NHS leadership: to err is human, to stay still is unforgivable

‘Leadership is the moral energy to move people’. We are perhaps used to the refrain that ‘leadership is all about people’, but the word ‘move’ caused my ears to prick up when I heard this phrase at the recent Future of NHS Leadership Summit.

With many acknowledging the case for change in our health system, a call for leadership to ‘move people’, or prompt them into action, seemed apt. This is especially relevant when interpreted in the context of The King’s Fund’s work on collective leadership, which highlights the importance of everyone taking collective responsibility for the success of their organisation.

Anyone who has worked in or with an NHS organisation knows that its greatest asset is the staff, but that often, for a variety of reasons, staff are not fulfilling their potential to take shared responsibility. Enabling them to do so is the core future challenge for NHS leadership. As an aspirant health leader myself, currently on a placement at the Fund as part of the NHS Management Training Scheme, I was lucky enough to have been encouraged superbly in my previous trust; I was given space yet also support, but most importantly, I felt trusted. Not only was this enormously helpful to me in that role, it was a model of good behavior that I will follow in the future. While not ground-breaking or difficult, so often this gets lost in a thicket of other priorities.

When we are developing services and improving care, patients are at the centre of all we do; but do we always remember to include and support all NHS staff equally? At the summit, Dr Vivienne Lyfar-Cissé laid down a powerful challenge – we have been talking about diversity for years, but to date our collective actions have not had enough impact. One of the key issues raised at the conference was enabling individuals from black and minority ethnic (BME) backgrounds to be better represented at senior levels – this will require us to do something differently; it’s clear that we need to create space for difference, and difference needs to be talked about.

Earlier this year, Dr Carolyn Johnston, Consultant Anaesthetist at St George's Healthcare NHS Trust, came to The King’s Fund to discuss the challenge of encouraging staff, especially junior doctors, to try and change things. In terms of collectively redesigning services to improve patient care, is the most caring form of leadership therefore allowing staff the space to explore and err, as long as certain safeguards are in place? It takes a brave leader to do so, but humans are fallible, and thus will make mistakes when they experiment.

Certainly that has been my experience; I was permitted to really try out new ways of doing things as I sought to improve a service. And you know what? It felt great, because I was allowed to make mistakes. I was supported to learn from these; I felt like I mattered. In a recent paper by The King’s Fund, Chris Ham argued that transforming the NHS is best done by engaging doctors, nurses and all staff in improvement programmes. To do this, they need both freedom from excessive 'top-down' initiatives, and freedom to move; to innovate and improve. While this can come from the head of organisations, we all have a collective duty to ask for forgiveness, not permission, when it comes to experimenting.

We can’t escape the notion that more change is coming, and this change is indeed necessary to create a sustainable health care system. To change we’re going to need to try new things, and to do that we must move, preferably all together. Maybe some of that ‘moral energy’ mentioned above will come in handy. We know that to err is human, but surely to stay still is unforgiveable?

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