You can’t be an effective leader if you don’t have the trust of your peers and the public. That is according to chair of the Royal College of General Practitioners writing in the Health Service Journal (HSJ). I suppose that depends on what you mean by effective. But if you mean get things done well many chief executives are not trusted by their staff or sections of the public but have deliver service reorganisations and dramatic budget cuts. This is a classic case of those who believe that major change is achieved through winning hearts and minds and those who say grab them by the balls and the rest usually follows.
It seems to me that the management culture in the NHS has always tended towards the authoritarian style of leadership and that in times of budget cuts and weaker trade unions persuading people that this is the right thing to do is less important than getting on and doing it. In any case wining hearts and minds assumes that the changes being proposed can be shown to be for the better, they will result in more flexible services or services that better meet the needs of patients/service users. Even if these changes are less convenient for staff, involve unattractive or longer hours of working, relocating or learning new skills they are harder to resist if they can be show to be better for the patient. But if they can’t be shown to be an improvement, if those doing the work say this will lead to poorer services, if professional and patient opinion is united in opposing the changes, if the reason for change are simply to save money then the leadership task is not to win hearts and minds but just get on with it.
The hearts and minds brigade will claim the leadership task then is to engage people in establishing how to live within reduced means, to make cuts that are fair not arbitrary. The pragmatists will say reductions of this magnitude can’t be achieved by salami slicing a little bit more off everywhere but requires closures, redundancies and out sourcing. These actions are not about fairness but about affordability so there is little scope for debate.
If trust is about believing those in charge will do what’s best for the service or the patient/ service user then it is hardly surprising it is in short supply but that doesn’t mean leaders aren’t delivering. Effective leaders deliver it’s just that in the public sector what they deliver isn’t always what the customer wants.
Blair McPherson author of Equipping managers for an uncertain future and People management in a harsh financial climate both published by www.russellhouse.co.uk
