Abi Masterson - Leadership in Healthcare Roles - Wednesday 8 March 2017

“Airport shops are full of books about leadership,” Abi Masterson told Care Conversation delegates. “But they tend to be based on leaders after they’ve made it. That’s not very predictive.”

This type of leadership theory also made the mistake of underplaying the role of vital issues like executive power and budgets, she stressed. “Everyone wants to be a charismatic, transformational leader. But if you’ve got money, you can do a lot. And if I can hire and fire you, I’ve got a good chance of getting you to do what I want you to do.” The recruitment crisis in the health services meant that the latter was not necessarily the case in the NHS, she said.

“We’re going through a bit of a fashion of plucking a successful leader from one context and putting them in another, then wondering why it doesn’t work out,” she said. “It’s about both leadership and context – we need to think about this differently.” It was also vital to move away from the concept of a single charismatic leader towards that of someone who was able to create an environment that allowed people to flourish, she said. “Someone who’s motivated towards altruism, rather than ‘whatever the last guy did, I’m going to do the opposite.’ It’s about influence, rather than control.”

A key challenge for health services at the moment – despite the rhetoric – was one of “power, control, muscle-flexing”, she said, which involved a culture of naming and shaming that was frequently carried out in a very public way.

“The first point of change is ourselves,” she told delegates. “Often what annoys us about other people is just a reflection of ourselves. ‘Change starts with me’ is an important thing to remember.” Humans had had centuries of experience of leading in person but very little in terms of “leading virtually”, she said. “Harness the power of email.” Twitter could be an excellent way of engaging with frontline staff, while leadership podcasts – “little clips about ‘here’s why we’re doing this’” – always went down well.

It was important to bear in mind that chief executives in health often had less power and influence than people might assume, she pointed out. “In terms of procurement, for example, even in our bureaucratic NHS structures a lot of contracts come down to trust and relationships. ‘I know you, I trust you, I’ve done business with you before’.”

Any meaningful change in health and social care also required a sophisticated understanding of all the professional groups involved, she stressed. “If you don’t get the doctors on board, you won’t achieve anything. Money and relationships are both vital – as long as I can put my arms around my little bit and hold on to my resources, these big system changes are not going to work.” In terms of advice to those leaders who found transparency a frightening prospect, meanwhile, it was important to be prepared to say “I don’t know – give me some time and I’ll get back to you,” she pointed out.

The significance of emotions was something else that should not be overlooked. “Understanding our own, and trying to understand other people’s. We need to feel what our guts are telling us – we’re not just logical thinking machines, we’re not computers. All of these things are going on inside us all the time.”

One of the hardest things to manage in health and social care was the dissonance between the rare examples of “shocking, shameful, appalling” care and the “millions and millions of examples of excellent, wonderful, caring human services being offered every day by people who passionately believe in what they’re doing. The image we’re having played to us on a daily basis is distorted – the only time we see social care in the media is when someone does something terrible. It’s a huge leadership challenge to try to turn this around.”

Good leadership could be learned, she told the seminar. “People talk about ‘born leaders’, but the most important thing about leadership is looking inwards rather than outwards.”