If it’s about Culture, it’s about Leadership
There are plenty of issues to keep health leaders awake at night: financial concerns, the winter crisis, the junior doctors’ strikes and experiences of poor-quality care are all in the news.
Some underlying issues behind the headlines:
Health leaders are concerned about staff reporting high levels of bullying and harassment and are considering strategies to deal with this. They are also concerned with high levels of discrimination reported by some groups of staff and are considering strategies to deal with this.
There need to be strategies to deal with high levels of staff stress and absenteeism. And then the ambition for the NHS to be the largest learning organisation in the world requires a strategy for ensuring continuous improvement. And there is a need to develop system leadership, which will require yet more strategies. Plus, the need to address the shortage of leaders throughout the health system, which requires a further strategy. So what we end up with is a patchwork of strategies, sewn more or less together in a diffuse set of responses to these important concerns.
If we want to deal effectively with all these issues, then, first and foremost, we need to develop organisations with cultures that deliver high-quality, continually improving and compassionate care. Research shows that such cultures are sustained by organisations that have:
an unwavering commitment to providing safe, high-quality care
a commitment to effective, efficient, high-quality performance
behaviours characterised by support, compassion and inclusion for all patients and staff
ways of working that focus on continuous learning, quality improvement and innovation
enthusiastic co-operation, team-working and support within and across boundaries.
We see these values and behaviours in high-performing teams across the health sector. These teams have seen considerable improvements in patient outcomes and staff wellbeing as a result of their efforts. If one can achieve it, all can achieve it.
The question is, how?
Research reveals that leadership is the most significant influence on culture. Every interaction by every leader, every day, shapes the culture of the organisation. So we need leadership that is focused on ensuring constant commitment to all the elements that contribute to a nurturing culture. And we need to ensure we have leaders, and a pipeline of leaders, in place to provide that focus. Not interim leads, vacant leadership posts and make-do-and-mend approaches to leadership that are now commonplace in some areas of the health sector.
Ultimately we need one strategy – a leadership strategy. This must ensure we have the right number of leaders in each area of an organisation over the next five years to nurture and sustain caring cultures. We need to identify the qualities these leaders need in order to meet challenges and we need to recruit, develop and select accordingly.
We must develop and continually reinforce the right leadership values and behaviours – such as developing and empowering people, encouraging shared learning and continuous improvement, building trust and co-operation, supporting inclusive climates, and managing performance – needed to nurture these cultures.
This means a move away from command-and-control leadership – still the dominant style in many areas of the health system – to collective leadership. Not because of ideology but because international research evidence demonstrates that collective leadership is associated with high-quality care. Collective leadership is where staff at all levels act to improve care – within and across organisations. It means ‘leadership of all, by all and for all’.
Culture change and leadership transformation must happen at all levels of the health system, from national bodies through to all provider organisations if we are to achieve and sustain consistent cultures of high-quality, continually improving and compassionate care. The challenge for us all is to look around your own department or organisation and see what you can do to enhance your leadership practice and improve the workplace culture.
About the Author:
Michael West is the Head of Thought Leadership at The King’s Fund and Professor of Work and Organizational Psychology at Lancaster University Management School as well as Senior Research Fellow at The Work Foundation. https://www.kingsfund.org.uk/