HealthManagement, Volume 13, Issue 5/2011

Effective Leadership: The Key to Successful Hospital Management

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Sue Hodgetts 

Chief Executive
Institute of Healthcare Management
[email protected]

The Top Hospital Award ( bases its criteria on five categories: Quality and change; safety; leadership; organisational culture; and external Influence. And although leadership is a separate category and specifies strong stable continuity of the CEO; distributed leadership model; empowered clinical leaders and patients; investments in development; and the totality approach, I can’t help but think that the other categories would be impossible to achieve without effective leadership.

Leadership is an overused word, but the capacity for leadership is often woefully lacking. If we start with the desire for leadership from organisations, a desire for someone to lead them through to greatness, to make the organisation famous for its good works so everyone working there will feel a sense of pride, we start with a dream. I'm not saying that these organisations don't exist (see " Top Hospital award" winners), or that there aren't leaders capable of the above, but more often than not, the organisations that desire leaders can be structured in ways that kill (metaphorically) leaders. Of course an effective leader can overcome this, take bold moves to change the culture and the structure and turn an organisation around. But organisations can become machines that destroy leaders; conformists or role-players are encouraged, with an impoverished sense of who they are and what they stand for. Ineffective leaders give rise to disenchanted followers and organisation malaise.

To continue in this vein (not much longer I promise), I believe our understanding of leadership is blinkered, despite all of the literature and the great films that depict the ideal leader, it is surprising how little we know about leadership. This is not a criticism of our academic colleagues, but an observation about the methodology used and the fundamental assumptions upon which much research has rested.

The main body of research is about the characteristics of leadership and has a strong psychological basis. The research implies that leadership qualities are inherent and leadership is something we do to others, rather than being reliant on forming appropriate relationships and working with others. I realise that of course there is a dichotomy of views here and I am aiming my criticism at one end of that spectrum.

My view, based on a lifetime of observation in both public and private sector work, is that there are no universal leadership characteristics; it can't be cloned. What works for one, may not work for another. Authenticity underpins the success of a leader and individuals who aspire to be leaders need to discover what it is about them that they can mobilise in a leadership context. Individuals need to identify and deploy their own leadership assets.

Effective leaders have an overarching sense of purpose together with sufficient self knowledge of their potential leadership assets, they don't know it all, but they know enough, and they are willing to listen and learn.

Three Axioms of Leadership

Individual leaders are driven to become more effective as a leader, but also to develop other leaders. Thus, I believe there are three fundamental axioms of leadership:

  • Situational; 
  • Non Hierarchical; and 
  • Relational. 

Common sense tells us that that leadership is situational; the kind of leadership required will be influenced by the situation. Many leaders have had their time and their place. For example, Winston Churchill: An inspirational war-time leader, but his bulldog style was ill suited to the reconstruction agenda in post war Britain. Nelson Mandela, by contrast has the ability to offer leadership across widely different contexts: A prison cell contrasting with the graceful lawns of Union House in Pretoria. 

I'm sure we all have examples closer to home. An effective hard edged turn around leader manager, who lacks the qualities to offer leadership when it is time to build organisations. More adaptable colleagues are able to take their teams with them. 

Situation sensing is the key to effective leadership; picking up important situational signals; understanding what is going on under the surface; having both micro and macro skills; walking the corridors as well as managing stressful and challenging board meetings. The situation/context is the starting point, once understood actions can then shape that context to deliver efficiently. Leaders can reframe the situation, not reframe themselves, support others to reframe the context and develop those all-important relationships.

Productive leadership is non - hierarchical. Interestingly, a job title may confer hierarchical authority, but that doesn't make you a leader. Qualities that take you to the top of an organisation may have nothing to do with leadership, but may arise due to political acumen, personal ambition, time serving, nepotism and the like. Great organisations have great leaders at all levels. Successful organisations seek to build leadership capacity widely and give people the opportunity to develop it.

Relational leadership is essential to success as a leader. You can't be a leader without followers. Leadership is a social construct that is recreated by the relationship between leaders and those who they aspire to lead. Leaders are actively engaged in a complex series of relationships that require cultivation and nurturing. The web of relationships is often fragile, requiring constant re- creation. Relationships aren't necessarily harmonious, they are often "edgy" and provide challenge in a healthy organisation; challenge to improve, innovate and take risks.

Underpinning all of the above is authenticity; consistency between words and deeds, coherence in role performance, and an underlying thread of focus and fairness. As a leader you need to be yourself, know and show yourself, challenge yourself and others and take risks. Take time to learn about the context, remain authentic, but be able to conform- enough, manage fragile networks, communicate with care and develop an authentic "followship." Without the above, you will be found out!

Effective leadership is hard. Never underestimate the amount of effort and energy required, never underestimate the skills and knowledge required. True leadership is evident through the behaviour of an individual. What you see and experience is what you get.

Accredited Managers

Good leaders measure themselves, and a robust way of doing this would be to look at the eleven behaviours that make up the IHM Accredited Manager continuous professional development, ensuring currency and competence for all managers. The eleven behaviours are as follows:

  • Contextual leadership; 
  • Managing the political and stakeholder environment; 
  • Delivery outputs; 
  • Putting safety first; 
  • Managing resources effectively and efficiently; 
  • Building winning teams; 
  • Communication and relationship management; 
  • Improvement and innovation;
  • Integrating equalities and diversity; 
  • Reflection; and 
  • Governance. 

All aligned to numerous competency frameworks and requiring a reflective dialogue to assure robust professional standards aligned to an academic framework. For more information, please visit: 

Thus I leave you with two quotes:

"There is only one thing more painful than learning from experience, and that is not learning from experience" Archibald Macleish

"Working is about daily bread... We have the right to ask of work that it include meaning, recognition, astonishment and life" Studs Terkel

True leaders never stop learning and champion the rights of others.



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Author: Sue Hodgetts Chief Executive Institute of Healthcare Management [email protected] The Top Hospital Award ( bases its criteria...

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