School of Clinical Leadership Clinical leadership: an impossible dream?  Pam Shaw (Deputy Head of Education)  Clare Penlington (Academic Head of KSS School of Clinical Leadership)

School of Clinical Leadership 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?’

School of Clinical Leadership 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’

School of Clinical Leadership 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 works—i.e. a change in how leaders ‘lead’

School of Clinical Leadership Clinical leadership: an impossible dream? ‘We’ve celebrated cowboys, but what we need are pit crews. There’s still a lot of silo mentality in healthcare—the mentality of “That’s not my problem: someone else will take care of it”—and that’s very dangerous”. (Atul Gwande, Harvard Business Review, April 2010).

School of Clinical Leadership 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 organization’s performance? (Hirschhorn, 1997, p. 45, in Reworking authority: Leading and following in the post-modern organization).

School of Clinical Leadership 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).

School of Clinical Leadership Clinical leadership: an impossible dream? As people in post-modern organizations experience greater risk, they need heroes— individuals who act courageously and intelligently to solve difficult problems or create new opportunities. Yet in just these moments they may create fantasy heroes—individuals who fend for themselves, while actually punishing real heroes. (Hirschhorn, 1997, p. 69, in Reworking authority: Leading and following in the post-modern organization).

School of Clinical Leadership 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 one’s 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).

School of Clinical Leadership 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)

School of Clinical Leadership 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).

School of Clinical Leadership 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: 1.What did you bring to this issue/dilemma (e.g. past experience, beliefs, emotions, values, skills, knowledge etc.)? 2.What did the organisation bring to this issue/dilemma?

School of Clinical Leadership 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

School of Clinical Leadership 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- answered 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 , in Reworking authority: Leading and following in the post-modern organization).

School of Clinical Leadership 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).

School of Clinical Leadership Clinical leadership: an impossible dream? Key questions—what 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?’