Health Service Focus

27.11.19

Leadership and Management are two different roles – what is your job, really?

Source: NHE Nov/Dec 19 

Dr Darren Leech, director at NHS Elect

‘Management’ remains a toxic word for the NHS. Managers have long been associated with a bureaucracy that impedes, rather than improves patient care and it is for that reason that many NHS organisations have focused on developing ‘future leaders’, rather than ‘future managers'. Telling everyone in the NHS that they are a leader is likely to cause problems. Not many people are able to clearly explain or differentiate between management and leadership roles, so there’s already plenty of scope for confusion and conflict.

So, what is leadership and what is management? Figure 1 below provides a clear summary, but concisely put, effective management ensures that systems are set up and working safely and efficiently. Management is focused on implementing, organising, measuring and ensuring everyone is clear on their role and contribution toward the task or goal. This is different to the role of leadership, which is more abstract - focused on developing and communicating a vision for the future that is different to the status quo. Leadership is about encouraging and empowering people to take risks and to innovate.

Figure 1. Leadership v Management

Leadership

Management

People

Process

Take risk

Reduce risk

Change

Consistency

Innovation

Replicate

Transformative

Incremental

Coach / Delegate

Direct / Mentor

Long term

Short term

Empower

Structure / Control

Vision

Procedure

Adapted from Handy (1993) and Kotter (2013)

A sizeable proportion of those with responsibility for managing people and services in the NHS were once (and may still be) proficient nurses, doctors, therapists or other clinically trained professionals. These folks were good at a role they originally aspired, studied and trained to do. They were recognised and rewarded (often via an unplanned period of “acting up”) with more senior “leadership” responsibilities.

Once promoted, they often learned how to undertake these new responsibilities through experience, mistakes and good fortune - rarely does the NHS provide such professional development pro-actively, prior to appointment. In addition, the NHS model of delivery remains one in which the patient expects to receive advice and direction from their clinician. The dominance of this ‘medical mindset’ along with a cultural reality that is heavy on regulation and hierarchy, means it’s no surprise that instruction, advice and mentorship are dominant. These management orientated styles remain the preferred professional approach of many senior people in the NHS - as opposed to leadership orientated traits such as coaching and delegating.

This situation poses several challenges and questions. Does the NHS really want senior people to coach and delegate more and if so, will there be some air-cover from regulators whilst ‘future leaders’ test out such skills? Do senior people in the NHS really understand the difference between leadership and management and if so, what is the dominant requirement of today’s day job? In reality, is visionary leadership really required given NHS objectives remain broadly the same - or do NHS organisations need more efficient and effective management?

Perhaps it’s time for the NHS to de-toxify and embrace the word ‘management’. Acknowledging that organisations need both effective management and leadership, the reality is that most senior people promoted from the ranks need to first consolidate their basic management skills and only then, can consider if they want to become a ‘future leader’.

 

Comments

There are no comments. Why not be the first?

Add your comment

national health executive tv

more videos >

latest healthcare news

NHS England commits £30m to join up HR and staff rostering systems

09/09/2020NHS England commits £30m to join up HR and staff rostering systems

As NHS England looks to support new ways of working, it has launched a £30m contract tender for HR and staff rostering systems, seeking sup... more >
Gender equality in NHS leadership requires further progress

09/09/2020Gender equality in NHS leadership requires further progress

New research carried out by the University of Exeter, on behalf of NHS Confederation, has shown that more progress is still needed to achieve gen... more >
NHS Trust set for big savings in shift to digital patient letters

09/09/2020NHS Trust set for big savings in shift to digital patient letters

Up and down the country, NHS trusts are finding new and innovative ways to leverage the power of digital technologies. In Bradford, paper appoint... more >

editor's comment

26/06/2020Adapting and Innovating

Matt Roberts, National Health Executive Editorial Lead. NHE May/June 2020 Edition We’ve been through so much as a health sector and a society in recent months with coronavirus and nothing can take away from the loss and difficulties that we’ve faced but it vital we also don’t disregard the amazing efforts we’v... read more >

last word

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad: ‘We all have a role to play in getting innovations quicker’

Haseeb Ahmad, president of the Association of the British Pharmaceutical Industry (ABPI), sits down with National Health Executive as part of our Last Word Q&A series. Would you talk us th... more > more last word articles >

the scalpel's daily blog

Covid-19 can signal a new deal with the public on health

28/08/2020Covid-19 can signal a new deal with the public on health

Danny Mortimer, Chief Executive, NHS Employers & Deputy Chief Executive, NHS Confederation The common enemy of coronavirus united the public side by side with the NHS in a way that many had not seen in their lifetimes and for others evoked war-time memories. It was an image of defiance personified by the unforgettable NHS fundraising efforts of Captain Sir Tom Moore, resonating in the supportive applause during the we... more >
read more blog posts from 'the scalpel' >

comment

NHS England dementia director prescribes rugby for mental health and dementia patients

23/09/2019NHS England dementia director prescribes rugby for mental health and dementia patients

Reason to celebrate as NHS says watching rugby can be good for your mental health and wellbeing. As the best rugby players in the world repr... more >
Peter Kyle MP: It’s time to say thank you this Public Service Day

21/06/2019Peter Kyle MP: It’s time to say thank you this Public Service Day

Taking time to say thank you is one of the hidden pillars of a society. Being on the receiving end of some “thanks” can make communit... more >
Nurses named as least-appreciated public sector workers

13/06/2019Nurses named as least-appreciated public sector workers

Nurses have been named as the most under-appreciated public sector professionals as new research reveals how shockingly under-vauled our NHS, edu... more >
Creating the Cardigan integrated care centre

10/06/2019Creating the Cardigan integrated care centre

Peter Skitt, county director and commissioner for Ceredigion Hywel Dda University Health Board, looks ahead to the new integrated care centre bei... more >
Helpforce to launch training programmes for NHS volunteers

10/06/2019Helpforce to launch training programmes for NHS volunteers

Kay Fawcett OBE, clinical advisor and education lead at Helpforce, and Lynn Twinn, talent development consultant, outline the new national traini... more >

interviews

Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

24/10/2019Matt Hancock says GP recruitment is on the rise to support ‘bedrock of the NHS’

Today, speaking at the Royal College of General Practitioners (RCGP) annual conference, Matt Hancock highlighted what he believes to be the three... more >
NHS dreams come true for Teesside domestic

17/09/2019NHS dreams come true for Teesside domestic

Over 20 years ago, a Teesside hospital cleaner put down her mop and took steps towards her midwifery dreams. Lisa Payne has been delivering ... more >
How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

24/10/2018How can winter pressures be dealt with? Introduce a National Social Care Service, RCP president suggests

A dedicated national social care service could be a potential solution to surging demand burdening acute health providers over the winter months,... more >
RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

24/10/2018RCP president on new Liverpool college building: ‘This will be a hub for clinicians in the north’

The president of the Royal College of Physicians (RCP) has told NHE that the college’s new headquarters based in Liverpool will become a hu... more >
Duncan Selbie: A step on the journey to population health

24/01/2018Duncan Selbie: A step on the journey to population health

The NHS plays a part in the country’s wellness – but it’s far from being all that matters. Duncan Selbie, chief executive of Pu... more >