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Doing your local leadership differently


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Title: Doing your local leadership differently

Doing your local leadership differently
  • Steve Onyett
  • Long Term Neurological Conditions
  • 1st May 2009

  • Leadership has been the neglected element of the
    reforms of recent years. That must now change.
  • Darzi Review final report (DH, 2008)

Putting People First
  • stated that national and local leadership is
    now essential if we are to achieve system-wide
  • and lists the first key element of a personalised
    adult social care system as
  • Local authority leadership accompanied by
    authentic partnership working with the local NHS,
    other statutory agencies, third non-statutory
    and private sector providers, users and carers
    and the wider local community to create a new,
    high quality care system which is fair,
    accessible and responsive to the individual needs
    of those who use services and their carers.

Thought for the day. Today Programme. Radio 4.
26th February 2009
  • Here is the gift of relationship. It lies at the
    very core of what it is to be human.
  • Rev David Wilkinson, principal of St Johns
    College, Durham

Start with what builds relationship for service
The artist is Mel Gittridge, and this image was
exhibited as part of Expressions, a touring
display of art by people who have experienced
mental or emotional problems- this picture
captures the idea of environments where people
can take power, supported by other environments
where people can take power.
Chris Ham on commissioning
  • Failed attempts at the purchaser-provider split
    suffered from lack of time to develop skills,
    relationship and experience
  • too much attention appeared to have been paid to
    the legal form of contracts and not enough to the
    development of relationships between purchasers
    and providers (HSMC, 3).

Make time (somehow!)
  • ..recent research into the impact of Local
    Strategic Partnerships .. suggests the need for
    development time to explore the type of
    relationships that local agencies want to have
    and the organizational processes and structures
    that will be needed to deliver this. Making this
    time and space is crucial yet difficult, as the
    pressure to deliver better outcomes for service
    users can often seem in tension with the need to
    develop the capacity of the board and thus the
  • Glasby and Peck, 2006 p.16

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Trust and social capital
  • .. the greatest loss over the past 50 years may
    have been in squandered social capital. Social
    capital consists of those social networks of
    mutual trust and the associated norms of
    reciprocity that made the NHS ours.
  • The NHS is essentially a national partnership
    between the citizens and those who work in it.
    For all partnerships the defining element is
    mutual trust and generalised reciprocitythe
    willingness to contribute, confident that at time
    of need in the future there will be support in

Welsh, T. Pringle, M. (2001).
Four underpinning principles in the new DH
approach to change
  • To engage people across the system to work
    together to make change happen
  • Ensuring that decisions are made at the right
    level, and as close to the user as possible Each
    tier of the system only does what it can only
  • Building on the Darzi concept of staff as
    Practitioners, Partners and Leaders.
  • Aligning different parts of the system towards
    the same goals as a way of achieving complex
    cultural change

CO-PRODUCTION- It is not just about delivering
public services
  • If co-production focuses exclusively on the
    types of labour needed to enable public systems
    to work better, it will tend to undervalue the
    significance of the effort invested in giving
    love and comfort, approval and disapproval,
    caring and mentoring and equally the effort
    involved in civic engagement ranging from
    attending meetings to making phone calls to
    mobilising social protest.
  • Personalisation needs to be rooted in mutual
    support and recognition that not everything can
    be bought
  • Should users use budgets to buy friendship?

Edgar Cahn. Foreword. Co-Production. A manifesto
for growing the core economy. NEF. 2
New Economics Foundation. Co-Production. A
manifesto for growing the core economy.2008. 2
It is about deepening and broadening public
  • The point is not to consult more, or involve
    people more in decisions it is to encourage them
    to use the human skills and experience they have
    to help deliver public or voluntary services

New Economics Foundation. Co-Production. A
manifesto for growing the core economy.2008. 10-11
Co-production and working from strengths
  • people are defined entirely by their needs and
    so those needs become the only asset they have.
    No-one should be surprised when people then
    behave in ways that perpetuate such needs (11).
  • When ..assets are deliberately ignored or
    sidelined they atrophy. (11)
  • Co-production demands that public service staff
    shift from fixers who focus on problems to
    enablers who focus on abilities. This role is
    not recognised or rewarded within the management
    structures that are currently in place.(13)

Front-line staff are essential to delivery and
  • Their morale is as important as client morale.
    Yet in practice, the participation that they are
    asked to extend to clients is often not extended
    to them.

New Economics Foundation. Co-Production. A
manifesto for growing the core economy.2008. 13
Trusting Relationships
Shared Vision
Conflicting Needs
Shared Values
Clear Communications
Reliable Information
Complex/Poor Data
Lack of Time / Prior Experience
Distrusting Relationships
Source Richard Lauve, MD (VHA Inc.)
The energy of social movements
  • Social movement thinking is about connecting
    with peoples core values and motivations and
    mobilising their own internal energies and
    drivers for change
  • evidence from change management studies show
    people change what they do less because they are
    given analysis that shifts their thinking than
    because they are shown a truth that influences
    their feelings
  • ..rather than a single individual, it is a
    network of leaders at multiple levels who guide
    and mobilise the successful movement
  • Helen Bevan of The NHS Institute

Four Column Matrix
Strategic Goals
System Level Measures
National Targets
Develop transformational goals that connect with
the values that brought people into healthcare in
the first place
Develop system level measures that track progress
against these goals
Show how externally set targets sit within the
context of the strategic goals to build ownership
to delivery
Align project level goals with the strategic
goals of the system to create a sense of purpose
and channel energy
Establish a system-level vision for improvement
with ambition and commitment.
  • Leaders need to commit personally to the vision.
    This means taking a stand and framing the
    objectives as promises to users and the people
    that support them.

Aims framed as promises to users
Users needs and wants Promise
I want to be involved in my own care planning Your care planning session will be attended by you and the people you know need to be there. The care plan will be signed by you to indicate your involvement
I want to be seen as a whole person not just an illness Assessments and care plans will cover all the areas of your life that are meaningful and important to you. You will be able to control what is looked at and be given information telling you what you should expect
I want to be confident that I have had the best care and treatment Your care and treatment will be evidence based It will be delivered by enthusiastic and skilled staff
System alignment
  • Allow yourselves with others to be moved by
    delivery stories
  • Give wide and shared exposure to the lived
    experience of service users
  • Envision the future together and ambitiously
  • Dont be coy about the love you put into your work

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Appreciative Inquiry
Is about developing the competence to CHOOSE a
way of thinking
  • Appreciative Inquiry is the cooperative search
    for the best in people, their organizations, and
    the world around them.
  • It involves systematic discovery of what gives a
    system 'life' when it is most effective and
    capable in economic, ecological and human terms.

From An opportunity to learn more about
Appreciative Inquiry Presentation by Anne Radford
We manifest what we focus on and we grow toward
what we persistently ask questions about
Solution focus/appreciative inquiry- exploring
what works so that we can do more of it
  • orWhat we talk about gets bigger!

It works to build the positive core of the
organisations involved.
  • Organisations need a lot less fixing and a lot
    more affirmation.
  • Appreciation builds relationships, collective
    intelligence, and freedom to innovate

From An opportunity to learn more about
Appreciative Inquiry Presentation by Anne Radford
The Power of Appreciation..
  • ..rests with its self-reinforcing and
    self-generative capacity
  • Srivastva and Cooperrider, 1999
  • This requires inclusion, safety in participation
    and good communication
  • Effective teamworking and leadership
  • Teams are where this is modelled and enacted

The 2007 NHS National Staff Survey
  • 93 responded positively when asked Do you work
    in a team?
  • However this shrunk to 42 when the survey
    explored whether the team in question fulfilled
    criteria for a well structured team
  • Findings consistent since 2003!

Real teams have..
  • Clear and shared objectives
  • Members who have to work closely together to
    achieve the objectives of the team
  • This interdependency includes users and their
  • Members who have different and clearly defined
    roles within the team
  • The minimum number of team members required to
    get the job done

  • Working well with living systems means working
    well with complexity
  • See for example
  • Bob Hudson. (2006). Whole systems working- a
    Guide and Discussion paper. CSIP-ICN
  • Jake Chapman. (2004). Systems failure. Why
    governments must learn to think differently.
    London Demos

Or just
  • Recognising how the universe works and just
    getting on with it
  • .. theory

Are your issues wicked?
  • Dont be surprised of they are the easy
    problems have been solved!
  • They involve many stakeholders with different
    values and priorities
  • When confronting frustrating problems, an
    enterprise would do well to recognise that they
    may be wicked. Moving from denial to acceptance
    is important otherwise companies will continue
    to use conventional processes and never
    effectively address their strategy issues

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
Wicked problems
  • Involve issues with roots that are complex and
  • Are difficult to get to grips with and change
    with every attempt to address them.
  • Have no precedent
  • So .. nothing to indicate the right answer

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
Properties of Wicked problems
  • There is no definitive formulation
  • It is not obvious when you have reached a
    solution (no stopping rule)
  • There is no immediate and no ultimate test of a
    solution- the solutions have their own
  • Every attempt at solution counts significantly

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
Properties of Wicked problems
  • Each problem can be seen as a symptom of another
  • Discrepancies can be explained in numerous ways-
    because people have different definitions of the
  • You have no right to be wrong- there is too much
    at stake!
  • Solutions are not true or false but good or bad-
    its all down to judgement
  • there is only better

Camillus, J. C. 2008. Strategy as a wicked
problem. Harvard Business Review
So its a bit swampy!
  • Swamps were generally seen as useless and even
  • Swamps are characterised by rich biodiversity
    and specialized organisms..
  • .. such as frogs.
  • . swamp draining is nowadays seen as a
    destruction of a very valuable ecological habitat
  • Wikipedia

From - Plsek, P. Complexity, culture and large
systems change presentation
Source Brenda Zimmerman, PhD
Questions? (after Chapman, 2004)
  • Are we spending too much time trying to apply
    complicated solutions to complex problems?
  • What approach would we adopt if we accepted that
    systems cannot be controlled nor their behaviour
  • What might we need to do differently?

The problem of Big Planning
  • Long term planning and the rigid structures,
    precise task definitions and elaborate rules that
    often accompany it, may be positively dangerous,
    fixing an organisation in pursuit of a
    particular vision when an uncertain world
    requires flexible responses.
  • Hudson, 2006
  • May need holding frameworks for relevant
    subsystems to keep direction and coherence

Build collective understanding of what working in
complex systems really means
  • Small changes can have big effects
  • ..and big changes very little effect
  • Emergence- the whole is greater than the sum of
    the parts
  • Tolerance of uncertainty and flexibility
  • Recognising the futility of control

The pointlessness of controlfrom Jenny Rogers
Influencing Skills
  • You cant force people to work effectively on
    something they disagree with.
  • Organisations are so complex and subject to so
    many diverse influences that it is pointless
    trying to control them.
  • Distance from most senior to most junior makes it
    unlikely that control can be exercised over that
  • Much control is unnecessary -where there is
    openess and willingness to give feedback
  • Control reduces risk taking- a necessary
    precondition for the innovation on which
    organisations depend
  • Its exhausting and your time can be better spent!

What implications of more ecological thinking?
  • Push and exhortation (nor even resources!) from
    leaders and policy makers can be

  • Peoples ability to stay the same will always be
    greater than our ability to make them different

Working with your stakeholders- what is their
  • Readiness to change?
  • Confidence to change?
  • Judgement of the importance of change?

Respectfully consider these cells and provide
information to inform
Advantages Disadvantages
Change -
No change -
What are their natural attractors?
  • Patient/carer benefit
  • Feeling effective
  • Getting to know people better
  • Autonomy
  • Choice
  • Self image (e.g. as a scientist)
  • Reduced paperwork and boredom
  • Geewhizz gadgets
  • Feeling part of something important
  • Lifestyle enhancement
  • Good stories to tell
  • CV brownie points
  • Etc., etc., etc., etc.

What implications of more ecological thinking?
  • Change needs to happen bottom-up but the right
    conditions need to be created.
  • like gardening, or throwing a party?

Working with complexity values
  • Allowing solutions to emerge by
  • encouraging rich interaction, removing barriers
    and oppressive controls
  • giving space and time,
  • not overspecifying means

Working with complexity values
  • Valuing multiple perspectives
  • Using multiple approaches that make effective use
    of experience, experimentation, freedom to
    innovate and working at the edge of knowledge and

Working with complexity as surfing the edge of
chaos, Pascale, et al (2000)
.. In systems as in life, when threatened, it
move towards the edge of chaos. At this edge
experimentation and mutation occur from which
creative solutions can emerge. When this occurs
living systems self organise and new forms or
patterns emerge. The challenge for leaders is to
disturb or disrupt the movement at the edge to
provoke the desired outcome sometimes referred
to as perturbing the edge. McKimm et al, (2008)
Panic Zone
Discomfort Zone
Comfort Zone
  • ..Success is the ability to go from one failure
    to another with no loss of enthusiasm.
  • Winston S Churchill

Leadership? Two broad approaches
  • Some view leadership as a set of traits or
    competencies possessed by certain individuals
  • others view leadership as an emergent social
    phenomena, a social process shaped by
    relationship within groups.
  • Bolden, 2004

  • . can be likened to Brighton Pier,
  • very fine in their own way, ..
  • but not a good way of getting to France
  • John Alban-Metcalfe quoting Neil Kinnock
    describing the 1981 Special Education Act.

Law of the Situation
  • Leadership is transient and contextual
  • Where knowledge and experience are needed the
    person who can is the right person to do it.
  • Not all leadership should be determined by
    position power yet people with authority should
    be prepared to exercise it.

  • Decision making should be located as closely as
    possible to the place where actions are taken.
  • This means addressing the flight from authority
  • .. and helping people love their monkeys!

  • If you do not fill your leadership space, voids
    appear, and in voids bad things happen
  • Hugh Martyn and Robert Scurr quoting William
    Calley on his lack of leadership in the Mai Lay
    massacre in Vietnam, 1968

The essence of leadership and management
  • is the creation of environments in which people
    can be creative.. Where they can exercise power
    to achieve outcomes valued by patients/users,
    their supports, and other key stakeholders.
  • This is usually a team

New paradigm approach to leadership
  • More soft stuff emphasis on working through
  • Leaders with more faith in other people than they
    have in themselves (and they have a lot of faith
    in themselves!)
  • More concerned with connectedness and

With acknowledgement to Bev Alimo-Metcalfe of
New paradigm approach to leadership
  • More concerned with vision
  • More concerned with improvement
  • Less concerned with Great man models of
  • Striving for excellence through optimism,
    openness and personal humility

With acknowledgement to Bev Alimo-Metcalfe of
Transformational leadership- roots
  • James MacGregor Burns transformation as that
    which turns followers into leaders and leaders
    into moral agents.
  • Transformational leadership occurs when people
    elevate each other into a higher level of
    motivation and morality.
  • Thus inextricably linked with the social meaning
    that people attach to their work.

Leadership as an ethical endeavour
  • Positive Emotional Climate an environment
    where managers take into account the emotional
    needs and personal growth of employees and
    encourage the sharing of positive emotions
  • Leadership practices that promote positive
    emotional climate associated with company gains
    in revenue, growth and outcome. Ozcelik et al,
  • Contrasted with charismatic (sometimes referred
    to as transformational) leaders who use their
    skills manipulatively in pursuit of
    organisational goals.

The importance of authenticity
  • Leaders lead most effectively when they are being
    themselves and being true to themselves.
  • Authentic leadership is about, being yourself-
    more with skill
  • Goffee and Jones, 2006

Leadership as an ethical endeavour
  • PEC associated with less cynicism and more

.. Sloterdijk (1987) observes that the whole of
postmodern society is living within an internal
dialogue or cognitive environment of a universal,
diffuse, cynicism. As a predominant mindset of
the post-1960s era, Sloterdijk takes the cynic
not as an exception but rather as the average
social character. It is argued that at both the
personal and institutional levels, throughout our
society there is a widespread disturbance of
vitality, a bleakening of the life feeling, a
farewell to defeated idealisms, and a sense of
paralyzing resentment. DAVID COOPERRIDER, 1999
Research using the Team Leadership Questionnaire
  • Showing genuine concern has the biggest impact
    on motivation.
  • Being interested in your needs and aspirations
    and how things feel for you.

With acknowledgement to Bev Alimo-Metcalfe of
Highlights from Host Leadership Towards a new
yet ancient metaphor by Mark McKergow PhD
MBADirector, sfwork - The Centre for Solutions
Focus at,
Forthcoming in the International Journal of
Leadership in Public Services
Shortcomings of the hero metaphor
  • The hero leader is seen as all-knowing and the
    followers all-dependent
  • The illusion of control
  • The homogeneous imagery of the followers - are we
    subjects or sheep!
  • The willingness of the hero (warrior, king, even
    shepherd) to die in the act of saving the flock

Shortcomings of the servant metaphor
  • The richness of the metaphor is not obvious. Your
    waiter or Jeeves?
  • The image of servant is not a compelling one to
    those (for example women and ethnic minorities)
    who are traditionally cast in such a role
  • The leader as servant has similar hierarchical
    issues to the hero, but from the other end- who
    are really the masters and mistresses?

Leader as Host, Host as Leader
Warren Bennis on Gladstone and Disraeli
  • If you had dinner with William Gladstone, you
    were left thinking That Gladstone is the
    wittiest, the most intelligent, the most charming
    person around.
  • But when you had dinner with Benjamin Disraeli,
    you were left thinking, Im the wittiest, the
    most intelligent, the most charming person
  • Gladstone shone but Disraeli created an
    environment where others could shine. The latter
    is the more powerful form of leadership, an
    adventure in which the leader is privileged to
    find treasure within others and put it to good
  • From introduction to Parks 2005 p xi-xii).

Advantages of the host metaphor
  • Its an everyday image
  • Host and Guest are co-defining
  • Hosting is an activity, rather than a defining
    characteristic of a person
  • Hosting gives a definite feel of some
    responsibility for the success of the event
  • The role of host can involve behaving as total
    hero or absolute servant

Elements of host leadership
  • The four balances 1

Principle of Response-ability
  • Defining the event
  • Responding to what happens

Principle of Co-participation
  • Engage and provide
  • Join in along with everyone else

Principle of Gate-opener
  • Protect boundaries
  • Encourage new connections

Principle of Alpha and Omega
  • Be the last
  • Be the first

The host is both the first and the last Arabic
The 5th principle?
  • Front stage work.
  • Back-stage work.

Parting comments on rethinking leadership
  • Focus on what counts rather than what is easily
  • ..and then measure with reports to the highest
    levels of governance
  • Remember to plot the bloody dots! but that..
  • Crude measures of the right thing are better
    than precise measures of the wrong things
  • Davis Balestracci, 2008

Parting comments on rethinking leadership
  • Focus on releasing capacity for effective hosting
    of important relationship building based on trust
    - rather than just talent spotting high fliers
  • Notice and celebrate the good to build the
    confidence for effective subsidiarity
  • Develop networks and teams based upon levels of
    interdependency required among people to deliver
    the task at hand

Parting comments on rethinking leadership
  • Build in incentives and support for giving back
    at all levels, for example
  • By service users in contributing to the support
    of others
  • By staff in managing their own managers
  • By all in the planning, design and delivery of
  • Create an environment where innovation is
    possible- it is OK to celebrate failure as long
    as there is learning
  • Create the infrastructure for learning
  • Start!- Use Rapid Cycle Thinking with small,
    short PDSA cycles where data is collected, shared
    and learned from

Parting comments on rethinking leadership
  • Consciously address sustainability
  • Maintain attention
  • Celebrate and communicate
  • Take away that which supports the bad old ways
  • Create and support the new roles and ways of
  • Model from above
  • Keep moving forward

Parting comments on rethinking leadership
  • Ask yourself

Paul E. Plsek, 2008
Its all about well-being
  • If you think you are too small to be effective
  • you have never been in bed with a mosquito
  • Betty-Reese

Thank you!-
  • Iles, P. Macaulay, M. (2007) Putting principles
    into practice developing ethical leadership in
    local government. International Journal of
    Leadership in Public Services, 3(3), 15-28.
  • Ozcelik, H., Langton, N., Aldrich. (2008).
    Doing well and doing good. Journal of Managerial
    Psychology, 23(3), 186-203.
  • Ham. C. (2008) Health Care Commissioning in the
    International Context Lessons from experience
    and evidence. 2008.HSMC
  • Ham, C. (2008)Competition and integration in the
    English NHS. BMJ. 2008. 336. 805-807
  • Welsh, T. Pringle, M. (2001). Social capital.
    Trusts need to recreate trust BMJ. 2001 July 28
    323(7306) 177178.
  • New Economics Foundation. Co-Production. A
    manifesto for growing the core economy.2008
  • for people
    involved in leadership and teamwork development
  • see page on solution
    focus for links to a range of other resources of
    solution focussed working.
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