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Wicked problems

Gerry McGivern, professor of organisational analysis at Warwick Business School, makes the case for managed networks. 

In times of austerity, can we afford compassionate NHS leadership? The findings of a three-year study of the NHS I was involved in suggests tapping into a sense of compassion is what often drives NHS leaders to face the difficult challenges of improving patient care. So if the NHS is to address its current challenges we need more compassionate leadership, not less. 

My colleagues Ewan Ferlie, Louise Fitzgerald, Sue Dopson, Chris Bennett and I studied eight networks providing cancer, genetics, sexual health and elderly care services. In our new book, ‘Making Wicked Problems Governable? The Case of Managed Networks in Healthcare’, we argue that effective ‘managed networks’ may be able to address the complex ‘wicked’ problems currently facing the NHS, such as an ageing national population, which are beyond the control of one organisation or profession. 

Small leadership 

One interesting finding from the study, which echoed the Francis Report’s findings on the Mid Staffordshire NHS Trust scandal, was that the best leadership teams are often driven by personal experience of good or bad patient care. Successful healthcare networks often needed clear evidence-based clinical guidelines to provide a ‘burning platform’ for service improvement – i.e. guidelines outlining service improvements they must make or there will be consequences. But what drives change is small leadership teams, containing doctors, nurses and managers, with the energy to develop and implement local evidence-based guidelines. 

What often provides this energy is relations’, friends’ or personal experience of the difference that good and bad healthcare makes. 

This fuels their passion to make change and a compassionate commitment to patient care. When this is combined with a belief in the guidelines, you’ve got the ingredients for improving patient care. 

Evidence-base

In the book we talk about the importance of ‘evidence-based identity work’. Translated from academic-language into English, this means that where network leadership was most effective, leaders were using evidence-based guidelines to drive improvements in patient care and in doing so becoming the kind of leader they could be proud to be – who knew they made a difference for patients, rather than spending their time nine to five ticking boxes. The study found that where these elements were missing, networks struggled to make changes.

The least effective network we came across was a regional elderly care network where there was no national guideline or policy and no leadership team, just a single part-time manager. With many different stakeholders involved, from the NHS, local authority, voluntary and private sectors, all viewing elderly care in different ways, the network became a ‘talking shop’ and nothing happened. 

Passionate professionals 

In contrast we found that cancer networks were highly effective in improving cancer care, in large part because there was a multi-professional leadership team co-ordinating the network who were passionate about using NICE’s national guideline for best practice to improve patient care.

Other inspiring examples of compassionate leadership from the study included an NHS consultant who talked about how the experience of telling tearful parents that their children might die inspired him to work unpaid overtime to help develop a NHS genetic testing service for sudden cardiac death syndrome, and palliative care nurses who passionately believed in implementing good ‘end-of-life’ care. 

Other clinical leaders talked about feeling deep anger about colleagues not acting in patients’ best interests but transforming this feeling into the energy to drive change. 

But dealing with illness on a day-to-day basis is inherently distressing. When combined with the frustration of struggling to improve services and patient care, this may overwhelm some NHS leaders, leading them to disassociate from this distress but also the sense of passion. And maybe it is because of this we hear about ‘box ticking’ mentalities in the NHS. 

That’s where working in leadership teams is helpful; leadership teams help members deal with distress and frustration, and turn this into the fuel to fight another day for patient care. 

The study was funded by the National Institute of Health Research Health Services and Delivery Research (NIHR HS&DR) programme (project number 08/1518/102; visit www.netscc.ac.uk/hsdr for more information) and could help steer future policy. The views and opinions are those of the authors and do not necessarily reflect those of the HS&DR programme, NIHR, NHS or the Department of Health.