The issues facing management and leadership

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In this essay, I will discuss issues regarding management, leadership and the theories they are related to. I will also demonstrate how knowledge of the theories of management and employment law and relevant legislation can create a harmonious working environment.

I will attempt to illustrate how I manage people within my sphere of responsibility for effective performance.

I manage the Nurse Bank at the East London and City Mental Health Trust. I manage two staff in the office and have over 1500 bank nurses who work both in permanent and temporary capacity.

My main role is to ensure that wards are adequately staffed and that I minimise the Trust spending on Agency staff. My strategic role is to look at the long-term problem of recruitment and retention in Mental Health. I have to ensure that new legislation such as the Working Time Directives are implemented and adhered to. I also have to incorporate the NHS plan and framework in my objectives and goals.


I will attempt to answer the managing people module by giving a definition of Management and linking it to its theories.


Is there a standard definition of Management?


Management is a complex and ever-changing art and therefore any definition is likely to be contentious.

Henri Fayol defined management as "forecast and plan, to organise, to command, to co-ordinate and to control."


Chartered management Institute defined management as; the use of professional skills for identifying energy in an organisational objective through the deployment of appropriate resources.

There are several theories of management; Frederick Taylor who pioneered scientific management, advocated for the participative culture linked to notions of satisfaction. He represented a more democratic, humanistic approach to the use of main in organisation.


The scientific approach called for detailed observation and measurements of even the most routine work, to find the optimum mode of performance. Charles Handy (1999), classical management theory proposed that effective performance of a team was dependent on the environment, which includes the position of a leader, relationship with the group, organisational norms, structure and technology.

Could it be that of the above definition of Charles Handy was describing the transformational leader?


One of the strategies for learning and transformation is to tap in the shared values of the organisation. The concept of transforming the leadership refers to the process of influencing followers or staff by inspiring them or pulling them towards the vision of the future state. The latter exhibits charismatic inspiration, intellectual stimulation any individual consideration.


What is leadership?


There is some confusion between the terms leadership style and management style with a view taken here is that leadership refers to some aspects of management such as direction and guidance of teams and individuals.


Kotter 1990 has successfully drawn the distinction between management and leadership. Management is about coping with complexity; management brings a degree of order and consistency to keep dimensions like the quality and profitability of products. Leadership by contrast is about coping with change.


Leadership is about tomorrow, emotional horizon and change management. The perceptions of leadership's are to engage as partners in developing and achieving a shared vision and ended in enabling us to lead.


Managing and leading are two different ways of organising people. The manager uses a formal, rational method whilst the leader uses passion and stirs in motion.

Jumaa and Alleyene's action and process (1998) is based on the hierarchy of clinical team issues and the concept of strategic learning. It concludes that effective clinical team leadership will take place when clinical course is explicit and clinical processes are clear and relationships are open. For example satisfactions between stakeholders, clinicians and managers.

Will the NHS needs a more transformational style of leadership?

The NHS needs a more 'transformational' style of leadership, a style which emphasises setting a direction, motivating people and managing significant change.

The calibre of the leaders needed by the NHS do not just emerge; it is often mistaken that those who are skilled in one aspect of healthcare or who have risen to senior level will in fact automatically make good leaders. To a large degree the skills of leadership can be taught acquired and flopped although of course individuals will vary in the expense to which they are able to deploy these skills.

Leadership is about investing in developing the skills and talents of professionals who can exercise those skills at whatever level they work.


Equipping nurses with leadership skills is not about taking them away from patient but enabling front-line staff to take forward the modernisation agenda. Nestling tissue program has a major impact in many areas if nurses feel empowered and can implement patient care in the ways they wish, they are less likely to leave the profession.


Organisation can be defined as systems of behaviour to enable humans and there machine to accomplish a joint function of human characteristics in the nature of the task in organisations like the NHS which put patient first and seek to integrate all aspects of care. Separate leadership programmes for nurses doctors and manages looks increasingly anachronistic.


Theories of motivation such as that pioneered by Abraham Maslow (1943) presented the human being as a kind of psychological organism struggling to satisfy its need for a quest for employment. This theory, which suggested that humans are motivated by hierarchy of need progressing through the physiological, the social, and the psychological, had very powerful implication, for it suggested that bureaucratic organisation which sought to motivate employees through money, or by merely providing secure job, can find the human development to the lower levels of the need of hierarchy.


Whilst classical theorists were concerned with structure and mechanics of organisation, the theorists of human relations were concerned with the human factor. The focus of human relations theory is on motivation, group motivation and leadership. At the centre of this is the focus on assumptions about relationship between employers and employee.


Argyris studied the needs of people and needs of organisation. He felt that classical models of organisation promoted 'immaturity'. He felt that it was important to understand the needs of people and integrate them with needs of organisation. Only in this way can employees become co-operative rather than defensive or aggressive.

Within my sphere of work I endeavour to ensure that there are clear messages and two-way communications between Managers, staff and myself. Changes such as the new pay agenda have created a feeling of disillusion within staff and I have to keep them informed of the situation to reduce uncertainty and promote trust. The above was achieved through a newsletter that was sent out to all staff.



The classic work of motivation by Frederick Taylor in the 1950s when he formulated the motivation hygiene tool, he identified several factors, such as salary levels working conditions and company policy, which demotivated rather than motivated staff.

For example, once a fair level of pay is established, money ceases to be a significant motivator for long-term performance. He applied the analogy that if the washroom is clean, no one cares if the floor is scrubbed even harder. The point is that you cannot and enhance team performance through these hygiene factors. What are crucial is the local environment and particularly the way in which you interact with your team.

For e.g. when I newly qualified and was working as a staff nurse, one the patients who had a Pneumothrax had stepped on his tube, I acted quickly and followed the necessary procedures. I was later congratulated by the ward Sister who told me that she felt I dealt with the situation very well, she made a written note on my file and asked me to organise a teaching session for the other staff. I felt appreciated and looking back I realise that she encouraged me to share good practice as well as acknowledged my contribution on the ward.


The positive motivation factor that the Ward Sister gave me was praise, recognition, the work itself, responsibility and advancement. These are what a team needs, loads of money is nice but not nearly as being valued and trusted. Leadership should be about facilitation, delegation and appreciation. It should provide direction, inspiration and motivation. A simple gratitude for a job or work done was a long way to encourage staff and boost morale to do more.


Health has always been, and is always likely to be, high on the agenda of the government of the day. The NHS reform programme, and the importance attached to deliver service improvements, has only serve to increase this profile.


The NHS plan has set challenging targets that we must meet and exceed if possible to make the service gains for patients needs. The government has made many pledges with regards to recruitment and retention; training more nurses each year, targeting key specialties, more consultants and most importantly improved pay for staff.



There is a massive demand for change in the NHS. "The vision is to offer people fast and convenient care delivered to consistently high standard. Services will be available when people required them, tailored to their individual needs."Ours is a vision of the renewed public services ethos, a system that values the dedication of staff and believes that the trust is still the glue that binds the NHS together."(NHS Plan July 2000)


Is it sensible and feasible to manage the NHS by targets, stars and traffic lights?

How is the NHS motivating its staff, is it fair to pour money in organisations that are already doing well and penalise the ones that are struggling, this concept has puzzled me.

The resources and capabilities need to be examined.


SWOT analysis; look at the competencies and resources available.


SWOT is an acronym for examining an organisation's strengths, weaknesses, opportunities and threats, and using the result to identify priorities for action (Ansoff, 1965). The main principle-underlying SWOT is that internal and external factors must be considered simultaneously, when identifying aspects of an organisation that need to be changed.


When they have done so they can determine the readiness and capability of these individuals and groups to interact the roles required of them in the change process. Understanding the readiness involves analysing attitudes: willingness, more motives and aims.


In health care organisations power is derived from a number of different sources this is not easy to identify as in other industries. In any change management process the location of power and the use to which it will be put needs to be known by those attempting to lead the process.




One of the most common ways to overcome resistance to changes to educate people about it beforehand. Communication of ideas held people to see the need for in the logic of the change. Employees are more likely to be committed to their work if they have a say in it. They are more inclined to believe and support decision which they have had some input. Employees will be motivated by successfully achieving a specific job in such as completing a job, solving a problem.

The Working time directives (WTD) 1998, was a legislation that came in to effect by the European Court of law with regards to temporary staff being entitled to annual leave. Bank staff were used to work all through the year and the change in legislation meant that they needed to have a break for their own benefit and for Health and Safety reasons. There was a lot of resistance regarding this issue as staff felt that they would lose out financially. A user group meeting was set up by myself where each department allocated a representative to attend and to voice their concerns, once they realised that the directive was for their own benefit, they no longer resisted to any change proposal. By informing the staff of the issues surrounding the WTD and that they were going to get paid for the time off that we were anticipating for them to take, staff were more co-operative and less aggressive


The feeling of achievement is similar to when you finish a race; unfortunately a sense of achievement in completing a specific task does not last very long. In this respect we as managers have to ensure that we provide the opportunities to employees to experience achievement regularly. Recognition is a strong motivator in most people; it is simply an acknowledgement and appreciation of a person contribution to the organisation.


How often do NHS workers feel that they are being appreciated?

Is it being reflected in their pay or in their working hours?


A major problem within the NHS is the recruitment and retention of staff. Politicians make all these promises and changes without explaining them to the workers hence not having a shared vision.


The Chief Executive of Sainsbury's motivates his staff by being on the shop floor once a week and arrive at the outlet unannounced to see it as a customer. Why does the NHS not share the same passion as this company, is it because the NHS is a non-profit organisation?


As Sir Peter Davis (Chartered Management Institute Gold Medal Winner May 2003); "Companies that do well have a clear strategy which focuses on the consumer or end customer and responds quickly to what the customer wants."


A catalogue of poor care and support from stakeholders such as employer's clinical manager's team leaders and patients hinders nurse's attitudes. For example if a nurse has finished her shift 15 minutes earlier is not allowed to go home, however this nurse has previously spent an hour over her normal working hours because the wards was too busy. Inappropriate attitude like this and lack of recognition of the staffing could make nurses feel unappreciated and hence leave the profession that they love.


The NHS wants to recruit high calibre of nurses with the right skills and right attitude. This may somehow rescue the nursing crisis. Poor communication of organisation intentions and unique objectives limits effectiveness and misunderstandings.


If organisations don't think strategically about their recruitment needs, they will find themselves recruiting people who can do the job now rather than those who have the potential to lead into the future. I have an active role in the recruitment of staff for the Nurse Bank at the ELCMHT. It is crucial to recruit the right calibre of qualified as well as unqualified staff. I have enquires from people from different walks of life and I have to select the people with the right experience and attitude to working with vulnerable people.


Recruitment and Retention (R&R) of staff is one of the key components of modernisation and improvement set out within the NHS plan. The Government has set the target to recruit over 30,000 personnel over the next four years. Recruitment has been damaged by a growing public perception that it an awful place to work.


To attract back the workforce, the NHS has to make itself an attractive place to work. The human resource performance framework has three clear objectives: improving working lives, flexible-working patterns, flexible retirement and provision of child care facilities.


To avoid a staffing crisis in the coming decade; one of the performance measures linked to the financial resources that trust receive would be based on the way NHS employers treat its staff.


Recruiting the wrong calibre of staff may hinder enthusiasm, talented staff can get fed up and move on, and both the organisation and its people stagnate.


By attending the Managing people module, I have developed new ideas to deal with the current recruitment and retention problem. I am hoping to survey the staff to identify what they want from the Trust. I am hoping to form an action group to address the issues and to further understand what motivates staff when they wake up, what gets them out of bed?

I have also learnt that if managers lack interview skills, they are in danger of hiring incompetent people, who they will then be forced to mico-manage.


My vision is that by improving R&R, it will improve the current working environment for staff and also the delivery of services and standards of patient care.


Patients want to be treated by well-motivated, fairly rewarded staff. By improving R&R rates will lead to more effective modernisation of the service.


Senior nurses and Managers are reluctant to share their knowledge as they feel they may lose their power. Some of the underlying reasons for this kind of attitudes are that there are competitions and rivalry.


Effective leadership makes for a happier, productive workforce and better quality staff retention. (Crouch 2002).


Group motivation arises not just from individual motivation, but also the ability of leadership to develop team spirit and obtain a high level of commitment from team members. This high level of interaction encourages the openness of the team to discuss and to become more compatible with the pursuit of task. For example in a multidisciplinary team, people come from different scope of work to add value to patient's care by having the appropriate skill m


Capability is the capacity for a team of resources to perform some task or activity. While resources are the sources of a firm's capabilities, capabilities are the main sources of its competitive advantage distinctive competence. (Grant 1991)


Within the NHS Framework, the 7 s approach is considered important because of its dual emphasis on "soft" organisational components (style, staff, skills and shared values) as well as the "hard"(strategy, structure and system).


The NHS will not be seen as a caring organisation unless it invests in its workforce training. If the NHS invests in its staff training so that they can attain self-actualisation and feel a sense of belonging, organisational pride and motivation, it will portray the NHS as a good caring employer that attract high quality staff and reduces excessive workload.


Most nurses who are aspired to do further training to attain higher qualification have to fund for their own studies and leave their job for better pay.


The working life standard has enabled staff in the NHS to work for in an organisation which can demonstrate its commitment to more flexible working conditions challenging traditional working patterns and giving staff more control over their own time; one which would provide the employee with annual hours arrangements, childcare support, reduce the hours options, flexible times, career support, career breaks and through flexible retirement.


The essence of care arose from a commitment in making a difference- the English nursing, midwifery and health-visiting strategy- to explore the benefits of men benchmarking to help improve care. It is essentially a toolkit designed to support measures to improve quality and contribute to the introduction of clinical governance.


Essence of care helps practitioners take a structured approach to sharing and comparing practice, enabling them to identify the best practice and the job action plans to remedy poor practice. The benchmarking process has played an integral part in raising staff awareness around essential aspects of care. It has motivated staff to become together to share and look at practices and has empowered them to improve local delivery through action planning. This has been achieved into the backdrop of a clinical governance agenda. National League, clinical government and has been the main policy driver for the essence of care.


Clinical governance provides a platform for which essential aspects of care, for example food and nutrition, personal and oral hygiene, privacy and dignity are all accredited to good practice. The importance given to them are by patients that staff has continued to receive valued feedback for both positive and negative scoring phase of the benchmarking of the care delivery system.


The concept of continuous improvement is based on the assumption that continually striving to reach high standards in every part of the organisation would provide a series of incremental gains that will build superior performance. In an environment dedicated to continuous improvement, managers and team leaders have a prime objective, the bringing out of new ideas and concept from their staff.


My aim is to organise for steering groups to create an environment in which new thinking is to be encouraged and welcome. My role and function would be to unlock an environment dedicated to continuous improvement. For e.g. improvement groups, team meetings, a suggestion schemes.

This module has exposed me to the success of organisation, high standards of quality is achieved trough people.


Quality is a race without a finish in which everyone in the organisation takes parts it is a race against staff competing to achieve and sustain world-class standard of performance. Continuous quality performance is to enable powerless patients to define the service they want, measure the first service they get and provides performance feedback to suppliers. Quality is achieved through culture change, behaviour modification and skills provision.


Total quality performance is an intensive, long term effort directed at the creation and maintenance of the high standard of product quality and service expected by customers.


The term CLINLAP-Clinical Leadership Learning and Action Process is used when the focus of the model is on nursing leadership. LEADLAP-Leadership learning and action process is used within healthcare education, to facilitate a collaborative understanding of the NHS'S cultural web, and how this awareness and action enhances strategic change implementation.


CLINLAP processes are based on the assumptions that there is a gap between the clinical action and the organisation needs.


LEADLAP is used in conditions of complexity, uncertainty, instability, and an environment where value conflicts abound. (Jumaa and Alleyne)

CLINLAP challenges rigid, unproductive beliefs and assumptions. CLINLAP challenges the system; questioning assumptions; understanding the reasons for doing what you do. (Jumaa & Alleyne1998)


Appraisals are the development needs of employees. The goal of appraisal is to meet the LOOP factor, which is legal, Occupational, Organisational and Personal.

Organisational performance is likely to be improved through the development of its members. The purpose of appraisal is enable employees to lift their level of performance, to provide feedback and to change things to support the employee's work and improvement, to develop and maintain a climate of trust in which frank discussion can take place.


As a manager I feel that the ability to create a climate of openness where subordinates feel free to 'appraise' is crucial, if a manger's practice is a hindrance to the employees doing his/her job effectively and is not able to tell you due to fear of the consequences; the job will not be performed optimally.


Staff development includes me as a manager and this may also include the improvement of my management skills and abilities, hence this course. In the end it takes feeling of confidence and security to ask members whether you (as a Manager) have any practices, which make your job difficult. For e.g. During my elective nurse training, I worked with a ward sister who had to have all the beds done first thing in the morning rather than prioritising and giving out her medication or preparing patients for theatre, my feelings are if I were to be appraised by this Ward Sister I may have had to think long before questioning her practice at the time, however now I would definitely question her practice.


Whose effective performance are we measuring?


People usually need to be clear about how the future state will look like. Project management approach will allow a 'fit' between the actions and those of you're the organisational needs.

Project management is a set of principles, methods, tools and techniques for the effective management of objective-oriented work in the context of a specific and unique organisational environment. For e.g. there is an attempt from the Government to implement NHS professionals, a nurse bank to take over the supply of temporary staffing throughout London.


Project management is about putting people in the right direction. When a gap has been identified for e.g. (SWOT Analysis), a project management approach deals with the problem.


Projects are organisational activities that are different from the organisational/unit or department.

Project have specific purpose and objectives, it has limited timescales and THEIMM.

THEIMM is an acronym for time, human, equipment, information, material and money.


Project management focus on achieving goals, it develops new work practices skills across teams.


LEADLAP five strategic questions can assist and ensure arrival of agreed goals. These questions are:

Where do we want to go?

Where are we now?

How can we get to our practice goal

Which route must we take to get to our goal and

What must we do on our journey, and check progress to ensure that we get to our practice goal?

The goal is to assist to find practical and agreed SMART (specific, measurable, achievable, realistic and relevant time bound) solutions for the project.

The ability to put projects together requires analytical and planning expertise and project management. These are needed to build capacity quickly.

The NHS has strived to operate in a 'no blame culture'; it has policies and procedures in place to deal with issues such as grievance, health & safety, counselling, consulting, networking and relationships.

The above policies are in place top promote fairness and order in the treatment of individuals and in the conduct of industrial relations. The rules that are set standards of conduct at work ensure that standards are adhered to provide a fair method of dealing with alleged failures to observe them.

In conclusion the NHS is an employer that needs to recognise the unique nature of the workforce and shape employment practice to provide the best opportunity to recruit and retain high quality staff.  Leadership and communication skills need to translate well in the new organisation culture. A simple formula for success: "Treat people well, in turn, they treat their patients well. Happy employees equal customer satisfaction."

There is a recognised need to build capacity and capability in the management of people and organisational change.