Other People*s Shoes

Ken Jarrold
The Dearden Partnership,
Chair of the North Staffordshire Combined
Healthcare NHS Trust.
Visiting Professor Durham
Other People’s Shoes
People, Performance, Leadership and
• What is leadership and what is management?
– definitions
• Leadership in Health and Social Care
• Management in Health and Social Care
• Why are leadership and management
• What behaviours enable leadership to
• What behaviours are needed for successful
• What matters in leadership and management?
• Servant leadership and management
• Hard questions for Leaders and Managers
• 10 steps to leadership and management
• 3 principles for leadership and management in
health and social care
What is leadership and what is and
management? - definitions
• Leadership is showing the way – showing what
to do next. Leadership is not dependent on
role and seniority
• Management is the responsibility for the use
of resources. Management is dependent on
role and seniority.
Thoughts on leadership from Robert
Greenleaf to support the definition
• If the word leader is a mere synonym for boss
it has no meaning at all
• Many occupy positions of great authority and
contribute little to leadership
• No one should be made a supervisor to whom
the workers do not go for guidance and
council before they are supervisors
• A leader is one who goes out ahead and
shows the way
Leadership in Health and Social Care
• Leadership in Health and Social Care can come
• Patients, clients and carers
• Voluntary organisations and other agencies
• Professions and Trade Unions
• Managers at all levels including Chief
• Chairs, Non Executives and Politicians
Management in Health and Social Care
There are 4 levels of managers
Team Managers
Senior Managers
Chief Executives
Team Managers
• Team Managers are the most important level of
• Team Managers are at the interface between the
management hierarchy and the front line staff
• Greenleaf on Team Managers – they were the
spot where the buck stops. The elaborate
executive hierarchy above them thought their
great thoughts about what ought to be done.
What actually gets done is what these fellows
were able [and to some extent] willing to do
Why are leadership and management
• People are one of the 3 factors in real change
• People are one of the 6 factors in performance
• A high quality of leadership and management
is positively associated with positive staff
attitudes to work, their well being at work and
with the achievement of organisational goals –
see separate handout on Engaging leadership
– research by Beverley Alimo Metcalfe
Why are leadership and management
• Robert Greenleaf – no matter how much an
executive knew about the technical side he
had to get things done through people
People and the other 2 factors in real
• Real change comes from three things
• 1 Developing people to their maximum
capability and capacity. Peter Drucker on
Robert Greenleaf – he was always out to
change the individual
• 2 Making process as effective and efficient as
• 3 Deploying resources effectively
People and the other 5 factors in
performance management
• There are 6 key ingredients in performance
• 1 Clarity about the objectives
• 2 Commitment to delivery – the will to do it
• 3 Evidence of progress – good quality
• 4 Rigour – effective monitoring
People and the other 5 factors in
performance management
• 5 Resilience and staying power – coping with
setbacks and keeping going until the job is
• 6 People – getting the best from the most
important resource – leadership and
What behaviours enable leadership to
• Understanding what leadership is
• Having the courage to show the way if you
know the way – RKG management takes
• Explaining what needs to be done clearly and
• Persuading people to follow the way
• Enabling others to lead the way if you do not
know the way
What behaviours enable leadership to
• Following the way as shown by others
• Persuading people to follow the way as
shown by others
What behaviours are needed for
successful management?
• The quality of managers is crucial to the
effectiveness, efficiency and well being of the
people they manage –research by Beverley Alimo
Metcalfe, Michael West, CIPD, IES
• People need 4 things from their managers
• 1 Support
• 2 Feedback including appraisal
• 3 Development and training
• 4 Clear job content
1996 Study on the mental health of
workforce in NHS Trusts
• Research by Carol Borrill, Michael West and
• The mental health of NHS staff is worse than
that of the employed population as a whole
• 7 reasons identified
• Work demands
• Role ambiguity
• Role conflict
1996 Study
Lack of social support
Lack of feedback
Lack of influence over decisions
Professional compromise
Research on Teams
• Michael West’s work has resulted in the Aston
Team Development Programme
• Effective Teams deliver better patient
satisfaction, performance and morale
• Effective Teams have;
• Clear identity and purpose
• Clear, agreed team objectives
• Role clarity
Research on Teams
Effective teams have;
Effective communication
Appropriate involvement in decision making
Constructive debate
Good inter team working
Meet regularly to review performance and
adapt appropriately
Culture and behaviour in the English
NHS - BMJ 2013
• Study by Mary Dixon Woods, Michael West
and colleagues
• Good staff support and management were
highly variable though they were fundamental
to culture and directly related to patient
experience, safety and quality of care
• The importance of clear, challenging goals
• Organisations need to put the patient at the
centre of all they do
Culture and behaviour in the English
• Organisations need to get smart intelligence,
focus on improving organisational systems and
nurture caring cultures by ensuring that staff
feel valued, respected, engaged and
What matters in leadership and
• What matters is how you lead and manage
• What matters is what you say, what you do
and how you behave
• The best test of servant leadership is do those
we serve grow as people? – Robert Greenleaf
• The core idea of servant leadership is quite
simple – authentic, ethical leaders who we
trust and want to follow – are servants first RKG
Servant Leadership and Management
• Robert Greenleaf – the modern founding
Father of servant leadership with an
international following
• 1904 – 1990, worked for AT and T 1929 – 1964
regarded as the conscience – the Abe Lincoln
• 1964 retired – a useful old age – life is growth
and when growth stops there is atrophy
• The Servant Leader published in 1970
Servant Leadership and Management
• Peter Senge – tells people not to bother
reading any other book about leadership until
you first read RKG’s book Servant Leadership
the single most important statement on
leadership I have come across
• Kenneth Blanchard – author of the One
Minute Manager which sold more than 10
million copies – was enthralled with RKG’s
Servant Leadership and Management
• Stephen Covey – the servant leadership
concept is a principle, a natural law, getting
our social value systems and personal habits
aligned with this enabling principle is one of
the great challenges of out time
• Warren Bennis – Servant leadership is a
counterbalance to the glorification, deification
and lionisation of leaders who have neglected
or forgotten what they are there for
Servant Leadership and Management
• Warren Bennis – Robert Greenleaf’s writings
are among the most original, useful,
accessible and novel on the topic of leadership
Servant Leadership and Management
• Ten characteristics of the servant leader and
manager defined by Larry Spears
• 1 Listening – RKG said listening is the premier
skill and ran Listening courses at Harvard
• 2 Empathy – putting yourself in other people’s
shoes – to know and understand each worker
• 3 Healing – people and organisations
Servant Leadership and Management
• 4 Awareness – constant scanning of the environment,
searching questions about what to do
• 5 Persuasion - convincement, difficult and time
• 6 Conceptualisation – perspective, goals, evaluate,
• 7 Foresight – the failure to foresee is an ethical failure
• 8 Stewardship – looking after things
• 9 Commitment to the growth of people
• 10 Building Community
Hard questions for would be Leaders
and Managers
• Warren Bennis and James O’Toole ask 9 hard
questions of would be leaders and managers
• 1 Do you lead consistently in a way that
inspires followers to trust you? RKG – trust is
first. Nothing will move until trust is firm.
• 2 Do you hold people accountable for their
performance and promises?
• 3 Are you comfortable delegating important
tasks to others?
Hard questions for would be Leaders
and Managers
• 4 How much time do you spend developing
other leaders?
• 5 How much time do you spend
communicating your vision, purpose, and
values? Do people down the line apply your
vision to their day to day work?
• 6 How comfortable are you sharing
information, resources, praise and credit?
Hard questions for would be leaders
and managers
• 7 Do you energise others?
• 8 Do you consistently demonstrate respect for
• 9 Do you really listen?
10 steps to Leadership and
5 process steps
1 Listen to other People
2 Think about what they have said
3 Exercise judgement – come to a decision
4 Explain your decision and persuade others
5 See it through with courage
10 steps to Leadership and
• 5 behaviour steps
• 1 Demonstrate your commitment to the work
of your organisation and your belief in service
• 2 Respect the people you work with and take
delight in their development
• 3 Exercise empathy – put yourself in other
people’s shoes
10 steps to Leadership and
• 4 Build trust by acting with integrity and living
your values
• 5 Act with humility and be willing to learn
3 principles for Leadership and
Management in Health and Social Care
• 1 Patients, clients and carers – first, last and
• 2 Front line staff second. Managers should
serve front line staff not the other way around
• 3 Treat people as you would wish to be
treated – no bullying, no harassment, be just
and fair
What people need from their
• Beverley Alimo Metcalfe’s survey of 2,500 NHS
managers identified 7 important qualities that
people most wanted in their managers
• 1 Concern for others
• 2 Ability to communicate and inspire
• 3 Decency
• 4 Humanity
What people need from their
5 Humility
6 Sensitivity
7 Respect for others
Beverley Alimo Metcalfe summarised the 7
qualities as the manager being a servant not a
Key thoughts on Leadership and
• Peter Griffiths Chair of the Foundation Trust
network and former Deputy CE of the NHs in
England describes good leaders and managers
as having 6 qualities
• 1 Passionate about high standards of service
and looking for improvement
• 2 Being willing to learn and to admit mistakes
• 3 Seeking consensus
Key thoughts on Leadership and
• 4 Concerned for the treatment of people
• 5 Having realistic visions
• 6 Committed to relationships with
professional colleagues
Key thoughts on Leadership and
• Beverley Alimo Metcalfe describes leadership
and management as;
• A contact sport
• Being obsessed with values – living inside out
• Connecting what you do with who you are and
those you serve
• Having more belief in others than they have in
themselves and keeping the faith until they
come to believe it for themselves
Key thoughts on Leadership and
• Max du Pre said that leadership and
management are about
• Polishing, liberating and enabling the gifts of
• Bearing not inflicting pain
• Giving people space to exercise gifts and be
• Behaving with consistent and dependable
Key thoughts on Leadership and
• David Wilkinson and Elaine Applebee courage is more important than charisma
• C S Lewis - courage is the master virtue
because it makes the practice of all the other
virtues possible
• Warren Bennis – real leaders and managers
move the human heart, demonstrate integrity,
provide meaning, generate trust and
communicate values
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