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 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’ 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
 McKergow M; Bailey H; Host – Six New Roles of Engagement; Solutions Books; 2014