How can we ensure that everybody within our healthcare and indeed social care organisations is focused on continually improving the care which is offered? Not just what is offered, but the way it is offered? What we know about culture is that there are really important influences on culture but in terms of malleable influences, the most important is leadership. It’s the leaders in organisations who really make a difference to the cultures of organisations, by what they attend to; what they value; what they monitor and what they model in their behaviours. The challenge for us is how then can we ensure we have leadership, which ensures that there is a focus on the vision of providing high quality, continually improving, compassionate care at every level of the organisation? Not just in the vision or mission statements but in the behaviours throughout the organisation. How can we ensure we have the leaders who nurture cultures where there are clear objectives around quality improvement and quality of care provision?
Working with the Centre of Creative Leadership, we have identified some of the tools that we need to create these leadership strategies that will deliver us the cultures that we require, and that means we need to design our future leadership capabilities around the strategy that we have going forward, which will be a response to the challenges that the system faces. Then we need to deliver a collective leadership strategy, actually to make it happen over a period of months and years, so we transform the leadership that we have within our organisations to deliver the culture we need. It means understanding what are the existing capabilities that we have in terms of leadership, and what capabilities do we need. We need more clinicians engaged in leadership; we need greater diversity in terms of BME and gender representation in leadership throughout the system, and we can’t wait for these things to happen by chance. We must design in the leadership for the future that we need.
What collective leadership means is that leadership is the responsibility of everybody in the organisation. When I see somebody as a member of a healthcare organisation behaving rudely, aggressively, brusquely or unsafely, it is my responsibility to take a leadership role and speak up, no matter how senior the person who is displaying those behaviours. It is leadership being the responsibility of all; it is interdependent, collaborative leadership, working together to deliver patient care, rather than in separate areas of operation. It is leaders and teams working across boundaries to ensure the seamless integrated delivery of care to the people that we serve in communities. That requires leaders at all levels to prioritise the success of patient care across the system, at least equally with their own area of operation. Collective leadership in practice will promote participation and involvement as the core leadership strategy so that we are hearing the voices of staff, so that we are enabling staff, in 2 order that they can shape the services and the cultures that we need. It is promoting autonomy; it is ensuring voices are heard; it’s encouraging proactivity and innovation and it’s in ensuring that we are moving away from command and control. Overall, collective leadership is about reinforcing values because culture is about values.
Culture is what is important to us here and we have to create collective leadership that reinforces the core values that are important to human communities around the world. After all, an organisation is simply another form of human community; collective leadership that is focused on wisdom, learning, in order to make a positive difference; collective leadership which embodies also courage; the courage to have a vision of compassionate care and pursue it; the courage to take on the big challenges, to change the way that we work across boundaries and make a difference; the courage to deal with the rude, aggressive, obstructive or lacking compassionate behaviours that we see in organisations, or the poor performance. What keeps communities going is optimism and senses of humour, and the warm interactions we have with each other, which I’m delighted to say I have experienced continually since joining the King’s Fund, and that makes the community work really effectively and creates a sense of psychological safety so that people engage. Leaders are encouraging that sense of optimism and humour, but also of wonder; the wonder of NHS organisations.
I always say, remember that NHS organisations have been the places where I have experienced the most profound moments of my life. Seeing my children born; seeing that process being managed by the most caring, concerned people who clearly treat that process of childbirth as something magical, almost spiritual; and seeing loved ones – my loved ones – dying in healthcare organisations in the NHS who received the most compassionate, respectful, dignified, spiritual care from complete strangers. It is a wondrous system that we have and we need leadership, which embodies those values to take us forward in the future.
Thank you very much indeed.
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