NHS leaders of the future: more like Thatcher or Nyborg?

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Aficionados of Borgen like me will have to contain their excitement as they wait for the third and final series of the Danish political drama to be broadcast on British TV. In the meantime, I have been reflecting on the lessons the series holds for NHS leaders.

The central character, Birgitte Nyborg, is prime minister of a coalition government faced with the challenge of negotiating with her partners at every turn. Nyborg makes things happen less through ideology than idealism and by being willing to compromise when necessary. Her skill lies in building alliances with others and finding common cause, even when this seems unlikely.

From a British perspective, the temptation to contrast Birgitte Nyborg with Margaret Thatcher is hard to resist. The iron lady was a conviction politician who brooked little dissent. In the now famous phrase, the lady was not for turning and was willing to pursue her convictions even in the face of opposition and outright conflict. These strengths ultimately became weaknesses, as when her cabinet turned against her and she was forced out of office in 1990.

What relevance does this comparison have to the NHS? For a decade or more, top leaders in the NHS have been closer in style to Thatcher than to Nyborg, making things happen as agents of the government of the day by overseeing the implementation of targets designed to improve patient care. In the process they have adopted a ‘pace-setting’ style consistent with the performance management culture that has characterised the fact that the NHS has been led from the top.

The shortcomings of pace-setting and performance management have come back into focus in the wake of the report of the Francis Inquiry. This has happened at a time when the financial and services pressures facing the NHS and local government cry out for much greater collaboration and partnership working to address the challenges that lie ahead. As I argued in a previous blog on whole-system working, now more than ever public sector agencies must rise above their own concerns and reach out to others to meet the needs of the populations they serve.

It follows that in future NHS leaders need to be much more like Nyborg than Thatcher. Their challenge will be to bring about improvements to care in an environment in which working with other organisations will be increasingly important. Rising to this challenge will mean influencing peers and partners in the whole system of care. Pace-setting alone is likely to be counterproductive in this context and a premium will be placed on pragmatic leaders who can create alliances to make a difference.

The Fund will be playing its part in supporting leaders through this transition in a new programme on collaborative leadership aimed at chief executives and their senior colleagues. The programme forms a core part of our work on integrated care in which we are moving beyond making the case for integration to offering support in making it happen at scale and pace. For those of us suffering withdrawal symptoms, the collaborative leadership programme may well open with highlights from the first two series portraying Birgitte Nyborg as one of the role models NHS leaders may be able to learn from.

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VIjaya Nath

Assistant Director,
The King's Fund
Comment date
21 February 2013
Great timing for us . Nicola and I worked with Medical Leaders in Western Australia who , today, examined the implications & merits of the pace setting style of leadership as modelled by Thatcher alongside contemporary Reagan and the new requirements of today's global healthcare where working with and through others and building relationships of trust are core to leaders at all levels..

shweta singh

Management and Leadership student,
Exeter University
Comment date
13 March 2013
As a Management and Leadership student, I believe that the combined approach may be more productive for the NHS.
The prime concern should be to provide the best quality of care to the patient through collaborative care in this economic situation and at the same time pace setting to achieve the target so that resource effectiveness can be one of the achievable aims of the NHS.

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