What's Love Got To Do With It?
As humanity adapts to the post Covid-19 world, is it time to reflect on the balance of fear based as opposed to love-based leadership approaches in the NHS? The very mention of love in the context of our work will I am sure make some people uncomfortable, embarrassed or dismissive. But maybe it’s time to accept that work is done by humans, 100% of the NHS workforce are human and a big part of our humanity is the need to connect, trust, communicate and feel part of something we believe in. There are huge opportunities to take the learning from recent events and the extraordinary acts of commitment and courage and build kinder, more inclusive primary care organisations in the NHS, where people can bring their whole selves to work and feel valued. Evidence shows this will improve wellbeing for staff and deliver better outcomes for patients and citizens.
Much of recent NHS management has been driven by a rational paradigm, with its roots in the concept of scientific management created over one hundred years ago. We focus on planning, return on investment and counting, and I have certainly lost count of the number of strategy documents and plans I wrote in my time in the NHS.
With this comes a strong culture of performance management around delivery; one that has undoubtedly led to improvements but also creates perverse incentives, encourages a focus on the short term and skews priorities. Research I did in 2011 also concluded that a low tolerance of mistakes rather than a learning culture exacerbates the negative effects.
Arguably, this approach encourages fear-based responses. A fear-based culture is one where people don’t feel heard, there is a culture of blame, secrecy, control or competition and the courageous conversations don’t happen. We know from research on effective teams that fear based approaches do not deliver. Lencioni’s model ‘the five dysfunctions of teams’ highlights this, with vulnerability-based trust being seen as the foundation for effective team working.
So, is our operating model outdated? Maybe much more relevant to the multi-faceted health and care system we operate in is the concept of complex adaptive systems and the fact that through human interaction and networks we achieve change and innovation. In these environments, leadership is emergent and distributed and if we are brave enough to accept it, can pop up from unexpected places.
What does this mean for primary care and the implementation of the Primary Care Home Model? Primary care has undoubtedly made progress in breaking down boundaries between professional tribes, but there is still a long way to go if we want to achieve a distributed leadership model. It is reassuring to see offers such as coaching being made into the system and it remains imperative that we pay attention to the human dynamic in Primary Care Networks, as well as the structural and contractual factors. The Buurtzorg Model has been viewed with interest and adopted in parts in the UK as a solution to Primary Care Home. This was developed originally to redesign care provided in neighbourhoods in the Netherlands. One of their catchphrases is ‘humanity over bureaucracy’ and they create a culture where individuals in a team feel a high level of personal agency and control.
There are also lessons from wider sociological tools. Marshall Rosenburg in introducing the concept of ‘non-violent communication’ talks about moving from ‘power over’ to ‘power with’. If we include activated patients in this, is there an appetite to move to a leadership model in our new primary care organisations where we encourage members of the team to truly lead with compassion and vulnerability?
The leaders of the future need to recognise that getting to know colleagues, accepting we are all imperfect, valuing diversity and taking time to communicate are important. They are not add-ons to the work of leadership: they are the work of leadership. This needs to be genuine and authentic. People can almost always tell if you are asking them how they are and if you are not really interested in the answer. In addition, leaders need to be comfortable having difficult conversations and holding others to account. Leading with love is not about being soft and fluffy; it is about supporting individuals to take responsibility and fulfil their potential. And, it works.
Rita Symons is an associate of PCC. She spent over 20 years in the NHS, ending her career as a CCG Accountable Officer. She is now an accredited senior practitioner coach and leadership consultant, mainly still working in the NHS, including on national programmes such as the Nye Bevan programme. She is also currently the UK President of the European Coaching and Mentoring Council (EMCC).
Much of recent NHS management has been driven by a rational paradigm, with its roots in the concept of scientific management created over one hundred years ago. We focus on planning, return on investment and counting, and I have certainly lost count of the number of strategy documents and plans I wrote in my time in the NHS.
With this comes a strong culture of performance management around delivery; one that has undoubtedly led to improvements but also creates perverse incentives, encourages a focus on the short term and skews priorities. Research I did in 2011 also concluded that a low tolerance of mistakes rather than a learning culture exacerbates the negative effects.
Arguably, this approach encourages fear-based responses. A fear-based culture is one where people don’t feel heard, there is a culture of blame, secrecy, control or competition and the courageous conversations don’t happen. We know from research on effective teams that fear based approaches do not deliver. Lencioni’s model ‘the five dysfunctions of teams’ highlights this, with vulnerability-based trust being seen as the foundation for effective team working.
So, is our operating model outdated? Maybe much more relevant to the multi-faceted health and care system we operate in is the concept of complex adaptive systems and the fact that through human interaction and networks we achieve change and innovation. In these environments, leadership is emergent and distributed and if we are brave enough to accept it, can pop up from unexpected places.
What does this mean for primary care and the implementation of the Primary Care Home Model? Primary care has undoubtedly made progress in breaking down boundaries between professional tribes, but there is still a long way to go if we want to achieve a distributed leadership model. It is reassuring to see offers such as coaching being made into the system and it remains imperative that we pay attention to the human dynamic in Primary Care Networks, as well as the structural and contractual factors. The Buurtzorg Model has been viewed with interest and adopted in parts in the UK as a solution to Primary Care Home. This was developed originally to redesign care provided in neighbourhoods in the Netherlands. One of their catchphrases is ‘humanity over bureaucracy’ and they create a culture where individuals in a team feel a high level of personal agency and control.
There are also lessons from wider sociological tools. Marshall Rosenburg in introducing the concept of ‘non-violent communication’ talks about moving from ‘power over’ to ‘power with’. If we include activated patients in this, is there an appetite to move to a leadership model in our new primary care organisations where we encourage members of the team to truly lead with compassion and vulnerability?
The leaders of the future need to recognise that getting to know colleagues, accepting we are all imperfect, valuing diversity and taking time to communicate are important. They are not add-ons to the work of leadership: they are the work of leadership. This needs to be genuine and authentic. People can almost always tell if you are asking them how they are and if you are not really interested in the answer. In addition, leaders need to be comfortable having difficult conversations and holding others to account. Leading with love is not about being soft and fluffy; it is about supporting individuals to take responsibility and fulfil their potential. And, it works.
Rita Symons is an associate of PCC. She spent over 20 years in the NHS, ending her career as a CCG Accountable Officer. She is now an accredited senior practitioner coach and leadership consultant, mainly still working in the NHS, including on national programmes such as the Nye Bevan programme. She is also currently the UK President of the European Coaching and Mentoring Council (EMCC).
