Leadership And Learning
By Engage


Theresa Douglas, explores the topic ‘Leadership and Learning: using yesterday to make tomorrow better’

No matter where you work today, public or private sector, retail or service industries, you cannot fail to notice that leadership (or the lack of it) is currently high on the agenda – societally, politically, strategically and operationally.

A superficial search for ‘leadership’ on Google returned 969,000 ‘hits’ and the Ovid database returned 32,118 journal articles covering the subject. Specifically, within the Health and Community Care sectors, it is just as hot a topic (an Ovid search returned 242 articles looking at a combination of NHS, Community Care and leadership) and increasing amounts of resources are being invested in defining and developing ‘leadership’ in order to support the ‘transformational change’ that we are told is crucial if the healthcare services of the future are to grow and be sustainable.

In today’s post modern society, the public sector generally is the focus of much attention and scrutiny, the aim to drive up the quality of services whilst also ensuring value for the tax payer’s money. In order to create the most conducive environment to allow that to happen, and to equip staff with the skills and capabilities to rise to the challenges that this poses, government policy has emphasised the need not only for strong leadership at the helm but for the development of leadership at every level of the organisation. But what does that mean in lay mans terms and for our every day reality?

With 25 years experience as a registered nurse working in both the public and private sectors and over 40 years experience as a user of healthcare services directly and indirectly, I have seen the best and worst of care and caring. Mainstream media present an unbalanced view highlighting horror stories which engage and enrage readers and listeners. Yet many of us who have horror stories to tell also have praise and gratitude for those who have looked after us and our loved ones, in fact, very often, the individuals’ story contain vivid examples of both.

What is it then that makes the differences that matters for staff, carers (in the widest sense) and the receivers of that care? 

The Difference That Makes The Difference
Raymond Gaita (2000) in his book ‘A Common Humanity’ suggests we seek:

  • Love
  • A sense of connection with others
  • To be safe
  • To learn
  • To lead a meaningful life
  • To be free from ridicule and harm
  • To be healthy and free from poverty

Humanistic Psychology, defined by Carl Rogers, considers that wellness – physical, emotional and mental wellbeing, is only possible when an individual is able to realise their full potential. Obviously, the prioritisation and importance attached to each of these areas will fluctuate depending on personal preferences and the actual situation. However, if these things aren’t happening for an individual, anxiety and perceived vulnerability will be raised.

In addition, when health matters are the main focus of the attention, emotions can be running high both for patients themselves and those around them. For the professionals, add in the pressures of the changing work and caring environment, time and workload issues, conflicting priorities, diverse perspectives and cultures of staff, there is a real potential for misunderstanding, fear and conflict to arise.

Yet sometimes we manage to meet the needs of our patients and clients perfectly and sometimes we don’t. There are undoubtedly instances when technical and clinical skills are the main issues however the fundamental area underpinning the technical aspects of care which is sometimes missed is how those involved empathise, communicate and behave towards others, the attitudes they adopt and the actions they take.

Scottish health statistics show that 15% of written complaints received by main NHS Health Boards 2003/2004 related directly to staff attitudes and behaviour with an additional 31.4% related to staff ‘issues’ generally.

Given the current and growing philosophy of enabling and empowering the public to become increasingly involved and more responsible for their own wellness and health issues (Scottish Executive 2004, 2005a), it seems useful then that, as Gaita states, humans seek learning and connection which could be opportune rather than threatening. The deciding factor being the perspective, approach, attitude and behaviour of those involved.

Learning And Leadership
Both learning and leadership are active and dynamic processes which require those involved to willingly participate if they are to be successful and achieve their aims. In some organisations, there has been a move to adopt the concept pioneered by Peter Senge et al (1990) to build ‘Learning organisations’ where, particularly in situations of rapid change, it is only possible to excel through an openness to learning from experience and by being flexible, adaptive and productive – leading to a combination of ‘adaptive and generative learning’ – learning that allows us to deal with the present while enhancing our capacity to create the desired future. 

This is a very important issue in the public sector where services must continue to be delivered to dependent people through hail, rain and shine. {mospagebreak}

Within the NHS, the link between high quality leadership, learning and high quality patient and client care is increasingly emphasised (Donaldson, 2001; Firth-Cozens and Mowbray, 2001; Edmonstone and Western, 2002). What emerges from the literature and a review of the policy drivers in the NHS, is the magnitude of the change which is needed. This is captured well by Donaldson who states that the agenda for healthcare in the 21st century will be:

‘dominated by a vision of quality…the ability to deliver safe, effective, high quality care within organisations with the right cultures, the best systems and the most highly skilled and motivated workforces will be key to meeting this challenge…developing leadership skills will be essential to achieving this transformation’ (p8)

It would appear that leadership and learning are fundamental to addressing the current drive for high standards of safe, effective care and services which provide value for money and are responsive to the needs of everyone irrespective of diversity. However, it is hard to say what must come first – learning or leadership – only that they must co-exist if we are to meet the challenging modernisation agenda and create a culture of willingness to learn and continuously develop new ways of working.

What is required is a supportive culture which inspires and motivates people to take personal
responsibility and be active participants in the process, realising that everyone contributes to the cultures which exist (Alimo-Metcalfe and Alban Metcalfe, 2000).

Leadership through transformational change, as described by the Scottish Executive (2005b) encourages everyone, not just those on the ‘top team’, to take responsibility for their behaviour and to be aware of their impact on others, colleagues, patients and clients alike irrespective of perceived status or role and the care services ultimately delivered.

A Personal Perspective
Both learning and leadership have become increasingly close to my heart through years of personal and professional experience of the NHS. Professionally, I see myself as a product of the movement to engage, involve and develop the role of both staff and users of the services in a more meaningful way. I have learned and grown, becoming a coach and facilitator of first clinical supervision and then leadership development in others and a recipient of the same programmes of learning. Through that I have become aware of the success that is possible in enabling people to fulfil their potential.

I also have become aware of the need to inspire and encourage in others an openness to all learning opportunities and to develop an attitude to change and learning which embraces the challenges that brings, knowing that to do so, will result in personal and professional growth and improved health and care services.

That is the essence of the leadership we strive for, living the philosophy that tomorrow will be enriched by the learning we take from today and apply thoughtfully.

References

  • Alimo-Metcalfe, B. Alban-Metcalfe, R. (2000) Heaven can wait Health Service Journal 110, 5726,26-29
  • Claxton, G. (1981) Wholly Human: Western and Eastern Visions of the Self and its’ Perfection Henley Routledge and Kegan Paul
  • Donaldson, L (2001) ‘Safe high quality healthcare: investing in tomorrow’s leaders Quality in Healthcare 10 (suppl 11) ii 8-12
  • Edmonstone, J and Westren, J (2002) Leadership Development in Healthcare; what do we know? Journal of Management in Medicine 16 (1) 34-47
  • Firth-Cozens J. and Mowbray D (2001) Leadership and the quality of care Quality in Health Care 10 (supp. II) 113-117
  • Scottish Executive Health Department (2002) Fair for All; The Wider Challenge Edinburgh SEHD: www.scotland.gov.uk/library3/society/ffar-00.asp
  • Scottish Executive Health Department (2005a) Delivering for Health Edinburgh SEHD: www.scotland.gov.uk/Publications/2005/11/02102635/26356
  • Scottish Executive Health Department (2005b) Delivery through leadership NHS Scotland Leadership Development Framework Edinburgh SEHD: www.scotland.gov.uk/Publications/2005/06/28112744/27452
  • Senge, P. Kleiner A. Roberts C. Ross R. B. Smith B. J. (1990) The Fifth Discipline Fieldbook London Nicholas Brealey