EFFECTIVE LEADERSHIP IN THE NATIONAL HEALTH SERVICE
The emphasis on leadership in the National Health Service (NHS) Plan has been one of the most important priorities for nurses and their health professional colleagues. Leadership throughout organisation and across the whole health economy is viewed fundamental for implementing and sustaining change (Department of Health (DH 2002).The NHS Plan clearly articulates the need to modernise the healthcare service with the intention to improve public's health (DH 2000). The goal of public health is to fulfil society's interest in assuring conditions in which population can be healthy through organised efforts and informed choice. To achieve this, the NHS requires dynamic intelligent leaders at all levels of the organisation.
The following paragraphs attempts to critically discuss how effective leadership strategies can contribute to the delivery of high quality health within contemporary public health through health protection in combating infectious diseases. Additionally, the paper presents a definition of public health, health protection, and leadership. Some leadership contemporary theories are examined before considering which theory is relevant to health protection and provides a rationale for choice. Key leadership competencies such as vision, communication and creating the environment will be outlined and discussed.
The term Public health is defined as the science and art of preventing diseases, prolong life and promoting good health and well being through organised efforts and effective leadership skills (Rowitz 2009). The concept is concerned with the health of the population rather than individuals. It has been stated, that public health is not just dealing with illness, and looks at the impact on health of social, economic, political and environmental factors but also acknowledges human behaviour.
Public health correlates with health protection. Both concepts play an integral role in protecting health of general public through effective leadership strategy such as prevention and emergency planning. As a consequent, reducing potential threats to health which includes infectious diseases both communicable or non communicable diseases, and environmental hazards such as chemical or radiation exposures. Furthermore, protecting the health of the public has emerged as a distinct area of practice as well as top priority on the government agenda (Reference).
WHAT IS LEADERSHIP
Leadership is imperative for the NHS to sustain success in Public health. Leadership is a very complex multidimensional concept and has been defined in various ways. The concept leadership and what makes an effective leader has evoked strong debates in the late 1970s and 1980s (Tamkin et al 2010). In addition, it was at this time that theorists started to defined leadership. From the wealth of available literature there appeared to be several common features central to the phenomenon of leadership. Leadership is a process (Bass 1990), involves influence, occurs within group context, involves goal attainment and leadership exist at all level (Northouse 2001). In other words leadership is seen as unifying people around values, constructing the social world for others around those values and helping people to mobilise change (Stanley 2009).
Management and leadership
Cook (2004) has found that leadership and management are two concepts that are used interchangeably. However, these words describe two different concepts (Day 2001). Leadership is a process which is similar to management. Both functions involve working with people. While management have to do with providing order and consistency in organisations; leadership produces change. On the other hand, Cannella and Monroe (1997) argued the difference distinction between leaders and manager are narrowing.
In order to demonstrate and maintain effective leadership characteristics an individual has to utilise emotional intelligence. Furthermore research on emotion intelligence has confirmed that this concept is what differentiate the good from outstanding leader Goleman (2000) thinks that leaders who developed emotional intelligence becomes aware of the emotions of others and are more likely to promote a healthy working environment. Gould (2000), further argued that leaders who show characteristics associated with emotional intelligence are more likely to have a positive impact on staffs. Thus this will contribute to the delivery of high quality public health which could improve organisation outcomes.
There are several types' contemporary theories of leadership such as the trait theories style theories and contingency theories. The trait theory developed from the great man theory assumes that effective leaders are born not made. This derives from the belief that there is a common set of trait of successful leaders. This theory provides foundation for considering the traits require of a leader. This theory is likely to be rejected by many people. Shaw (2007) argued that the trait approach is limited because the context in which leadership take place is not acknowledge. In contrast, the contingency theory which is based on situational theory argues that the effectiveness of leadership style depends on the particular situation and that leaders are more effective when they are able to change their style to adapt to different situations (Bolden et al 2003). The essence that underpinning this theory is that there is no single "best" style of leadership approach and that different situation will require different style of leadership (Bolden et al 2003) which is important in today's health service. For instant should an emergency situation arise, the leader would demonstrate autocratic leadership skill rather that participative.
Effectiveness correlates with transactional and transformational leadership. Transformational leaders use transactional leadership strategies as well to be effective and this combination corresponds closely to ideal leadership (Lowe, Kroeck & Sivasubramaniam, 1996).
Also, emotional intelligence has a strong connection with transformational leadership. Transformation leaders are well suited to today's fast changing health care environment where adaptation is extremely important. Within this leadership theory there is an emphasis on empowerment and the development of potential for the achievement of long term goals (Shaw 2007), through mobilisation in order to make change (Bolden et al 2003). Recent research states that transformational leadership style is positively associated with higher employee satisfaction and better performance thus would improve public health. According to Taylor (2009) it is possible to use transformation leadership skills within a transaction setting. On the other hand, transactional leadership is concerned with influencing others to achieve goals through rules corrective actions, and contingent rewards (Burn 1978 and Bass 1999). Transactional leader avoids risks, is result focused, not flexible and adaptive to situations. It could be said that the environment in which the NHS operates lends itself to transactional leadership for the achievement of targets, performance management and impact of competency or outcomes. Whereas, transformational leaders are creative, innovative, takes risks and influences and inspires others.. For this reason, many theorists in leadership theory advocate transformational approach in organisation to enable people and organisation to achieve their fullest potential.
Theorist have indentified many different leadership styles. Firstly the trait theory as known as great man theory identifies characteristic that such as intellect, personality and class. The can be considered as genetic influences.
Tamkin agrees that it is very difficult to teach people the traits they need but says that some of these can be learned. Some forms of management training, an example of this is psychometric profiling as this will give staffs an insight into what they are like and what might be areas for improvement
Discussion health work environment
As the shortage of nurses increases and resources remain limited leadership in the NHS setting has become a topical point for discussion. Thus organisations are searching for ways to create a healthy work environment in attempt to recruit and more importantly retain staff. Tamkin et al (2010) argued in their report that outstanding leaders are also able to see things holistically. Tamkin et al 2010 adds. "outstanding leaders act in a way that makes a difference to the immediate recipient and they also think about how this will impact on the organization; that is to say, creating a good atmosphere in the workplace will not only affect staff but feed through to the public." This can be achieved through flexibility, trust and respect. Support, consideration and motivation are also some of the characteristics of an effective leader which correlate with transformational leadership. Furthermore Tamkin et al (2010) confirms that flexibility trust and respect are the corner stone of effective leadership. Such leadership characteristics are the key thus, can result in positive outcomes and therefore a healthier work environment.
Many of the problems that occur in an organization are the direct result of people failing to communicate. Leadership has its corner stone, the ability to communicate.Â When theÂ word communicate used, it is referring not only to the words one uses to transferÂ factual information to others, but also to other "messages" that are sent andÂ received.Â The purpose of communication in an organisation is to make agreements on what action is going to be taken to achieve the desired outcomes to create results of shared vision. The NHS need to create an effective communication cultures within it organisation to sustain success. In fact Tamkins et al (2010) points out that, listening may be the single most powerful skill of communication because it is an act of respect and valuing others. Being a good listener enables individuals to understand where each team members are coming from and analyze how each individual thinks. Communication correlates with productivity, profitability, public satisfaction and employee retention. Effective communication is a key to bring confidence and trust among employee. Effective communication skills are therefore essential.
. Effective communication needs to be straightforward in order to aid and understanding (Tamkin et al 2010). Tamkin et al (2010) illustrates some essential aspects of communication, slowing the thoughts processes, increasing understanding, testing conclusion, listening constructively, getting to the essence of things and exploring areas of disagreement. This indicates that, to be an effective leader one has to understand all the factors that influences communication which transform into effective message in order to address current public health issues such as infectious diseases (Rowitz 2009).
Effective leadership is essential if the health service is to modernise and provide improvement through health protection and public health. The leadership qualities required in modern health care service derive from transformational leadership theory and include the ability to motive and influence others to produce change to provide high standard of care for patients and a harmonious working environment for staff. Leadership provides vision and mobilisation to achieve goal.
In essence, for organisation to run effectively including the NHS there need to be leadership and management. While leaders develop and articulate strategic vision to produce change and move organisations forward managers co ordinates to ensure that the job gets done. One thing that is certain is that change will always be a part of the NHS and learning how to work within this culture to the benefit of the public will remain a priority. Leadership describes the ability to influence, motivate and enable members of an organisation to contribute to the effectiveness and success of the organisation.
Leadership is valued in the healthcare setting, especially when it helps to achieve goals that are beneficial to protecting health, such as the enactment of effective preventive- health policies. Most importantly, individuals with effective leadership qualities can foster a culture of cooperation which may improve public health.
Thus, it is evident that meaning of leadership and management are noticably different. Indeed some managers may dislike the distinction, because it illustrates that managers are not leaders, however leaders are actual managers (Machie1987).
1. Seeing the bigger picture Outstanding leaders recognise the interconnected nature of their organisations and act accordingly.
2. Understanding that talk is work Outstanding leaders talk to staff to find out what motivates them and how they can boost enthusiasm.
3. Giving time and space to others Outstanding leaders allow people more freedom and influence over the work they do.
4. Growing through performance Outstanding leaders invest in their workforce and use challenges presented to encourage growth, learning and engagement.
5. Putting "we" before "me" Outstanding leaders work hard on team spirit, shared decision-making, collaborative working and forming strong bonds between teams.
In short leadership should be trustworthy.
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