What do you think are the particular challenges facing leaders in today’s health and social care landscape?
There are three big challenges that leaders face today – uncertainty, ambiguity and shifting identities. The pace of change is so rapid and the nature of the work so complex and unpredictable that health and social care leaders are frequently expected to occupy many different roles. These roles can take them beyond their familiar personal, organisational or sector identities.
Every question that a leader faces contains multiple, often contradictory and equally legitimate perspectives. So knowing ‘what to do’ and ‘how to be’ is also a constant challenge! Leaders in these situations require a particular kind of adaptive confidence – not least, the ability to let dilemmas sit lightly with them and be comfortable with ‘not knowing’.
Integration and increasing recognition of the need for whole-system objectives have also changed the focus for leaders. The ability to work collaboratively, with shared system agendas rather than personal or organisational agendas, is one of the most pressing challenges for today’s leaders.
How does the Top Manager Programme (TMP) help leaders to meet these challenges?
Over a period of nine months, TMP creates a temporary learning system in which the dynamics of a participant’s work-based realities are recreated with the purpose of them noticing, learning and experimenting. Participants explore how they exercise leadership in the temporary system. They tackle issues such as how you take up your role in different situations; what your leadership impact is; what happens to your authority when you lead and when you follow; and what it’s like to be on the receiving end of you! They look at how boundaries (personal, organisational and system) get worked with, held and crossed, and explore who they are as a leader, how they think about their leadership role and purpose.
The TMP is The King’s Fund’s longest-running programme, with a 33-year history. What makes the programme so enduring?
I think it’s a combination of the programme’s distinctive approach to learning and its transformative impact on participants – both personally and as leaders. By creating a temporary learning system, TMP makes the familiar ‘strange’ in order to generate long-term and sustainable learning. It puts people in touch with themselves and their context in a profound way. Participants often describe their TMP experience as life-changing. Many senior leaders today continue to use the TMP alumni network as a trusted learning community. They regularly meet in small groups to help each other to develop continuously and put their TMP learning into practice as their leadership careers evolve.
How has the Top Manager Programme adapted as the NHS and care system has evolved?
A particular shift in emphasis has been the move beyond personal development to building the participant’s capabilities for system leadership. The programme is now much more explicit about the connections between a participant as a person and the role they take up in groups, organisations and systems. We now recruit more participants from social care, and the private and third sectors as well as NHS organisations to create a temporary learning community that better reflects the wider health and social care system. The programme design has evolved to include more ways of helping participants to develop their own theories of change, relevant to their own contexts.
What is the range of backgrounds and sectors of the participants on the TMP?
Participants come from across the four UK and Republic of Ireland health and care systems as well as from further afield. While there is no typical TMP participant, they tend to work in a range of senior roles across different sectors and hierarchies in NHS organisations, local government and the third sector. So we get clinical leaders, mental health specialists, academic leads and public health leaders. We’ve had GP leads for a clinical commissioning group or a vanguard pilot; the finance director of a community hospital; the deputy chief nurse of an acute trust; a director of adult services in local government; and chief executives of third-sector organisations or social enterprises.
Are there any groups of potential senior leaders whom you’d like to encourage onto the course?
We would particularly welcome more participants from social care and third-sector organisations, and can offer some bursaries to support leaders from these sectors to apply. We would also particularly encourage applications from black and minority ethnic (BME) groups – leaders from these communities are often under-represented in development programmes. We can offer some bursaries and application support to BME applicants in acknowledgement of the systemic issues that can block their participation.
What do people tell you about the impact of the programme?
Participants say that the impact continues to develop years after the programme ends. They describe how scenarios from the temporary learning community unfold time and again throughout their leadership careers. As an excellent example of the feedback we get, one participant told us how the programme helped her to confront her own assumptions and prejudices. She said that it was only after attending the TMP that she really understood what it means to listen – confronting her own assumptions was part of that. She described how it forced her to understand her own and others’ difference, her own behaviour and the things that could have been driving that.
- Read a participant's perspective in Dilys Lai's blog, Making the transition from NHS clinician to manager.
In the context of tightened budgets, cuts and increasing time pressures, what are the benefits of doing the TMP now?
TMP is a long-term, rigorous investment in the individual and the system. The context right now invites – perhaps even demands – this kind of rigour. The challenges we face are inherently complex and require more than simply reactive leadership. The programme helps leaders to feel more equipped to deal with these and better able to understand and work with the nuances of complex challenges. Equally importantly, they have developed a network of peers with a shared language and a more sophisticated set of practices for leading the future shape of health and social care.