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Leadership? Huuuuh! What’s it good for?

June 11, 2015

By Basket Press

This term is thrown around like the proverbial confetti: this and this  are just a couple of recent examples from my in-box. But does anyone know or agree what we mean by the terms “leader” and “leadership”? Or what “leaders” are there for, especially in a health service context?

Personally, I am hugely confused.

I was, as a Band 7 senior nurse, once told by one of my least competent managers that I “didn’t display enough leadership”. Oddly, I asked what was meant, only to be met with a lot of bluster and jargon which seemed to indicate that I didn’t automatically toe the management line (me? With my reputation?). I replied that I had no intention of displaying that kind of leadership.

As a consequence, I was instructed to attend the trust’s then flavour-of-the-month Myers-Briggs based“leadership” training. I declined, citing lack of evidence of efficacy, and the fact that I had successfully undertaken one of the previous flavour-of-the-month “leadership” courses, Leading an Empowered Organisation (LEO to his friends – and me). Innocently, I asked if this meant that LEO was no longer valid…

I think my trust was confused…Especially as the “leadership” style of our then director was to claim that a meeting had agreed something it hadn’t; and that of his successor (originally a nurse) was to thump the table and shout at anyone who challenged what he said, no matter how wrong it was – obviously, I was a target here. Correct me please, but as I recall it, these are not LEO-approved patterns of behaviour.

Neither are some others I’ve heard of. In at least one trust the “leaders” are so busy “leading” that staff don’t know who they are. This does not surprise me. In order to bring people together from across a geographically widespread area – as mandated by the then “nursing strategy” of the trust – we set up a senior nursing group for Child and Adolescent Mental Health Services (CAMHS). We invited members of nurse management to discuss professional issues with us and give us guidance, but our invitations mostly went unanswered, and no-one ever attended. Also too busy “leading” I guess. Mind, I feel this whenever I read the term “nurse leaders”; I think “Who are you? Never heard of you!”.

Even the “leadership” industry is no clearer. In her tellingly titled book The End of Leadership, Barbara Kellerman of Harvard’s Kennedy Business School pointedly refuses to offer a definition of the word (p xxi), referring to “some 1500” definitions of it and “around 40” theories of leadership, before tautologically stating “I assume that leadership development implies developing good leaders, and that good leaders are both ethical and effective”. Pick the bones out of that…

The link to that recent King’s Fund paper I gave above is no more help, as the comments BTL show. Nor can I recall LEO offering any credible definition.

So if the relevant academics and industry, one of the UK’s leading purveyors of the stuff and one of the most popular recent programmes in the NHS can’t tell us what is going on, how can we know? And what is the point of the training?

With a heavy heart, this means I must return to LEO. I was, as a G-grade in early 2002, one of the first to meet LEO, and I have to say I was not in the slightest bit impressed. For a start I was so “empowered” that I was ordered to attend the course, on this date, in that place, without any discussion or identification of need via appraisal, with a threat that if I didn’t attend I would be financially penalised. The irony and hypocrisy involved were clearly lost on the manager who made the threat.

The course itself was little better. Psychobabble and unsupported assertions ago-go to the point that at times I could not understand what was being said (remember, I am a mental health nurse by background and have a science degree). Ludicrously simplistic diagrams vied with patronising Microsoft stick folk, an incredibly basic problem-solving model, and, best of all, within the first hour I spotted a Mehrabian Fallacy in the wild. Really very, very bad..

And yet, apparently, it is highly rated by attendees, I mean several pieces of “research” say so. Or do they? At least one claims that a questionnaire was given to EVERY participant. Errrr, no, it wasn’t.* Not to me and the other 25 on my course, not the 6 other people from my service who did it and their groups, nor several other people I knew in other trusts who did it and their groups. Certainly throws a chunk of doubt at this “research” if they can’t even get something that basic correct. Beyond that, they do not in any way indicate what questions were asked of their sample of 109 out of 32 050. Another used the ludicrously small sample size of 4, yes 4…And another all of 15…Yet another acknowledges “the limited quantity and quality of research literature (n = 6)”…

And this is adjudged a popular and successful “leadership” programme. How many folk have drunk the Kool Aid? Did we just attend an especially badly run version of it? Were our expectations too high? Or are there other factors at play?

The stuff my old trust subsequently used was little better, being based on Myers-Briggs…Ask a psychologist about Myers-Briggs if you dare and you will very quickly be informed that all the “evidence” showing any efficacy comes from within the “priesthood”, nothing from any external, independent source. But attendance on the “training” required an acceptance of Myers-Briggs…And in these days of evidence-based practice…

At this point open, enquiring minds should be asking what is actually going on here. And then asking how this state of affairs benefits anyone at the sharp end of clinical practice and service delivery or how the contradictions and confusion described above contribute to much of the mess we have to clear up. Let alone how much time and scarce training resources are wasted on such things…

*I did write to the Nursing Times about those failings in the Faugier and Woolnough paper, but they never even acknowledged receipt of my letter, let alone addressing the content.


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