. ‘To get to the next level of greatness, depends on the quality of the culture, which depends on the quality of the relationships, which depends on the quality of the conversations. Everything happens through conversations!’ - Judith Glaser
There are level 1 conversations which are transactional, Luan explained, level 2 which are positional, and level 3 which are transformational. When the work involves complexity and risk, and there is a need for stable alliances and fresh approaches, ‘level 3’ conversations are vital. This requires an openness of mind and willingness to look for mutual benefit and co-creation. It means investment in building trust, empathy and relationships, using accessible language, ensuring community participants have an equal voice, and welcoming different perspectives.
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Here are some of the key points made by speakers and in the discussion that followed, and by three respondents to the discussion: Sam Spencer Continuous Improvement Officer at Kensington & Chelsea council; Will Nicholson, independent Health and Wellbeing Consultant; and Olivia Butterworth, Head of Public Participation at NHS England.
Those in leadership roles should recognise the best starting points for service design are people and their experiences, not requirements imposed from above. Leaders should therefore ensure that real life experiences are always present in the room, in some form.
We need to abandon outdated hierarchical models of ‘strong’ or ‘natural’ leadership, and leaders as ‘fixers’. It is possible to flatten hierarchies, to ‘turn the pyramid upside down’ or even create circles instead.
We need a more human approach to leadership. Leadership should mean being in service to people and communities, and the truly strong leaders are those who can resist the controlling pressures from within or from outside, and create a safe space for the workforce to be curious, engage in creative conversation, make connections, and do the right thing.
Sometimes people feel trapped by a system that is just not working in the way it should, and oppressed by pressures of demand from below and target setting from above. There is a lot going on that needs to be called out - engagement exercises for example when the answers are decided in advance.
Yet despite the many difficulties it is not hard to find good people, who care, and who are often able – in their immediate sphere of influence – to make a positive difference. These are the true leaders, and the task of those who are in management roles should be to make it easier for them to do more.
We need bold, brave, radical conversations about the scope and purpose of our health and social care system. Not least to address the huge racial, gender, and class inequalities.
Building a movement of people who are encouraging each other to practice better leadership, is a powerful way to achieve widespread and lasting change, and more effective some thought than attempting to force change on reluctant politicians or on other national leaders who simply don’t want to change.
It some parts of the country there are determined efforts to improve the ways things are done, with public authorities demonstrating that it is possible to share power more – in Dorset, Somerset, Fleetwood, for example. Sometimes the initiative is coming from the NHS or council leadership, sometimes from a GP, or from a community activist.
A more honest open transparent style of leadership in the fields of health and care is therefore possible, to replace the closed, opaque defensive leadership styles that remain prevalent. But it won’t be easy – there will be resistance to change and negative scrutiny of those attempting to drive change. So supportive networks for leaders who are attempting to work in a better way are very valuable.
The note of the second meeting, on April 17th 2023, can be found here.