A return to values-driven leadership or more of the same?

As Secretary of State for Health Jeremy Hunt reminded the audience at this year’s NHS Confederation annual conference, ‘values-driven leadership matters in every walk of life, but it matters more in health care than anywhere else’. He suggested that people in the NHS work at the ‘intersection between the financial, the operational and the moral’ and challenged the audience to lead through modelling the values of those they lead.

So what does values-driven leadership look like? Although the priority assigned to these values varies as individual motives vary, frontline teams are often driven by moral imperatives, to provide care and comfort to the patients and relatives they serve, while there is a perception that those who lead them often look for the ‘efficiencies’. This has traditionally led to an adversarial standoff and the casualty, it could be argued, has been quality of patient care.

During one of my previous roles in the NHS, I was involved in a national ‘values’ exercise conducted at great expense by an external agency around the strapline ‘patients – central to what we do’. I heard first-hand the derision with which the clinical profession approached this exercise; they already knew patients were central to what they do, this was a value they signed up to when they joined the health service.

Thinking about how to define the values of those who must now lead across a system in the challenging period ahead took me back to our report on the practice of system leadership which draws on the experiences of 10 senior leaders, who give some very candid reflections on their successes and failures.

Many of those interviewed resisted being labelled as system leaders. Their reluctance may be due to another belief: that to achieve change you need to give credit to others. They exemplify the Chinese philosopher and poet Lao Tzu’s saying: ‘A leader is best when people barely know he exists, not so good when people obey and acclaim him, worse when they despise him ... But of a good leader who talks little when his work is done, his aim fulfilled, they will say, “We did it ourselves”.’ However, without the motivation and effort of individual leaders, the changes they set out to achieve would never have happened. What they collectively embodied was values-driven leadership, the style of leadership that is built from demonstrating the component parts of trust: ‘character and competence’.

Values-driven leadership that comes from prioritising the moral and clinical imperative will win hearts and minds on the front line. But these values need to be strengthened by investing in and building capability in quality improvement and innovation. There is a danger that placing financial imperatives first drives behaviour that runs contrary to what we have acknowledged through our work on culture. If leaders in health and social care ignore the watershed moment highlighted by Mid Staffordshire – from which we have committed to creating compassionate cultures in which patients and their carers flourish – then the rhetoric on values-driven leadership may give way to cynicism as before.

At the NHS Confederation annual conference, The King’s Fund set out to make the case that understanding organisational culture is essential in order to provide firm foundations for developing high-quality, compassionate and continually improving care; this is crucial for developing values-driven leadership. The conference also marked the launch of our culture assessment tool – in collaboration with Aston OD – to help organisations understand and diagnose their culture.

On his first speaking engagement as new Secretary of State for Health here at The King’s Fund, Jeremy Hunt was asked a question we posed to many leaders that day: ‘What leadership qualities do you most admire?’ His answer began ‘Listening, truly listening’. My wish as we go forward at a critical juncture for health and care is that all leaders, from the Health Secretary to those leading on the front line, go even further and demonstrate true values-driven leadership.