Policy & Management

Dr Umesh Prabhu, FRCPBH, Medical Director at the Wrightington Wigan and Leigh Foundation Trust (WWLFT)

Leaders, leaders, everywhere…

Good leadership is the key to the success of any organisation. What makes a good leader? Those that believe they know the criteria required have filled endless textbooks, generated a myriad of TED talks and swollen the coffers of the management consultancy firm they are working with. And indeed, there is no doubt that if you put that question to a roomful of disparate people who do not perceive themselves as leaders, you would get a plethora of answers depending on their attitude to leadership, team working, outcomes and the place of work.

Rather like pain, leadership is what the individual says it is. We all want different things from a leader, which makes their job that much more difficult. And are the leadership skills required in the private sector the same as those required in the NHS? Are NHS staff particularly clinical staff, inherently good leaders? Do they have to be taught leadership?

The next question is this; what makes a good manager? At this point, you could repeat the first two paragraphs and replace the word leader with manager.

I have argued that a manager isn’t necessarily a good leader, nor is a good leader necessarily a good manager. After all, Arsen Wenger is an excellent manager, but team leadership relies on Mikel Arteta. The director of nursing at your organisation may be an excellent manager of finances and people, but not necessarily the one who is leading with a vision – or vice-versa (NB, for information, if you do not know who your director of nursing is, or you haven’t seen them walking around your clinical area for some time, they are not a leader, they are a manager...).

However, while I have much experience to look back on, Dr Umesh Prabhu, FRCPBH, Medical Director at the Wrightington Wigan and Leigh Foundation Trust, who Tweets frenetically about leadership, is more highly placed to comment. Therefore, I put some questions to him:

Dr Prabhu, please tell us a little about your NHS career

I have always had interest in leadership; I became the Lead Clinician for Paediatrics within few months of my appointment as a Consultant to Fairfield General Hospital Bury in 1992. In 1998 I was appointed as Medical Director (MD) of Bury NHS Trust. In 2003 after a merger with other Trusts, I stepped down as the MD of Bury and went back to full time clinical work.

From 2001 – 2003 I was both clinical adviser for Paediatric complaints to Healthcare Commission and a Non-Executive Director at the National Patient Safety Agency. From here I moved to the National Clinical Assessment Service (NCAS) as an advisor (2003-2014) and in 2010, I became Medical Director at the Wrightington Wigan and Leigh Foundation Trust (WWLFT).

What is it about ‘leaders’ you have worked with previously that frustrate you the most?

Leadership is not everyone’s cup of tea and it can be a poison chalice! I did not know what true leadership was. Most frustrations were due to my own ego, anger and behaviours. I thought leadership was telling people what to do and how to do it; I used to get worked up quickly, I used to get angry and others could see my anger in my behaviour.  A good leader knows how to control his/her own behaviour and also understands the impact of his/her behaviour on others. Many meetings were fire-fighting; many times I wondered ‘why others do not see what I see’.

While working with the NPSA the Healthcare Commission and the NCAS, I saw too many preventable tragedies involving patients and their family, and saw the effect on doctors and their family. These preventable human tragedies made me wiser and matured as a leader. I defined my purpose in life, and began the change in my own leadership style. I learnt a lot about ‘Authentic leadership and value based leadership.

I realised leadership is all about being a role model, being kind, caring and compassionate, and mostly about inspiring, motivating, helping, supporting and guiding staff to do their best. When they make mistakes or their behaviour gives rise to concerns, then a leader has to understand their difficulties and frustrations and work with them to make sure they continue to provide excellent care for their patients.

It is all about caring for staff so that they can care for patients.

What do you feel are they key qualities of a leader?

In addition to the qualities outlined above, good leaders are:

  • Self-disciplined
  • Kind, caring and compassionate
  • Understand the impact of their own behaviour on others
  • Listener and learners
  •  Good servants and good followers
  • Able to identify other leaders and encourage them to lead
  • Have the ability to connect with people and get the best out of fellow human beings.

Good leaders do not have egos, anger or frustrations or know how to control them and behave accordingly. Most importantly, a good leader holds very high personal values. They know leadership is all about their own behaviours and values; in NHS good leaders care for both patients and staff.

Of course, no leader is a perfect leader and even today there are times where I fail to control my own anger and frustrations. But leaders are only human!

Is there a difference between leaders and managers? Can a leader be taught management and vice-versa?

Leaders do the right things right and managers do the things right.

Leaders are people focused whereas managers are task and result focused. Good leaders are also good managers, but they mainly focus on people to get the task done. Good leaders have very high emotional intelligence and understand the feelings of staff and they listen to staff and work with staff.

If managers do not have good people skills or focus only on task and targets then they may not understand the importance of inspiring people. They may frustrate staff by forcing them to achieve targets by bullying, naming, shaming or undermining staff by failing to understand their difficulties or day-to-day frustrations.

Does working within the NHS model stifle leadership?

Absolutely not! And in some ways, the NHS is the easiest organisation to lead or manage provided one has good leadership and management skills. NHS has many amazing value based staff who would do anything for their patients; they do not generally work for financial gain but to care for fellow human beings.

The sad reality is that many NHS staff are frustrated and demoralised due to poor systems and processes and a culture of shaming, blaming, disciplining and bullying. Financial pressures, targets, inspection, regulation etc, all serve to disempower staff and thus affect patient care.

Leaders must have the courage to say ‘enough is enough’ - it is the systems and processes which require review – don’t try fit care into a pre-determined process, ensure the process facilitates the best care for the patient.  NHS leaders must care for staff and engage and listen to them and their day-to-day frustrations and work with them to transform the systems and culture.

What have you been doing to develop you organisation?

Success is rarely due to one or two individuals. Success is always due to all of us working towards a common purpose and in our Trust it is our patients

We have transformed our Trust by working with our staff and creating a culture of staff happiness and staff engagement.

In 2011 staff feedback was poor, hence the Trust Board and CEO decided to implement ‘Listening into Action’ (LiA). With the help of staff we defined our values, defined our culture and reorganised our divisional structure. Our staff defined the behaviours they expect from their managers and leaders. We also implemented robust governance and accountability for all and appointed values based leaders and managers.

Today with the help of our staff, we have transformed the Trust. For example:

  • Each year 450 less patients die in our Trust
  • We are within the top 10% for most quality measurements
  • We have achieved an 90% reduction in patient harm
  • The Trust has received many awards
  • Staff feedback has improved - the Trust is 4th best place to work in the country

If you could create a great leader for the NHS from a composite of people, who would you choose and which quality of theirs would you use?

Mahatma Gandhi, Nelson Mandela, Martin Luther King Jr, Mother Teresa and Florence Nightingale would be my choice of leaders.  Mahatma Gandhi inspired the whole of India and achieved India’s independence without any violence. Nelson Mandela was able to forgive without lasting bitterness, people who imprisoned him for many years. Florence Nightingale genuinely cared for patients. Martin Luther King Jr fought against slavery and was an amazing orator. Mother Teresa cared for very poor and vulnerable children and people in slums of India.

But essentially, they were all kind, caring, compassionate and courageous leaders. They were all ordinary people who did ordinary things in an extra-ordinary way. They all did what they believed to be the right thing to do for fellow human beings.  They conquered the world with sheer love for fellow human beings and did the right thing right. NHS does have many wonderful leaders and one has to look at the leadership of well performing Trusts and CCGs. Important for NHS is to make sure that all Board leaders are appointed not simply for their technical skills but also for their values and leadership skills. All senior leaders and managers must be role models for their staff so that staff feel motivated, inspired and do their best for their patients. Happy staff – Happy patients. NHS must make sure there is a culture of staff happiness, staff engagement where all staff feel an integral part of their organisation and NHS.

For me this is what true leadership is about.