Can CLAHRC WM Enact Distributed Leadership

Why Distributed Leadership? 

The emergence of ‘Distributed Leadership’ (DL) reflects disillusionment with heroic models of leadership.[1] For Heifetz, the prevalence of ‘wicked issues’ [2] that health and social care organisations are required to address, means that leaders leave many problems unsolved and hence often have to disappoint the expectations of followers. DL offers a potential solution to this problem by seeking to reduce follower dependency by enabling followers to take on leadership; i.e. enact ‘adaptive’ leadership.[1] DL is also viewed as desirable in public services because it is inclusive, and aligns with recent organisational re-structuring towards the flatter organisation. It may foster collaborative and ethical practice, and avoid alienation associated with lack of power by those positioned as followers. Finally, DL leverages skills and strengths across the organisation to enhance organisational resourcefulness [3]; and is considered to be particularly appropriate for complex, contemporary organisations, where knowledge is distributed. Thus, Currie et al. [4] [5] [6] highlights that the government has increasingly viewed DL as a panacea for both poor organisational performance and the democratic deficit within public services. However, the government’s vision of DL as a policy panacea for poor organisational performance has been difficult to enact for two reasons – professional organisation and policy orientation towards individualised accountability.

Distributed Leadership in Health and Social Care? 

Within the health and social care domain, first, power is likely to be concentrated with specialist doctors,[7] so that others have struggle to assert themselves in influencing doctors; e.g. nurses [8] and managers.[9] [10] Further, despite policy encouragement to allow for DL to service users, health and social care delivery is likely to remain professionally defined as a consequence of traditional professional hierarchy.[11]

Second, public managers in England are forced to enact ‘target-based leadership’, which is orientated more towards individualism, rather than collectivism, as accountability has been concentrated in the few, rather than the many.[4] [5] [6] Its effects upon leadership ‘on the ground’ within English health and social care organisations has been highlighted by the way those at the apex of the management hierarchy have been castigated for failures in the delivery of health and social care. Recent examples include the ‘sacking’ of health and social care leaders, such as the Director of Children’s Services, the Haringey Local Safeguarding Children’s Board, following the death of ‘Baby P’,[12] and the resignations of CEOs of hospital trusts at Mid-Staffordshire and Maidstone and Tunbridge Wells, following patient deaths attributed due to poor quality service. Within this context, leadership is likely to be concentrated, rather than distributed, because any leader situated at the top of the organisation may be unwilling to distribute leadership to others, and others unwilling to take on leadership.

In summary, I suggest that in English health and social care organisations, professional hierarchy and traditional power relationships, combined with a strong centralised performance regime, will act to stymie policy makers’ aspirations for enacting DL. As such, the health and social care context creates a paradox for DL.

Distributed Leadership in CLAHRCs?

Readers may reflect upon these points above, in assessing prospects for CLAHRCs to distribute leadership in an authentic manner consistent with the ‘C’ in the CLAHRC acronym; i.e. ‘Collaboration’. Let the debate begin regarding the extent we might distribute leadership across clinician scientists and social scientists, NHS managers and academics, NHS managers and clinicians, extending to patients and carers. Indeed CLAHRCs may constitute an exemplary site for the study of DL – see our study 2 in the Implementation and Organisational Studies theme of CLAHRC WM.

— Graeme Currie, Professor of Public Management, Warwick Business School, Lead IOS Theme & Deputy Director CLAHRC-WM.

References

  1. Heifetz RA. Leadership without Easy Answers. Cambridge, MA: Harvard University Press; 1994.
  2. Rittel H, Webber M. Dilemmas in a General Theory of Planning. Policy Sci. 1973; 4: 155-169.
  3. Gronn P. Distributed leadership as a unit of analysis. Leadership Quart. 2002; 13: 423-451.
  4. Currie G, Lockett A, Suhomlinova O. The institutionalization of distributed leadership: A ‘Catch-22’ in English public services. Hum Relat. 2009; 62(11): 1735-61.
  5. Currie G, Lockett A, Suhomlinova O. Leadership and institutional change in the public sector: The case of secondary schools in England. Leadership Quart. 2009; 20(5): 664-79.
  6. Martin GP, Currie G, Finn R. Leadership, Service Reform and Public-Service Networks: The Case of Cancer-Genetics Pilots in the English NHS. J Public Adm Res Theory. 2009; 19(4): 769-94.
  7. Fitzgerald L, Ferlie E. Professionals: back to the future? Hum Relat. 2000; 53(5): 713-39.
  8. Nancarrow SA, Borthwick AM. Dynamic professional boundaries in the health care workforce. Sociol Health Illn. 2005; 23: 897-919.
  9. Ackroyd S. Traditional and new management in the NHS hospital service and their effects on nursing. In: Soothill K, Henry C, Kendrick K, editors. Themes and Perspectives in Nursing. London: Chapman and Hall; 1996. p. 337-355.
  10. Ferlie E, Ashburner L, Fitzgerald L, Pettigrew A. The new public management in action. Oxford: Oxford University Press; 1996.
  11. Martin GP. ‘Ordinary people only’: knowledge, representativeness and the publics of public participation in healthcare. Sociol Health Illn. 2008; 30(1): 35-54.
  12. Laming, Lord. The Protection of Children in England: A Progress Report. London: The Stationery Office. 2009.
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