The value of leadership in the contemporary healthcare organisations - Essay Example

Introduction The National Health Service (NHS) in the UK is faced daily with issues that make service delivery more and more challenging. These problems bare a direct effect on the health of every individual, because if the Healthcare organs function in a strain it would transcend into less quality services provided. Healthcare workers include various professionals from Doctors, nurses, administrators and sundry other stakeholders who are relevant to the delivery of good Healthcare are affected by the issues of funding, inadequate or shortage of manpower. However in the NHS one major clog in the wheel of adequate, humane healthcare delivery is the issue of personnel. Due to the nature of synergistic collaboration needed to provide adequate services at these organisations, human resources management must be at the most efficient level. Bickering among stakeholders from Government agents to Medical staff has escalated, assuming alarming proportions. Therefore the importance of rightly qualified persons to handle all aspects of healthcare institutions is all too clear. According to former Health Minister John Denham (1999): "The NHS is only as good as its one million staff. For too long the NHS has acted as if it wasnt." This paper will focus on the importance and increasing role of Human resources management in providing ‘good’ Leadership in the NHS by examining some of the challenges and issues that directly affect its organisations. The importance of the value system in the choice of Leadership of these institutions and what qualities medical professionals and administrators of NHS should possess in synchrony with the roles they play in the Leadership of their organisations. Challenges in Contemporary Healthcare Management Verninga (1982) writes that Health administrations will increasingly confront multitude of pressures, criticisms and challenges in the performance of their duty (p. 2). A seeming lack of organisational efficiency in the guise of Bureaucracy and duplication is an anathema to good practice. Across the [UK] public sector there is increasing demand from --- the public to deliver greater efficiency in public services (Gershon, 2006). Healthcare stakeholder’s should therefore be aware of the issues that are likely to challenge the industry in these present times. The quality of Healthcare will be affected not only by these, but also by the industrys own unique set of issues such as “problems of excessive politicisation and managerial control [which] has eroded a lot of staffs professional freedom, and [left] morale low” (Bapat, 2002). Bapat (2002), states that “another problem with the [healthcare organisations] is a conflict of interest”. He explains that a lot of medical or clinical directors or doctors in managerial positions also have a thriving private practice. He points out that most of these Doctors would be considered to have a vested interest in reducing the efficiency and output of the healthcare system, concluding that such people [in Leadership positions] cannot command respect from their colleagues. In a recent survey of general practitioners done by the British Medical Association, results showed that the current shortage of general practitioners in the UK was set to worsen. The result stated that 40% of the youngest doctors wanted to reduce their hours of work in the next five years and most doctors in their 20s intended to retire early (BMA, 2001). Among other reasons ventured, young doctors said they “perceive that managers of healthcare organisations may have a different agenda”a difference that is referred to as an "ethos gap" and that is often at the root of conflict between [these] managers and clinicians or indeed within healthcare teams (Fletcher, 1997). Reason (2000) writes that these failures often happen in very dysfunctional organisations due mainly to a lack of fundamental management systems for quality review. On the face of it, the problems often center on a break down in the ‘management’ of personnel, leading individual clinician and stakeholders to “contradict the conventional belief that most threats to patient safety result from systems failure rather than from the individuals’ behavior” (Reason, 2000). Major reforms however, have been formulated and are still being put in place to address the shortcomings of the healthcare organisations. But how the [NHS] organisations respond to these issues and [reforms] will shape their destiny (Redd & Kongstvedt, 2004). Today, healthcare challenges require --- human resource managers, administrators and clinicians “to have not only technical knowledge, but also strategic insight and Leadership skills” (Redd & Kongstvedt, 2004) In the U.K, government is genuinely seeking change according to a Research that examines change initiatives in the public sector in the UK. The process of achieving that change has been insufficiently attended to through approaches such as legislation, setting up of programmes, introduction of partnership working, and other initiatives. Such methods are however likely to be ineffective unless more attention is given to the people-management aspects. As a result more leadership development is needed if leaders are to sufficiently drive change forward. In order to counter a lack of leadership in the public sector and of expertise in how to achieve transformation or change, Policy makers need to focus more on managing the transformation process, by introducing a better way of organising the public services. Value of Human Resource Management in NHS Encarta (2006) defines value as “the accepted principles or standards of a person or a group”. Values are deeply held views that act as guiding principles for individuals and organisations. Several studies over the past decade have indicated how powerful an organisations values can be in improving its performance. Carolyn Regan (2006), Chief Executive of North East London SHA says that “Leaders must live by their values”. Collins and Porras (1994) analysed why a number of companies had outperformed their competitors over many years. They considered several possibilities and showed that the companies that were successful in the long term were strongly oriented to values. Though Healthcare organisations are perfuse with values, they tend mostly to emphasise their standards. Standards and values are similar in many ways as both act as guiding principles and are most powerful when they are declared. While values state what is important; standards on the other hand state what is good or acceptable. Brian Ward (2004) argues that “many people in management positions struggle with understanding what makes a great leader”, claiming also that “Leaders tend to have a very poor understanding of themselves”...and furthermore states this as the “biggest barrier to Leadership effectiveness”. In their own study, Pendleton and King (2002) think that [‘cash-reward’] values from the commercial sector could be applicable to the healthcare sector. In disagreeing Bapat (2002) states that “the basic difference between commercial sector and healthcare sector is that commercial companies value their staff on the basis that they will generate more cash, and reward them in the form of bonuses, higher salaries, or other perks”. He opines that Healthcare sector on the other hand does nothing of the sort rather depending on the caring and conscientious workers to do their best for the patients and derive satisfaction from it”. He concludes that “Instinctively, all humans like to be valued and recognised, and if workers are not valued then no amount of Leadership or management would enthuse them into performing at their best as is seen in the healthcare sector”. Leadership and Human Resource Management. Julian Hartley (2006), states that “The NHS is at a critical stage and good leadership in the NHS is vital if we are to remain focused on what is important”. Encarta (2006) defines Leadership as the ability to guide, direct, or influence people. In concurrence, Steers (1998) defines it as a process by which people are imaginatively directed, guided and influenced in choosing and attaining goals. He explains that “it is what one person does to influence others”. Leadership re-examines the procedures that organisations follow and ensures that these procedures fully reflect the organisations vision and values, and that they prepare it for its future challenges. McGregor (1985) classifies Leadership roles as either Task orientated or Emotive Leadership roles. He explains that while in the former the leader organises and influences the group to achieve specific objectives, in the latter the leader helps provide satisfaction for the individual needs of the group members; helping them gain satisfaction of these needs while preparing the way for task performance (p. 311). In a large healthcare organisation these roles are usually played by more than one person (p. 312). In his book Supervisory Management for Healthcare Organisation, Author Theo Haimann (1989) opines that Organisational success or failure is largely attributed to Leadership. He enthuses that ‘Managerial’ Leadership is responsible in establishing a climate that would facilitates motivation and successful performances in institutions, stressing that this makes the difference between an effective and an ineffective organisation (p. 308). In spite of around 30 studies in the UK and US mainly in the private sector which show its benefits there is still some scepticism about the value of Human Resources management. Some have questioned whether the benefits from Human Resources management in businesses can be meaningfully translated into the NHS? Evidence has however shown that “good Human Resources practices lead to better outcomes both clinically and for staff” (DOH, 2002: 10.1). Research has already shown amongst other things that staff attitudes to their work have a direct effect on patient care. In the US for example, hospitals with progressive human resource practices have led to better patient care. Crucially too, the studies also found better clinical outcomes. For example, pressure sores were reduced, stays were shorter and there was a reduction in post-operative mortality rates. (DOH, 2002: 9.3) According to the department of health (DOH), “Leaders and leadership are at the heart of making all parts of the NHS model employers – not just leaders at the top of NHS organisations but leaders at all levels and in all professions”. Stressing that management style needs to be facilitative, involving, seeking to help each individual to make the most of themselves through coaching, mentoring, development and devolving authority to small, integrated teams not hierarchical and controlling. Managers need to accept that “relying on staff commitment and partnership is staff” is of utmost importance (DOH, 2002: 3.3). The Importance of Human Resource Building and sustaining a high performance Leadership culture takes time, patience and a clear focus on the vital few characteristics that Leaders can develop naturally and authentically. This is done through good human resource management. Human resources management is vital to the NHS and leads to improved efficiency through a culture that supports and develops its staff and allows the workforce to share in the organisation’s objectives. (DOH, 2005). John Denham (1999) highlights the importance of good human resource management, explaining that it is should be a concern not only of core HR practitioners but also that Staff are the key to a successful NHS. He reiterates that “with good staff we can meet the challenging agenda we have set to build the NHS so it is modern, dependable and meets the health needs of the public. The role of human resources management in the NHS is to “develop people management skills by building the capacity and skills” of the all practitioners both clinical or administrative (DOH, 2002). This should be done by evolving various developmental programmes for all staff. These programmes will address inherent lapses and prepare the NHS organisations both nationally and locally for change. On their part government and regulators “will need to support these changes [while reinforcing] the importance of good HR management practice to the achievement of organisational goals” (DOH, 2002: 3.5). To butress this point Professor James Buchan (of Queen Margaret University College, Edinburgh and a member of the National Workforce Taskforce that reviewed Magnet organisations and HRM in healthcare for the DOH), submits that “the message from the key research on Human Resources management and organisational performance is that the evidence base supports--- that good practice Human Resources management (defined and measured by different sets of indicators in different studies) can make a positive difference to the performance of the organisation"(DOH, 2002: 10.2). Human Resources management will sustain efficient organisations by supporting their objectives, ensuring effective recruitment, retention and development of highly competent people with the skills required, developing a supportive culture which promotes partnerships, communication staff involvement and which will lead to improved morale and individual performance.(DOH, 2002: 10.5) Indeed when team relationships work well and morale is high, it is often because the team members share similar values and these in turn are invariably modelled right at the top of the organisationthrough the role of Leadership. Morale is a complex issue involving things such as professional status, pay and working practices and management style (DOH, 2002: 9.5). Crucially, values are inextricable from vision and this must be present in any Leader. For an organisation to be well led, its management needs to lead with vision and values to define its purpose. Its values must be clearly articulated while it states unambiguously what it stands for and what guiding principles it will use in making decisions and governing its affairs. It may even be that it is more important for an organisation to know what it stands for than where it is going, as the former will not change whereas the latter will change regularly in response to the issues of the day. (Collins & Porras, 1996) The advantages of Leadership. The merits of good human resource practice translated through commensurate leadership in the NHS are a transformation of the NHS organs from a loosely bound to a rigid more effective system where good leadership will bring about improved health and services for local people (Crisp, 2004). It will also help in reforming the NHS: helping to maintain a healthcare system where clinical standards are much more transparent and public confidence hinges. Good leadership will also help other stakeholders keep focused and reorientate management systems around clinical lines. (Crisp, 2004: 12). Leadership will also address the use of managements tools like manipulation, force, or domination, choosing instead to drive change through balance of this alignment is the fundamental lever for driving change. It will also facilitate strategic management by supporting local organisations in achieving strategic goals namely equality and diversity, health outcomes with clinical quality and safety, improved patient experience, improved working lives for NHS staff. Good Leadership will also align with HR and in creating and developing a workable organisational strategy framework by establishing HR as key business partner and change agent. Ultimately this will help to reduce bureaucracy and duplication (DOH, 2006). Good Leadership will see everyone as on the same side; problems become shared issues; and synergistic collaboration will be encouraged (Protter, 2003). Richard Smith (2003) writes that one of the best ways to change an organisation is to change its Leader. Mary Bousted, General Secretary of Association of Teachers and Lecturers, provided a non-NHS perspective on successful leadership. She states that a good leader never believes that he works harder than anyone else or that his job is the most stressful but rather focuses on understanding the issues relating to his work environment. She asserts that “It is essential to know something about what you are leading, the organisation, its purpose and its people,” she explained. Through delegation of duties a leader can bring about a synergistic environment where “performance is optimised when work is specified in detail and shared out to distinct operational units” (Taylor, 1911). The leaders role is to create systems that disseminate rich information about better practices, while allowing others to adapt those practices in ways that are most meaningful to them. (Plsek & Wilson, 2001) Conclusion Successful Leaders lead by example. Every healthcare worker should know what values they are supposed to believe in and strive for. Leadership will be seen to be failing if it is not setting the right examples (Bapat, 2002). A good manager must know how and when to use any style of Leadership. McGregor (1985) concludes that all Leadership styles however must be adapted as situations and challenges present themselves (p. 315). Strongly ethical cultures that support predetermined and declared values have to be developed and in order to have maximum beneficial effect on the NHS; these values must be discovered and then imbibed. No "designer" values would do; values have to be real and credible. They have to be embodied in the very fabric of the organisationin its systems, processes, practices, and rewards. The Leadership of human resource management and the leadership of clinicians and other stakeholders is critical in driving this process. Without the Management willing to transform and show Leadership and other stakeholders willing to participate in the fashioning of values, to communicate the values, and to live them [their] daily life [and work], nothing will be [achieved ] (Protter, 2003). Indeed many initiatives have failed because management tries to "do" values on the rest of the organisation without personally getting into the process itself seriously. A Leadership approach based on value is validated by the results --- and has been proved by a lot of management research (Collins, 2000 & McCall, 2002). Leadership is a product of good Human Resource Management To deliver high-quality, effective healthcare, all executives including professionals in management positions, must appreciate Human Resource Management issues and the strategic role that they play in enabling organisational excellence. Human Resources is everybody’s business though clearly there are particular responsibilities for Human Resource professionals we need to strengthen their capacity and capability in the NHS (DOH, 2002: 10.7) The NHS should not define Leadership only in terms of results, as this would offer only a partial measure of success. “Leadership in the NHS is a privilege we need to embrace with courage and character.” (Hartley, 2006) Reference Bapat, P.P. (2002). Leadership, Value and the NHS. Retrieved February 4, 2006 from http://bmj.bmjjournals.com/cgi/eletters/325/7376/1352#27759 Bousted, Mary (2006). External perspective on leadership. Department of health. 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