Emerald Group Publishing Limited
Copyright © 2008, Emerald Group Publishing Limited
Article Type: Editorial From: Leadership in Health Services, Volume 21, Issue 2.
This issue of Leadership in Health Services includes articles from South Africa, Spain, and the UK reflecting our increasingly global span. Certainly, as I travel the world, listen to the news and scan the health service environment, I realize the vast complexity of health care services. Although issues may seem local in nature, related to staffing, funding, service delivery, in fact they are global. The same pressures are being felt the world over.
Health delivery services everywhere are truly stretched. The problems created by the coming together of aging populations, the shortage of trained medical personnel, expensive pharmaceuticals, the need for increasingly sophisticated and costly medical equipment, and the increasing rise of chronic health conditions related to obesity and smoking are placing enormous pressures on the delivery of our health care systems. Leadership and innovation are vital if we are to cut through the swath, and start to find solutions that address the gap between the services we can deliver and the ever increasing demand for them.
In this vein, (although I do not live in the United Kingdom), I recently had the opportunity to view the Gerry Robinson series filmed by the BBC, about how to create change in the National Health Service in the UK. Two papers included here actually deal directly with some of the issues raised by the series. The first is a paper (one of a series) written by Professor Dennis Towill. Towill’s paper expands on some of my own observations in the series, the need for collaboration and innovation to create change by those who know best, the individuals who really work on the “coal face.” The other, written by Mike Pedler and Christine Abbott, is a research paper that addresses an action learning program designed to bring about service improvement on the part of health service middle managers. These managers, at the same time that they are trying to improve their own service delivery, are subject to the ongoing change policies and directives of their political masters who really run the show.
The Gerry Robinson television series served to bring home to me what I really believe good leadership is, and how rarely we see it. As I viewed events in Rotherham Hospital, I found myself sharing the sense of frustration expressed so often by Sir Gerry as he came up against various professional groups within the hospital structure, many of whose members had good ideas about possible change initiatives to improve service delivery, but who were simply unable to communicate with each other. Communication was blocked at all levels, in particular between medical consultants and nurses, and between all groups and the hospital management. In addition, the new CEO had little contact with anyone, and had already encountered an attempted vote of non confidence on the part of the consultants.
The end result was an environment where, despite lots of good ideas, no-one really knew how to go about making it better. From my perspective it seemed that the overwhelming organizational culture was one of learned helplessness and finger pointing. No matter how wonderful their professional training, everyone felt equally disempowered, including the CEO.
Sir Gerry’s skill, it seemed to me, was his ability to show his frustration without becoming personal, and actually ask people “eye to eye” for change. His success was to create an environment where people actually started to talk to one another, where they could contribute their skills and begin to work with much more intentioned collaboration.
Perhaps this is what true leadership is the ability to bring about real change conversations that result in action actions that change culture. The idea of change conversations, knowledge cafes, dialogue, innovation, collaboration and so on, is nothing new. Indeed, “Innovative Collaboration” was the theme of this year’s World Economic Forum in Davos, Switzerland, where politicians, journalists and business leaders from around the world come together to pool their viewpoints and information on the common problems we all face. Management literature is replete with calls for similar actions, for systems thinking, quality initiatives, effective communication techniques, organizational learning all tools which encourage us to pool our knowledge to bring about organizational improvement. We know that nothing happens in isolation, that our ability to communicate is our greatest tool. Yet somehow, communication is the one aspect of organizational life that we are not very good at. The paradox is that the more we know, the more difficult change conversations become. Could our ever increasing knowledge be getting in the way of our common sense? It is tragic that an organization as vast as the National Health Service, (the third biggest employer in the world) has to call in a person like Gerry Robinson to implement changes that, once the picture is painted, anyone can see are needed. My biggest learning from this series was that as much as leaders have to shut themselves away and develop long term strategic plans, they also have to be able to create culture change to start people talking to each other- so that instead of a culture of learned helplessness, it becomes one of real empowerment, where people feel sufficiently energized and comfortable to create the change they believe is necessary. In my opinion, this is the leadership we need to celebrate and cultivate.
Sir Gerry Robinson and the NHS
Sir Gerry Robinson is a successful business manager recognised for his ability to turn around failing organisations within the commercial sector. He was invited by the Open University and the BBC to participate in a major documentary which looked at the problems of public sector management in the NHS.
The documentary challenged Gerry Robinson to tackle waiting lists within one large modern-day hospital within six months without any additional funds. The series was shown early in 2007 with a number of common aims most notably:
raising the quality of debate about the NHS;
giving people insight into the real and systemic difficulties of managing performance and change in such a large and complex organisation; and
to question whether the large numbers of managers within the NHS hinders its ability to achieve effective management and leadership.
Opinion regarding the outcomes of the documentary has been divided both within the health care sector and the public domain. However, it did raise debate and identified issues about leadership which could be relevant for any large organisation within the world and particularly within healthcare.
Within this context, Professor Denis Towill has produced a number of short discussion papers which are highly informative having both local and international relevance. The first of these papers extract the key emerging issues and learning opportunities from the perspective of hospital practice as observed from the logistician viewpoint.