However, the extent to which charismatic or inspirational leadership helps bring about
improvement in organisational performance is open to much debate. For example, Conger
also draws attention to the danger that the leader’s vision, dynamism and inspirational
nature are highly attractive to followers, which leads to a natural dependence. Staff see this
extraordinary figure as a model to be emulated and the leader’s abilities become the yard-
stick by which they measure their own performance. This is a potential source of
leadership derailment. Dependence makes the followers more susceptible to deception.
62
CHAPTER 8 THE NATURE OF LEADERSHIP
305
Improvement in
organisational
performance
The National Health Service is currently facing the chal-
lenges of the most significant change since its inception.
It was built on traditional models of leadership and
beliefs that ‘managers’ should manage, and doctors and
nurses should provide clinical care. The NHS has survived
numerous structural changes in the last fifty years but none
have fundamentally challenged that philosophy. Clinical
leaders were encouraged to take senior roles in the leader-
ship of their specialist clinical areas (the Director of
Nursing, etc.), but the function of managing the ‘business’
(financial resources, human resources, strategic planning,
etc.) was always perceived as being safe in the hands of
the professional ‘general manager’. Occurrences of clini-
cians moving into senior general management positions
were rare and usually involved them in divesting them-
selves of their clinical roles.
In the 21st century it is now recognised that the NHS
needs fundamental modernisation in the way it develops
strategic plans, determines priorities, allocates and man-
ages resources and manages performance and quality
improvement.
The media have drawn the public’s attention to quality fail-
ures, clinical negligence, and inequity in resource allocation
and recruitment and retention difficulties. The Government’s
modernisation agenda challenges the NHS to:
■ improve collaborative, integrated working across all
agencies and professions in the system;
■ move from a system focused around the clinical ‘expert’
to a consumer-centred service;
■ introduce a learning culture both within professional
groupings and organisations; a major shift away from
the prevalent ‘blame’ culture;
■ implement innovative approaches to the delivery of
health and care.
Above all, this requires a new model of management and
leadership in the NHS. The NHS needs to develop leaders
who have credibility with clinicians and can inspire and
motivate, an often-demoralised workforce, to own and
drive continual change. The simplistic model of the past –
managers plan and allocate the resource while clinicians
control and spend the resource is no longer tenable.
The NHS needs to develop outward facing managers
and clinicians who can lead system-wide change across
the NHS.
Writers in the field of leadership have refocused. The
early writers often interpreted leadership as an authority rela-
tionship, referred to as management. This is now referred to
as Transactional leadership. The new model leadership is
that of the Transformational leader; a process of influencing
followers or staff for whom one is responsible, by inspiring
them towards the ‘vision’ of some future state.
The ideas of the Transactional and Transformational
leader are pertinent to the development of leaders in the
new NHS. Many NHS organisations have encouraged and
rewarded Transactional managers. These leadership qual-
ities may have been appropriate in the NHS of the last
century when managers were leading complex organisa-
tions in a more predictable and static environment. What is
needed now? A group of leaders for tomorrow’s NHS who
share a set of common values and act as a leadership
community, who can lead confidently in clinical areas, who
understand how to run a patient-centred service;
who deliver continuous performance improvement and who
reflect the diversity of the communities they serve.* Above
all what is needed are leaders who can provide strategic
direction to and inspire a complex workforce in an environ-
ment that is turbulent, ever changing and difficult to predict
(Transformational leaders).
To achieve the leadership community that will take the
NHS successfully into the 21st century will require an inte-
grated approach that is adequately resourced to:
■ Provide education and development for the leaders of
tomorrow,
■
Achieve a shift in culture to develop learning organisations,
■ Break down the barriers that exist between manage-
ment and clinical leadership model,
■ Restructure NHS organisations to place decision-
making closer to patients and clinicians.
The NHS is undergoing a fundamental rethink of its tradi-
tional leadership and management models. It needs to
move from a position that believes ‘managers’ should lead
and manage, to one where ‘leaders’ (whether clinicians or
managers) provide strategic vision and leadership, and
managers support them in the implementation and opera-
tionalisation of strategic vision and plans.
* Internal Paper from Hugh Taylor, Director of Human Resources, NHS
Executive (2000).
(I am grateful to Anne Tofts, Director, Healthskills, for providing the above
information.)
Developing leadership in the NHS of the 21st century
EXHIBIT 8.1