Leadership

Reflection and Discussion

Think of the leaders/managers you are currently working with. What qualities, competences and styles do you observe? Consider how they use their political and contextual knowledge. How do they role model professional expertise and capability?

To what extent would you like to lead/manage as they do? What might you do differently?

Key Points

• Look back at some of the theories about leadership and management mentioned in the chapter. Read further in relation to those that interest you. Consider how they might inform your day to day work and support your career development as a leader and manager.

The Tasks of Managing

Resourcing Teams

Scenarios

A team member has just announced they intend to move on. You are dismayed as this colleague is long-serving and has taken on many different roles within the team. You are aware that they are popular, well-liked by service users and other staff. You yourself have often seen them as a ‘go-to’ person for advice and when things are difficult, and they can always be relied on to step in when something needs doing at short notice, and to do it well. How can they possibly be replaced?

In an alternative scenario, the person leaving and you have not always seen eye to eye, perhaps you have seen them as leading a faction within the organisation that has not always been easy to manage.

Reflection and Discussion

What are your initial reactions? What do you plan to say/do? What do colleagues think about these scenarios, are their reactions the same or do they differ? What do you recall managers you know having done in similar circumstances? What did they do that worked well; that was not so successful?

Key Points

• Talk with the individual who is leaving and agree what about their leaving they want known to others, but make sure your managerial freedom to act is not compromised in an unhelpful way.
• Take a good look at the current and foreseeable future service needs and, in consultation with others as appropriate, decide how the role is to be replaced.
• What are others staff’s aspirations and how might they be accommodated?
• Make plans for the recruitment into the role and communicate these.
• Make enough time, more than once, to talk with the remaining team about the transition and the future.

Managing Teams

Scenario

The administration manager tells you that one of the clinical team had an argument with one of the administration staff yesterday and as the office door was open it was clearly heard by patients in the waiting room. One of the service users had complained to him that it was distressing to hear and had destroyed her confidence in the psychological service, apparently she had said words to the effect that if the psychologists could not manage their relationships how could they help their clients to do so? The administration manager conveys an expectation that you will institute some sort of disciplinary action.

You reflect that this staff member has seemed to be more withdrawn than usual over the last few weeks – she used to be the team member who was always offering to do things for the team, and take part in new initiatives, but this had stopped. You reflect too that she has seemed reluctant to take on new clinical cases at the service intake review meetings, and has also come across in a rather uncompassionate way on occasions when discussing clinical work. You know that she has complicated caring responsibilities at home.

Reflection and Discussion

What is the first step? What options are open to the manager in this situation? Is disciplinary action the right move? What factors are at play here, what else needs to be considered?

Key Points

• Is there a working relationship difficulty between the two staff here that needs addressing? If so, is either informal or more formal mediation an option?
• Is the staff member stressed? The manager should consider a stress risk assessment and offer of support for example from psychological support services for staff. The stress risk assessment should consider the demands of the work, the control the staff have over how it is done, the support that is available, working relationships, role clarity, and whether there are pressures from organisational change. Sensitive and appropriate enquiry as to any difficulties at home that may be impacting on work is also appropriate.
• Is there a patient safety issue in terms of fitness to work currently/do any adjustments need to be made for the staff member on a temporary basis? Is there a need for occupational health advice?
• Are there structural issues in how the work is organised that are causing problems between clinical and administrative staffs, and do some procedural changes therefore need to be made?
• Does the complaint from the service user require a further response or has the administration manager addressed it to their satisfaction?
• Is there a need to engage others in the organisation e.g. human resources for advice; occupational health; the complaints department; or can it be managed appropriately locally?

Supervision

Reflection and Discussion

How are the functions of supervision being met in your service from the staff’s point of view?

Put yourself in the shoes of the manager with their accountabilities for patient safety, outcomes, and experience. Is the way supervision is being organised for the staff giving them sufficient oversight to meet their obligations?

Key Points

• Do staff feel supported in their supervision? Does the supervision feel sufficiently safe? Is it enabling them to grow and develop in their professional practice?
• Is there provision of sufficient line management oversight of practice? How is that organised?

Clinical Governance

Scenario

Your service waiting list is growing. There are access targets the service is about to fail. There are increased pressures on the service due to closure of a service in the locality that used to take up some of the demand from service users whose presentations were clinically less demanding. Your service currently triages service users for assessment based on need assessed from the referral. They are then allocated for treatment, the start date, nature and duration of which is decided according to the decisions made at assessment including their preferences, evidence based practice, and current clinical guidelines. There is pressure from some quarters in the organisation to introduce efficiencies into this process.

Reflection and Discussion

Who needs to be involved in thinking about this? Where could improvements be made that would in fact benefit service users and be more efficient and cost-effective? Is there an incipient professional ethical dilemma here in relation to the demands of the targets? How will service users be affected both by the current missed targets and by any changes? What are the personal and commercial performance pressures the organisation, manager, and potentially team members are facing?

Key Points

• Engage all the relevant stakeholders in the issue, including commissioners, quality and improvement champions/leads, all levels of staff involved, and if possible service user representatives.
• Find out what organisational resources are available to assist with service redesign to make genuine improvements for example in the referral pathway.
• If staff’s working patterns or other terms of employment are affected, are they being properly represented (e.g. by their union)?
• Stand back and think about whether there are any undue pressures on individuals or the organisation as a whole to engage in ‘gaming of data and goals’ (Berwick, 2013) and what support and mechanisms (e.g. raising concern policies) should be consulted to address this, taking appropriate advice (e.g. from trades unions or other staff support services).
• Sometimes governance issues can be raised as a smokescreen for resistance to needed change; there is a need to be open to a genuine issue that needs to be addressed and remain confident to challenge a smokescreen.
• Implement any changes with a period of monitoring both quantitative (access targets and clinical impact) and capturing qualitative feedback on patient and staff experience to assess impact, with a commitment to a review from senior management.

Service Quality

Reflection and Discussion

How do you know your service is clinically effective? Is safe? Gives service users a good experience? Is a good place to work?

Key Points

• Don’t forget that staff satisfaction, engagement and wellbeing is closely tied into top quality patient care – staff cannot care well for others if they are not well cared for themselves. If you are an NHS service, what is the NHS Staff Survey telling you? The Staff Friends and Family Test?
• The service may use various measures of outcome either across the board such as the IAPT Minimum Data Set, or more individually. What are these measures telling you, and also not telling you? Might the measures be distorting performance in some way?
• How is your service measuring service user experience? What are the messages in this data? Try not to rationalise specific responses and instead focus on the truths in the criticisms, as well as ensuring the service can do more of what is being valued.
• Service audits can also be planned s as to reveal areas needing improvement.

Service Users

Reflection and Discussion

Brainstorm all the ways in which service users can be involved and engaged in your service.

Key Points

• Consider for example: governance as representatives on the board, or part of inspection teams; recruitment either as candidates or to provide an input to selection processes; volunteering in patient support roles. Can you think of any others?

Personal and Professional Development

Reflection and Discussion

Take some time to take stock personally of where you want your career to go. What is your personal preferred style of career management (a careful planner, an opportunity seizer, a serendipity operator)?

Key Points

• Assess (with the help of a mentor if necessary) the gaps in your experience and make plans to fill them.
• Keep on the lookout for high profile special projects to get involved in, especially if they are cross-organisation.
• Consider whether there are other ways you can develop leadership competences and gain experience, for example in a representative leadership role among your peers, or with your professional body (British Psychological Society).
• Use opportunities to get feedback and if there are ways to get developmental feedback as part of learning and development programmes (e.g. 360 degree feedback) this is often invaluable.
• Learn to manage well upwards as well as downwards. Do you make yourself easy to manage, are you seen as reliable, are you sought after to work on new initiatives, complex problems, to help in tricky situations?

Make the time to go on learning and development programmes such as personal effectiveness, leading teams, and use any opportunities that arise from them such as participating in action learning sets with peers; coaching.