NHS Leadership

Move forward by stepping back – How to get more love into the workplace – Part 4

The world of healthcare delivery is becoming much more complex, and so the leadership style that worked well to reduce waiting times, increase quality and move to a system of earned autonomy (Foundation Trust status) is no longer effective. The phrase VUCA – volatile, uncertain, complex and ambiguous – better describes the world we now find ourselves in.

So what type of leadership can prevail in this challenging and unknown environment?

The leadership skills that will be needed in the NHS to deliver high quality patient care in an environment that is becoming increasingly constrained both financially and politically are different to those that have been employed over the past decade.

Recently I’ve been exploring the concept of Host Leadership[1] which suggests that the leader needs to understand both when to step forward and more importantly, when to step back.

McKergow and Bailey’s 2014 book ‘Host’[2] introduces the metaphor of the ‘Host Leader’. This builds on the thinking of the leader as ‘hero’ and ‘servant’, which have been the two popular metaphors in leadership theory. The leader as ‘hero’ has been particularly dominant in the healthcare environment, but over the past few years it’s become apparent that the heroic leadership style is too simplistic an approach. The increasingly complex world of chronic, co-morbid healthcare needs, delivered across health and social care systems with an expectation of delivering more with less funding, requires a much more adept, flexible and engaged style of leadership. Leaders will need to have the ability to work across organisational boundaries into systems, whilst at the same time maintaining an engaged and high performing organisational workforce – quite a challenging ask.

The leader as ‘host’ gives the flexibility of approach required to work in this new and emerging environment. Knowing when to step forward to initiate; take the lead; drive forward and when to step back to create the space for others to generate ideas; encouraging debate; and explore options is a very delicate balance and one that getting right will enable leaders to navigate this VUCA world.

McKergow and Bailey describe the six roles of the Host Leader:

Initiator – noticing what needs to be done; the ‘call to action’ and getting things going

Inviter – ask people to participate; make a compelling offer and enable invitees to consider their contribution

Space Creator – create a useful space; hold the space to enable a generative and emergent approach

Gatekeeper – draw boundaries that help to create and sustain progress; create identity; know when to step forward and exclude, and step back to include

Connector – enable connections through people; information; outside usual hierarchies; make links between different scenarios or problems

Co-participator – engage with people, ask questions and seek opinions; both lead and follow

The final one, co-participator, reminds me of a ‘back to the floor’ blog that I wrote in August 2015, which focussed on the importance of connecting with staff; asking their opinions and creating the environment for them to make change. It is the most vital one when it comes to really engaging the health and social care workforce in the design of the solutions.

Enabling the NHS to move forward by stepping back is the key leadership challenge of today.


About the author

Sarah Morgan is the Director of Organisational Development and Strategic Lead for Leadership for Guy’s and St Thomas’ NHS Foundation Trust

[1] http://www.hostleadership.com

[2] McKergow M; Bailey H; Host – Six New Roles of Engagement; Solutions Books; 2014


Change for change’s sake? – how to get more love into the workplace – part 3

Aloha from the beautiful Hawaiian island of Maui.

Aloha means love and is the traditional Hawaiian greeting for friends, loved ones and strangers. This universal approach to love fosters fellowship and kindred understanding within Hawaiian culture; a culture of love which I think we need to bring into the workplace. Catch up with Part One and Part Two.

I was in the US on ‘Super Tuesday’ (Tuesday 1 March 2016), when eleven states voted for their favourite Republican and Democratic candidate. What fascinated me more than anything were the two questions that pollsters were asking:

“Do you think this candidate best represents change?”

Do you think this candidate best represents your values?”

The results were quite astounding. More people rated Donald Trump as the candidate that represented change, however rated him least aligned with their values. Despite this lack of alignment with values he went on to win the majority of the states that day.

This started me thinking about what we mean by change and how that aligns with our values.

In the NHS we talk a lot about ‘culture change’ and ‘transforming services’ however we often can’t articulate a change from ‘what to what’ or describe what transforming services will mean for our patients and staff.

Is it good enough to have a culture that is strong on values; patient centric and spends a considerable amount of time getting the basics right rather than consistently striving for change?

Patients can find it difficult to judge great patient care as they are often having a once in a lifetime experience. What patients do know is how the staff make them feel, whether the healthcare provider feels like a good place to work and if the staff feel valued. Having a culture that is values-driven, brings more love into the workplace and has the ability to unleash the intrinsic motivation of staff to deliver the best quality care that they can is surely the Holy Grail for every healthcare provider?

This sounds a sensible and obvious approach, however it is not one that is found universally throughout our health system. Why is that the case when it seems to be a winning formula?

Well going back to the Super Tuesday, change is often regarded as the main requirement regardless of what the change will bring. Leaders have to be seen to be doing something and with the average tenure of a Chief Executive in the NHS being 700 days; then they have to be seen to be doing something quickly. Discovering the values of an organisation takes time and patience and therefore often doesn’t yield the results quickly enough. So how do we put values first?

Changing organisational culture through values was the topic of a Royal College of Physicians Future Hospital Journal article I contributed to in October 2015. This charted the leadership journey of Guy’s and St Thomas’ NHS Foundation Trust which spanned almost a decade to drive a values based culture. This work was undertaken with the staff through a process of discovery and has taken patience; fortitude and an unrelenting focus on the basics by the leadership team (1). The leadership team at Guy’s has been relatively stable with only a recent change in Chief Executive Officer after eight years.

This patience, hard work and focus on values has paid off. In the 2015 staff survey results, Guy’s and St Thomas’ came out top in acute and community trusts for staff engagement. The basics of staff feeling able to speak up; recommending the Trust as a place to work or receive treatment and feeling that the Trust considers patient care a priority were all top in class scores.

This approach has not been easy and, like many other organisations, in order to keep pace with the NHS finances and upward demand, we will need to adapt our approach, however we will do this through a continued focus on our staff and our values.

One thing is for sure, change for change’s sake has no place in high quality healthcare provision.



(1) 2006 Infection control
2012 Fit for the Future – quality, safety and efficiency
2013 Barbara’s story – focus on dementia patients 2013
2015 Speaking up


About the author

Sarah Morgan is the Director of Organisational Development for Guy’s and St Thomas’ NHS Foundation Trust