Adaptive Leadership in the NHS

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As part of the Academy’s two year story, we have asked a range of people from across health and social care to share their own stories and experiences of what leadership means to them.

It wasn’t the most inspiring definition of my new role: “Leadership is all about disappointing your own people at a rate they can absorb”.

And initially, I didn’t thank Ron Heifetz for letting me in on the secret.  Wasn’t leadership all about having all the answers and cheering everyone up? Presumably Ron knew what he was talking about, he was a Harvard Professor. But it didn’t seem to match any definition I’d ever heard.

There was worse to come. Leaders disappoint people in not one, but two ways. The first is that they can’t possibly know all the answers; not in a complex, rapidly-changing system like the NHS. It’s just too difficult.  Leaders have to equip the people who are closest to the coal face to make their own decisions. That may be disappointing for some.

And the second problem is that many people in the system probably like things just the way they are. Heifetz talks about “the myth of the broken system”, the idea that there are just a few technical tweaks to be made and mistakes to be corrected, and everything will be OK. But in fact “the system is perfectly configured to produce the results it does produce”. Which sounds tautologous but means that people are doing things for what feel like good reasons. To introduce change means to disrupt this complex system, to cause people to experience some immediate concrete loss in return for some future possible improvement.

I could feel a resignation note coming on. But then I thought about my previous work in international development, building a firm of “extreme management consultants” to kick start better governance in places like Afghanistan and Sierra Leone. Going in to a new country we knew that there was no point in flying in with our own slick solutions. We knew we had to help local people to work things out for themselves. Not just for the boring change management reason that it achieved buy-in, but for the more profound reason that we weren’t clever enough to think it all through ourselves.

I haven’t yet worked out exactly who I’m going to disappoint. I do know that it would be good to create a system where everybody routinely makes the right decisions because they have the right values and information and incentives, not because I’ve done something that feels clever. It sounds pretty difficult, and at the moment I believe it intellectually more than I feel it emotionally. So the first person to experience loss will be me (Ron tells me it’s good to know what that feels like, before I impose it on others). But if any system needs to escape from top-down leadership, from a culture of introducing a new initiative to correct the unforeseen consequences of the previous initiative, it must be the NHS.

If I can chip in to help create a truly adaptive system that responds quickly and simply to the myriad needs of diverse patients, that must be worth a little bit of discomfort along the way.