Becoming an Effective Leader Reflection and Personal Development Plan

Becoming an Effective Leader

Evaluate own ability to use a range of leadership styles, in different situations and with different types of people, to fulfil key responsibilities of the leadership role.

My first experience in a leadership role was six years ago when I commenced employment at Nethergreen Surgery as Assistant Manager, prior to this I had held lower level administrative roles within the NHS for a number of years. In my role at Nethergeen Surgery I was responsible to seven GP partners, the Practice Manager and alongside the Practice Manager led ten members of a clinical and administrative team. My current position, which I have held for five years, is Practice Manager of Rustlings Road Surgery, a smaller practice that consists of three GP partners, two practice nurses, a healthcare assistant, practice administrator and four receptionists.

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In order to evaluate my own ability to fulfil key responsibilities of the leadership role I feel I first need to explore what leadership means to me and to understand the difference between being a leader and leadership itself. The Oxford English Dictionary (2011) simply defines a leader as the person who leads or commands a group, organisation or country.¹ For me this definition only touches on what it means to be a leader. Webb has looked in depth at leaders versus leadership and believes leaders encompass leadership beliefs and attitudes, meaning it is who you are as a person that makes you a leader. Simply undertaking leadership actions or holding a leadership title does not make you a leader. ² Scouller (2011) gives us greater understanding of the difference between a leader and leadership when he describes leadership as a process; a series of choices and actions around defining and achieving a goal.³ Simply on a day to day basis I view this as the process of working with and supporting my team towards a shared goal, in our case an effective well ran practice providing excellent patient care. I view my main leadership responsibility in this process is ensuring the correct staff are leading on each given task based on experience, skill set and willingness to achieve our common goal and being a constant support to enable them to do this. In order to help me evaluate my ability to fulfil key responsibilities I have undertaken several exercises to help me identify and understand my style of leadership two examples of this are the the Blake and Mouton managerial grid which identified me as a team leader and the Thornfield’s “What is my leadership style” exercise which identified me as a democratic leader. I feel both these results are a true reflection of how I perceive my leadership style to be.

My role as Practice Manager is a complex one and to be an effective leader can be challenging at times, I am responsible for leading eight clinical and administrative team members but I am also responsible to three GP partners who may have differing opinions and leadership styles. At times this can cause difficulties in leading the team and working towards our common goal. For instance if there has been a change in an administrative process following discussion with myself and the team but a GP partner decides they do not agree with the changes quite often the team do not know who they should be taking direction from, leading to confusion and unrest within the team. In order to effectively lead the team I do have to adopt different leadership styles depending on the situation I am faced with or the individual or group I am working with at the time, this is generally described as following a situational or contingency leadership model. Lewin (1939) identified three styles of leadership.⁴ Having researched several leadership styles to enable me to understand my role as a leader I feel I identify most with Lewin’s thinking. Lewin recognised three styles of leadership authoritarian, participative and delegative. At times my leadership behaviour falls into all three styles described by Lewin. Firstly the authoritarian style, also known autocratic, whereby the leader makes all decisions on their own with no or very little involvement from the team. Decisions are made and cascaded to the team spelling out the goal, method and deadline. Although I do not favour this form of leadership style, at times it is necessary to ensure safe, effective practice or to ensure the practice meets contractual requirements. Secondly the participative style also known as democratic style whereby the leader outlines their priorities and goals but works with and accepts input and advice from the team, however the final decision still rests with the leader. This style is thought to be more advanced and original in its thinking than the authoritarian style and can encourage the team to develop their problem solving skills and creative thinking. Finally the delegative style can also be known as Laissez-Faire, whereby the leader hands over the responsibility to the team letting them set their own goals, methods, roles within the team with little or no guidance and giving the team the freedom to make their own decisions.

During my time at Rustlings Road Surgery I have used and continue to use all three of Lewin’s leadership styles and at times have moved from one style to another in certain situations if the situation required it. For example a new contractual requirement in 2018/19 is to send all secondary care referrals via the electronic referral route. This is a big change for our practice as our clinicians and administrator have always favoured the postal or fax route for referrals and this has been met with a high level of resistance. To ensure we are not in breach of contract it has been necessary to develop and implement new processes to ensure we are compliant. Due to the high level of resistance from our administrator in particular it was necessary to implement this using an authoritarian style initially to ensure we were compliant. I developed and implemented the new referral process with no input from the administrator, spelling out the method and goals I expected from her. However once this had been implemented and was working the attitude of the member of staff did begin to change and I was able to include her in discussions on how we could improve and streamline the process, eventually moving to a more participative leadership style. Although it was necessary to follow an authoritarian approach initially due to the attitude of the member of staff I would much rather follow a participative approach as I feel this approach fosters an effective working team and by including them you are more likely to see a motivated team eager to work towards the common goal with a shared purpose. After the initial resistance once the team member became involved in decision making it was obvious by her attitude change she felt more empowered to implement the changes needed. Lewin’s delegative approach is probably the style I use least in my leadership with the administrative team due to the nature of general practice and the team I work with, we are a very small team and by the nature of our team tend to automatically lean towards a participative approach. In comparison I would say I use the delegative approach more with the clinical team when it comes to cascading new clinical processes as I have a higher level of expectation that they will manage and implement this change in order to continue to work to the latest clinical guidance. An area where I do delegate responsibility to the administrative team is the reception staff rota to our senior receptionist; she manages all reception staff holidays and the cover needed. I have a very hands off approach to the reception staff rota the majority of the time and find the team manage this well amongst themselves. They understand the need for adequate cover and have a mutual understanding between themselves to ensure this works well. I have only encountered one occasion where it was necessary for me to step in and take back control of the situation when a member of staff was refusing to cover however this was easily rectified by temporarily moving into a participative style of leadership and sitting the team down coming to a mutual agreeable solution.

Alongside Lewin’s three style model I have also found Tannenbaum and Schmidt’s (1958) leadership behaviour continuum ⁵ a very useful tool in helping me understand how I lead and highlighted the decision process that is followed when leading that I had never really acknowledged. Tannenbaum and Schmidt suggest a leader has seven decision making options when leading a group – this is highlighted in the below diagram

The continuum moves from the leader holding all the power and authority moving along slowly relinquishing that power until the team are eventually encouraged to contribute and lead on decision making. As practice manager I am continually moving along the continuum with the team and depending on the situation will start out at varying levels and at times will move along the continuum either taking more control or relinquishing more control. For example when a change in childhood immunisations came in last year I cascaded the change to the clinical team and passed all responsibility to the team to ensure the change was implemented, I had no involvement at this stage in the process so would say I sat at stage six to seven of the continuum. After a couple of weeks it was identified that there had been a vaccination error and a child had received an incorrect vaccine. At this stage I moved back along the continuum to around stage four to five whereby I sat the team down and we looked at why this mistake had happened and discussed ways we could improve the process ensuring no further mistakes could be made and I then ensured these changes were implemented.

Use theories of emotional intelligence to review the effect of emotions on own and others performance.

Emotional intelligence was originally developed as a psychological theory in the 1990’s by Mayer & Salovey (1990), both Professors in Psychology. Emotional intelligence is the ability to manage and recognise your own emotions and emotions in others. The work of Mayer and Salovey (1990) was further developed by Goleman (2011) some years later. Goleman⁶ developed a framework of five elements that describe emotional intelligence – self-awareness – the ability to recognise and understand emotions; self-regulation – the ability to control your emotions; motivation –working consistently towards your goal; empathy –recognising the needs and feelings of others and social skills – good communication skills, approachable and respect for others.

Measuring myself against Goleman’s framework I consider myself to have quite a high level of emotional intelligence. I feel I have a high level of self-awareness and I consider myself very good at being aware of others feelings and needs. I see myself as being very easy to talk to and tend to be the person in the practice that people run things by for my opinion whether that’s work related or personal. An area that I feel I need to improve is self-regulation, I find I can over worry and analyse situations and sometimes worry too much about others feelings when decisions have to be made. For instance I find it very difficult when dealing with conflict amongst staff. An example of this would be when reception staff timetables were being changed and two members of staff both want the same shift. Both staff had very valid reasons why they wanted the specific shifts and I very much felt empathy towards both and found it very hard to be in the position to have to choose. In order to manage this I decided to pull names from a hat therefore the decision was made fairly but I was not seen to be putting one staff member’s needs above the other.

Goleman et al (2002) ⁷ describe six emotional styles; the visionary leader – inspiring and empathetic; the coaching leader -connecting personal goals with the organisation goals; the affiliative leader – promoting harmony within the team; the democratic leader – collaborating and listening to the team and the pacesetting leader – focusing on performance and meeting goals.

The role of practice manager can bring its challenges daily and involves working with a wide range of staff and personalities; it requires me to use all the six emotional styles of leadership described by Goleman et al at one time or another. Decisions I make in the practice may be superseded by a partnership decision and this can affect both my emotions and that of the rest of the staff. It has become clear over the last few years that our practice administrator has lost her motivation and sense of job role and responsibilities which has led to a drop in performance and an increase in mistakes. The member of staff has worked at the practice for over twenty years and is held in high esteem by the partners. The situation had progressively got worse over several months and I had taken on some of her job roles to ensure the service still ran smoothly which had negatively impacted my workload. I discussed the issue with the partners and was met with a mixed response. The general consensus being they did not want to upset her and we needed to tread carefully. Alongside my own frustrations I was also dealing with the frustration of the administrative team who were having their workload affected by her mistakes. I discussed this with the partners and explained that although I understood they did not want to upset this member of staff her actions were having a negative effect on the whole team and staff morale was particularly low. A plan was put into place to offer more support to the member of staff in a calm, unchallenging manner. Regular supervision was put in place to ensure she felt supported and areas where we could improve processes were looked at to try and improve her job satisfaction thus improving work performance. During the process I ensured the other team members were also supported and ensured any extra workload was managed appropriately to avoid further animosity amongst the team. To boost morale and to improve relationships within the team we arrange a staff night out to enable to the staff to relax together away from the pressures of the practice.

On reflection of both examples of difficult situations within the practice I feel that without a high level of emotional intelligence both situations could have ended very differently. Being part of such a small team does mean that situations do have to be handled differently to those in a larger, less personal organisation. I feel there is a constant need for reflection of situations to enable me to develop my emotional intelligence further and have recently implemented supervision sessions for myself to enable me to discuss and look at the way situations were handled and ways they could have been improved.

Review own ability to set direction and communicate this to others.

My role as practice manager requires me to set direction and communicate these directions to different staffing groups and levels and to enable this to work effectively requires different methods depending on which staffing group I am dealing with. I found Hersey and Blanchard’s situation leadership model ⁸ a very effective model to enable me to understand how I involve and communicate with members of the team and how I can improve on this. Hersey and Blanchard’s model has two elements – leadership style and the maturity level of the team/person being led broken into a four grid as can be seen below.

During any working day I may use all four elements of the leadership grid. I would use telling for example in situations of high importance such as the example earlier with the contractual obligation to send all secondary care referrals electronically – this required precise firm instruction in the form of a one to one meeting followed by written instructions as to the process I expected the member of staff to follow and I carefully monitored the progress and outcomes, there was a lack of willingness on the team members part which required firm direction.

An example of when I used selling was when we introduced electronic prescribing in the practice – the team were ready and eager to take on the challenge but lacked ability therefore I was on hand to explain and train staff face to face on the day of implementation alongside a step by step desk aid for the to follow. I remained on hand as and when needed and continue to be to this day to regularly directly assist staff when problems occur.

I used a participating approach with the team when we were looking at changing our appointment rotas. I set time aside to hold a reception team meeting to specifically discuss ways we could change the system and encouraged the team to work together to suggest new ways of working and to suggest new ideas. The team were experts in the demand for appointments and understood the issues faced so were well placed to suggest new ways of working but needed leadership to ensure we stayed on track and to give the final go ahead and approval. I feel this is the style of leadership I use most often with the team in situations where there is no time pressure.

I find delegating the hardest element of the leadership grid when working with our administrative team; I feel this is partly down to me struggling to relinquish control and a fear that if something doesn’t go well this reflects badly on me. This is an area I need to work on. I believe time is also a factor in our practice as we are such a small team I don’t find I have the time to get to the delegation stage often with the team as this requires a degree of time commitment initially to enable you to then step away allowing the team to manage a certain task. I find it far easier to delegate to the clinical team as mentioned previously as there is the expectation that they have a duty and responsibility to ensure change is managed correctly.

Due to working in such a small practice both in team numbers and practice building size I feel we communicate very well on a day to day basis. We are in constant contact and work very closely together. At times this can mean that we don’t formalise meeting schedules as often as we should and tend to work on an ad hoc basis. In order to rectify this and ensure continuity I have recently implemented a schedule of monthly reception meetings and monthly clinical meetings to ensure a timetabled opportunity for discussion and to cascade change to the team in a more formal way.

Review own ability to motivate, delegate and empower others.

When I commenced my position at Rustlings Road Surgery my predecessor had been at the practice for over ten years and mainly managed the business side of the practice, he had very little to do with staff management and the general feeling amongst the staff were they had been very unsupported by management.

During my first weeks at the practice I took the time to get to know the staff and listened to any issues they had at that time. My first impression was that the majority of problems simply related to feeling unsupported and there was a general feeling of lack of motivation amongst the team. The previous manager held ad hoc hours and they never knew when he would be at the practice I ensured that all staff knew my working hours from the outset and consistently stuck to them. To motivate someone can be described as to give someone a reason to do something or behave in a certain way, it can also be described as to encourage or to inspire a person or group of people to achieve or work towards a goal. Herzberg (1959) identified factors that motivate people and developed what is known as the Herzberg motivation-hygiene theory ⁹. Herzberg identified hygiene factors that if present lead to increased motivation amongst team members and if absent lead to dissatisfaction. Herzberg’s hygiene factors include reasonable supervision and reasonable relationships and he recognised motivators such as achievement and recognition. With Herzberg’s theory in mind it is clear to see why the team had lost motivation for their job when I first joined the practice. After a short period of time I quickly saw a marked improvement in team morale. Since starting at the practice I have always maintained a door open policy, staff can approach me at any time and will always be supported. I am always open to new ideas and suggestions from all members of staff and go out of my way to ensure staff feel valued and empowered to contribute their ideas and have their say whether that’s a suggestion for change or they need to get a moan off their chest. Staff achievement is recognised and rewards are given such as following a successful CQC inspection the whole team were taken out for a meal as a thank you. All staff receive a substantial voucher at Christmas and all big birthdays are celebrated with a large bunch of flowers or champagne. I feel by showing the staff our appreciation they go the extra mile for the practice and are motivated and empowered to do a good job. This is reflected in a conversation I had with a practice nurse when I asked if she could do some extra hours to cover sickness – her answer was I do this for you, you know, not because I want the extra hours but because I know you have supported me and been flexible when I have needed it and I want to help you out in return. It very much feels like a family environment at Rustlings Road and I believe this is a combination of the staff feeling they can always approach me, will always be supported and their efforts are rewarded.

The Oxford English Dictionary (2011) defines delegation as the act of entrusting a task or responsibility to a person who is usually in a less senior position to you, alongside this, empowerment can be defined as to give a person or persons authority or power to take responsibility for a task or action.¹ When it comes to delegation I feel this is an area I need to work on. As previously mentioned I find this far easier with the clinical team when cascading new guidance or when there needs to be a change in practice as it is presumed they are qualified to a level whereby they can implement and manage change autonomously and often they are duty bound by their clinical registration to ensure they follow new guidelines. When it comes to the administrative staff I feel this is an area I need to improve in. I find being part of a small team requires me to have the ability to undertake all of the non-clinical roles within the practice and as such at times I have the ‘it’s just quicker if I do it myself’ attitude, I recognise that this does not motivate the team and also is not the most time effective way to work. I have had a bad experience of delegating recently whereby a task that had been delegated to our administrator had not been completed by a deadline which resulted in the practice losing a considerable amount of money. Although I had delegated the responsibility of this task to the administrator the overall responsibility still rests with me and I had to explain the loss to the partners and accountant. I find it very hard to relinquish control anyway by nature of my personality but its examples such as this that makes it even harder for me. This is an area of my leadership that I plan to develop and will ensure time is given to allow staff to learn and develop in their roles and put plans in place to ensure this is adequately reviewed and performance managed. In order to assist me to accomplish this and remain on task to eventually reach a stage where I can pass full responsibility over to the team/team member I plan to use the delegation planner discussed during the Thornfield’s Becoming an Effective Leader workshop and found in the work book provided (2016). ¹⁰ I feel the planner will help me stay focused on my goal and by following the step by step actions will ensure that the process is not rushed and both the team and myself will have the opportunity to ensure the task is delegated properly and effectively, thus empowering the team to take on total responsibility and ensuring I am confident in the ability of the team to complete the task to a standard and in the timeframe expected.

¹Oxford Dictionaries (2011) The Concise Oxford Dictionary (ONLINE), Available at: https://en.oxforddictionaries.com/definition/leader

 ² Keith Webb –Multiply your impact (ONLINE) Available at: http://keithwebb.com/big-difference-between-leadership-and-being-a-leader/

³ Scouller, J (2011) The Three Levels of Leadership 2nd Edition: How to Develop Your Leadership Presence, Knowhow and Skill (ONLINE) Available at: http://www.three-levels-of-leadership.com/blog/tag/james-scouller/

⁴ Lewin, K; Lippitt R; White, R. (1939) (ONLINE) Available at: http://changingminds.org/disciplines/leadership/styles/lewin_style.htm

⁵Tannenbaum, R. & Schmidt, W. (1958) How to choose a leadership pattern (ONLINE) Available at: https://hbr.org/1973/05/how-to-choose-a-leadership-pattern

⁶Daniel Goldman (1998) Emotional Intelligence (ONLINE) Available at: https://www.learning-theories.com/emotional-intelligence-goleman.html

⁷Goleman, D., Boyatzis, R. E. and McKee, A. (2002). Primal Leadership: Realizing the power of Emotional Intelligence (ONLINE) Available at http://changingminds.org/disciplines/leadership/styles/six_emotional_styles.htm

⁸Hersey-Blanchard (1982) Situational leadership theory (ONLINE) Available at: https://www.leadership-central.com/situational-leadership-theory.html

⁹ Frederick Herzberg (1959) Motivation Hygiene Theory (ONLINE) Available at: https://www.mindtools.com/pages/article/herzberg-motivators-hygiene-factors.htm

¹⁰Thornfields Primary Care Training Specialists (2016) ILM5 Becoming an Effective Leader – Day 1 & 2 Course Workbook