Friday, 22 August 2008

Leadership: What is it and Does it Matter in Healthcare?

I'm doing a presentation on leadership next week for the senior management team of NHS Greater Glasgow and Clyde, the largest health authority in the Scotland employing upwards of 40,000 people. This has caused me to think seriously about what I can usefully say - without being academically bland - to experienced people operating at a senior level on matters that can have extremely serious outcomes.

Like most management academics in these situations, I've chosen to do something which challenges the shibboleths of the 'leadership industry' from an evidence-based perspective and points to some useful things that leaders and leadership can achieve, again drawing on evidence rather than managerial cant. Some of this evidence is drawn from the provocatively titled and beautifully written books by Jeff Pfeffer and Robert Sutton on 'Hard Facts, Dangerous Half-Truths and Total Nonsense', Phil Rosenzweig on 'Eight Delusions that Deceive Managers', and Rakesh Khurana on 'The Irrational Question for the Charismatic CEO', with a of little Henry Mintzerg's 'Managers not MBAs' thrown in for good measure.

Other evidence, however, is taken from recent articles in journals or reports that most managers wouldn't pick up on. These include new material by Helen Dickinson and Chris Ham (2008) Engaging Doctors in Leadership', which can be found on the NHS Institute for Innovation and Improvement website at the bottom of this page; research into the importance of social capital; research into public value creation, including Mark Moore and Jean Hartley's (2008) paper 'Innovation in Governance' Public Management Review, 10, 1, 3-20; and two articles in the current issue of the British Journal of Management on something call 'top echelon theory', which deals with the impact of top management teams on performance (Patzelt, H., Zu Knyphausen-Aufseff, D. and Nikol, P., 2008, Top management teams, business models and performance of bio-technology ventures: an upper echelon perspective, British Journal of Management, 19, 3, 205-221; Naranjo-Gil, D., Hartmann, F. and Mass, V. S. (2008) Top management hetrogenity, strategic change and operational performance, British Journal of Management, 19,3, 222-234).

It's a real shame that these latter two articles weren't written with managers in mind because they have important practical things to say about what effective senior management teams in the healthcare sector need to take into account and need to become. However, I'm drawing readers, especially my postgraduate healthcare students, attention to these articles and to the other references because they are certainly worth reading, though some are more easily understood than others.

My storyline is as follows:

  1. that leaders matter a little less than the leadership industry would have you believe, especially in organizations that remain professional bureaucracies, dominated by doctors,
  2. that investment in followership and microsystems of distributed leadership in healthcare is key to effective performance, but they need to be connected to:
  3. diversely-constituted top management teams that both fit and shape innovative 'business models' or organizational architectures. These TMTs can be a positive force for strategic change in healthcare in ways that charismatic individuals can't. However, the composition of these teams matter a great deal because it determines their absoptive capacity to take in and exploit new knowledge. The diversity of these teams also matters because different people bring different things to the table and, equally importantly, diversity is also likely to reduce professional tribalism and motivate increasingly dissenchanted and/or sceptical clinicians to become more involved in the running of their organizations.

There may be little that's novel in this message, but I hope the evidence-base just about makes it credible.

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