Clinical leadership: an impossible dream?

1
Clinical leadership an impossible dream?

• Pam Shaw (Deputy Head of Education)
• Clare Penlington (Academic Head of KSS School of
  Clinical Leadership)

2
Clinical leadership an impossible dream?

• Key questions
• Why are so many hopes and dreams pinned upon
  clinical leadership as the panacea to the ills of
  the NHS?
• Is the clinical leadership movement a quest for a
  new kind of hero in the NHS?
• What is it that differentiates a clinical leader
  from a competent professional, or a good doctor?
• From what does the notion of clinical leadership
  draw its authority in practice, particularly
  within organisational contexts?

3
Clinical leadership an impossible dream?

• Two opposing narratives about clinical
  leadership
• Everyone can be a leader
• Leaders will unlock the door to a positive future
  for the NHS
• A spectrum between nothingness and
  everythingness

4
Clinical leadership an impossible dream?

• Working Hypothesis an organisational paradigm
  shift
• Where there was a boundary now there is a network
  (Cooper and Dartington, 2004)
• Bounded containing structured
• Networked - flatter, more networked, strategic
  alliances
• Devolved authority, partnership, lateral
  relationships
• This shift in how organisations work means a
  change for how leadership worksi.e. a change in
  how leaders lead

5
Clinical leadership an impossible dream?

• Weve celebrated cowboys, but what we need are
  pit crews. Theres still a lot of silo mentality
  in healthcarethe mentality of Thats not my
  problem someone else will take care of itand
  thats very dangerous. (Atul Gwande, Harvard
  Business Review, April 2010).

6
Clinical leadership an impossible dream?

• Since the post-modern organization thrives on the
  ability of individuals to negotiate their roles
  and their authority depending on the task, it
  seems as if the post-modern organization creates
  a contradiction Can a leader project openness,
  while feeling more exposed than ever? If not,
  might the leader suppress his passion, thereby
  letting loose feelings of envy and rivalry that
  will ultimately undermine the organizations
  performance?
• (Hirschhorn, 1997, p. 45, in Reworking authority
  Leading and following in the post-modern
  organization).

7
Clinical leadership an impossible dream?

• Consultants often like to paint a world in which
  perfect team members, without an ounce of
  self-centredness, feel no rivalry with anyone. As
  we have seen this is a fanstasy. An organization
  is effective only because individuals have
  various talents, some more highly developed than
  others.
• (Hirschhorn, 1997, p. 44, in Reworking authority
  Leading and following in the post-modern
  organization).

8
Clinical leadership an impossible dream?

• As people in post-modern organizations experience
  greater risk, they need heroesindividuals who
  act courageously and intelligently to solve
  difficult problems or create new opportunities.
  Yet in just these moments they may create fantasy
  heroesindividuals who fend for themselves, while
  actually punishing real heroes.
• (Hirschhorn, 1997, p. 69, in Reworking authority
  Leading and following in the post-modern
  organization).

9
Clinical leadership an impossible dream?
Organisation-in-the-mind is what the individual
perceives in his or her head of how activities
and relations are organised, structured and
connected internally. It is a model internal to
oneself, part of ones inner world, relying on
the inner experiences of my interactions,
relations and the activities I engage in, which
give rise to images, emotions ,values and
responses in me which may consequently be
influencing my own management and leadership,
positively or adversely. (Hutton, Bazalgette and
Reed, 1997, p. 114, in Developing the
Organisational Consultancy).
10
Clinical leadership an impossible dream?

• Armstrong 2005 the concept of organization in
  the mind
• Emotional experience is not, or is not just, the
  property of the individual alone it is not
  located purely in individual space. In work with
  organisational clients, be they individual
  members or groups of members, the individual
  experience present and presented is always, or
  always, contains a factor of the emotional
  experience of the organization as a whole - what
  passes or passages between members. (p.6)

11
Clinical leadership an impossible dream?

• Armstrong 2005 the concept of organization in
  the mind
• The emotional experience of the organization as a
  whole is a function of the interrelations between
  task, structure, culture and context (or
  environment). Members contribute individually to
  this experience according to their personality
  structure At the same time, you could say that
  they are contributed to - that there is a
  resonance in them of the emotional experience of
  the organization as a bounded entity, both
  conscious and unconscious. (p. 6).

12
Clinical leadership an impossible dream?

• Working alone, choose and anonymise a leadership
  issue or dilemma which has recently affected you
  personally in your leadership role, in your
  organisation. Make notes in preparation for
  discussing this issue within a small group.
• Key questions you may want to consider
• What did you bring to this issue/dilemma (e.g.
  past experience, beliefs, emotions, values,
  skills, knowledge etc.)?
• What did the organisation bring to this
  issue/dilemma?

13
Clinical leadership an impossible dream?

• Organisation-in-the-mind task
• Groups of 3
• Part 1
• A shares his/her leadership issue/dilemma
• B listens and asks for clarifications
• C and D listens
• Part 2
• B, C, D reflect on what they have heard /
  associations / feelings / thoughts / hunches
• A listens to discussion without being involved
• A responds to what he/she has heard about the
  leadership issue/dilemma

14
Clinical leadership an impossible dream?

• Engaging our heroes means building a sharing a
  vision of the enterprise, a sense of its purpose,
  that supports (if only temporarily) the sense of
  identity of a hero or a non-hero. This vision
  helps people to address some never-to-be-fully-ans
  wered questions What is the good professional?
  What is the moral meaning of work? What does it
  mean to offer my services? How does good design
  give meaning to objects? When heroes and others
  share this vision, they can engage one another
  and stimulate more heroism, more action, and more
  planning. (Hirschhorn, 1997, p. 84-85, in
  Reworking authority Leading and following in the
  post-modern organization).

15
Clinical leadership an impossible dream?

• Organisations are people behaving the question
  is how they behave.
• (Hutton, Bazalgette and Reed, 1997, p. 113, in
  Developing the Organisational Consultancy).

16
Clinical leadership an impossible dream?

• Key questionswhat answers have we arrived at?
• Why are so many hopes and dreams pinned upon
  clinical leadership as the panacea to the ills of
  the NHS?
• Is the clinical leadership movement a quest for a
  new kind of hero in the NHS?
• What is it that differentiates a clinical leader
  from a competent professional, or a good doctor?
• From what does the notion of clinical leadership
  draw its authority in practice, particularly
  within organisational contexts?