Talking leadership: Sally Hulks on organisational development in the NHS

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The national leadership and improvement strategy places a focus on fostering compassionate, collaborative and inclusive leadership at a time when there are many other pressures on NHS leaders. What role can organisational development play?

Sally Hulks, Assistant Director, Leadership and Organisational Development at The King’s Fund, had more than 20 years’ experience in leadership and organisational development roles before joining the Fund. She is leading the new Advanced practitioner programme – health and social care, which aims to help OD practitioners develop their ability to bring about cultural change. We asked Sally why she thinks organisational development is so important.

Why focus on organisational development right now, when there are other huge pressures on leaders in health and social care?

As well as day-to-day management, staff in the NHS and local government, along with those in the third sector and other partners, are working to find ways to rebuild the health and care system in line with the ambitions of the NHS five year forward view. Searching for solutions that will bring about sustainable, whole-system change requires a whole new level of understanding and connectedness.

Taking an organisational development approach to change encourages staff to take time to work through differences and to find new ways of working, rather than sticking plasters on old ways. Teams and leaders alike have to become comfortable with adapting as a new direction emerges, coping with a degree of uncertainty about how things will play out. An OD approach encourages ownership and responsibility so that people arrive at the point where they can face up to what they, as individuals, need to do to change patterns of working and bring about fresh ways of thinking and new solutions. This is how long-term, sustainable change can be achieved.

What does your experience in different organisations tell you about the potential for this approach to enable change in health and social care?

Our experience across a wide range of sectors undergoing extended periods of immense change suggests that, at its worst, repeated top-down change can result in a sense of insecurity and anxiety. It can leave people experiencing a loss of control, a sense of not being heard, being ‘done to’, so that they are unwilling to engage with future challenges or to take risks. Once people start keeping their heads down, communication becomes increasingly difficult.

OD practitioners aim to start with work that revolves around relationships and trust. Taking the time to enable people to connect, to participate in conversations, can move them forward in ‘unblocking’ relationships and communication. For the long term, the regular reinforcement of change, particularly behaviour change, has to be built in to business as usual.

Why is collaborative and inclusive leadership so important? How can it be encouraged organisationally?

The level of collaboration that’s now needed between services has never been seen before. Leaders now work in patient-focused systems rather than simply within their own organisations, and they have collective responsibilities for budgets and services that cross organisational, clinical and managerial boundaries and hierarchies. At times this requires them to put the system first and the needs of their own organisation or department second. This can be a real test of how well all parts of the system are included and also of the trust between different parts.

OD approaches aim to reduce existing power differentials and to create the safety for people to speak. It is not just the ‘usual suspects’, or the most powerful, who generate fresh thinking and increased engagement. We have found that new ideas do not come from more of the same.

How can organisational development practitioners support compassionate leadership? What are the benefits of this?

An organisation’s leadership culture affects its entire culture. If it is compassionate and caring, this permeates all levels of the organisation, including those who provide care and those who receive care. Evidence suggests that there is a direct correlation between staff satisfaction and patient satisfaction.

OD practitioners draw attention to the emotional world, encouraging people to be open and curious about what is going on beneath the surface. They encourage leaders to pay attention to how they operate as well as what they do, and they support them in embodying the organisation’s values and taking thoughtful and appropriate action.

Can you tell us a bit about the Advanced OD practitioner programme that you’ll be running in June?

Our Advanced practitioner programme aims to build a network of organisational development practitioners, both during and beyond the programme. The programme is highly interactive and enables work on real issues in real time, along with challenge and support from within the group, and also draws on The King’s Fund resources to inform the work.

We will run action learning sets during the programme. As well as allowing participants to learn from each other, the aim of these is to encourage the group to capture and share insights from current change projects so that best practice in emerging trends can be disseminated across the system. By creating this network we hope that organisational development practitioners can build lasting connections to the benefit of themselves and the system as a whole.

Find out more about our Advanced OD practitioner programme