The entrenched workings of the NHS are being challenged at Surrey and Sussex SHA, which has turned to sports psychology to shake things up
Fostering cutting-edge leadership in the NHS isn’t easy. Decades of underfunding and deeply entrenched hierarchies have resulted in a culture in which staff at all levels are even more suspicious of change than those in the private sector.
What’s more, many senior medical staff don’t take kindly to new-fangled management ideas such as consulting employees or experimenting with entrepreneurial ways of thinking. Despite these obstacles, coaching is increasingly proving to be a useful tool in promoting new management styles.
One example of this is the Leadership for Service Improvement scheme, which was launched by Surrey and Sussex Strategic Health Authority (SHA) in March this year. The £150,000 programme is part of the National Management Development Initiative, which aims to support the development of middle and senior managers across the NHS.
The objective of the scheme at Surrey and Sussex SHA was to foster a new style of leadership at the trust, with particular emphasis on improving services and financial management.
“The whole health economy is affected by a tendency to overspend, and we knew that a certain leadership style was failing to stick to the finances available,” says Jonathan Harding, former head of leadership and organisational development at Surrey and Sussex.
It may have been true that one goal of NHS leaders was to lobby for fairer funding patterns in the NHS – higher levels for the South with its ageing, disease-prone population, for example. But in the meantime staff needed to stay within existing budgets.
This goal wasn’t a new one – but Harding says that it had thus far proved impossible to attain. “We had lots of experience of trying to effect change in the organisation, and lots of schemes that looked great on paper,” he stresses. “What the organisation needed was well known – but the energy to remedy it wasn’t as universal.”
The authority came up with the idea of developing the skills of 80 leaders, taking two or three from each of the 33 constituent organisations. Each organisation would itself identify the key leadership issue that needed to be addressed. Each participant would then identify a person who would act as their mentor or coach.
“When choosing a coach, we advised the managers that they should choose someone who they respected, and who would be supportive, but who would also challenge them,” says Harding. Several coaches were selected by more than one person, so in the end there were around 50 coaches supporting the 80 managers.
The authority brought in performance development consultancy Lane4 to help deliver this by running a development scheme for the coaches. The scheme included:
- an online self-assessment tool, to help staff assess their particular needs;
- a development centre, designed to test out NHS leadership and service improvement needs;
- action learning sets – working groups that would review progress, challenge practice and offer support;
- masterclasses, in which people with experience of service improvement both inside and outside the NHS would share their experience with participants.
Lane4 places a lot of emphasis on sports psychology as a motivational tool – managing director Adrian Moorhouse won an Olympic gold medal in the 100m breaststroke at the Seoul games in 1988 – but the company also uses occupational psychologists with broader experience across industry, and rejects the quick fix.
“Our perspective is that there is too much emphasis on the big, one-off initiative in sport, and lots of sports people telling their stories, doing after-dinner speaking and so on,” says consultant/account director Wil James, who is working on the scheme. This leads to the mistaken assumption that what sports psychology has to offer is the chance to score dramatic wins like David Beckham or Andrew Flintoff. But James and his colleagues stress that top-flight sports performers need to develop intense discipline and tenacity over weeks, months and even years. This is the skill that is most valuable in leadership terms, not the ability to score quick hits.
“We are about sustainable change, continual change, and supporting people who are developing a different way of thinking. If people are breaking habits, it takes time, and they need long-term support,” says James.
The flexible, long-term approach is welcomed by Sue Giddings, director of nursing and quality at Horsham and Chanctonbury Primary Care Trust, who is coaching two colleagues under the scheme. She believes that the whole process is a valuable learning opportunity for staff throughout the authority.
One of her coachees is a senior nurse at a community hospital, and among his responsibilities is service development and clinical leadership. The project he wants to address involves the nurse-led intermediate care unit. Her other coachee is the district nurse team leader, who is looking at the interface with the 24-hour community nursing service “I wasn’t expecting to coach both people, but I am responsible for both schemes, so there was an element of self-interest there,” she says. “Both are managerial leadership roles, but neither have had big change management roles before. And both were looking at change management as the main area they wanted to develop.”
Giddings went on a two-day coaching course with Lane4, while her two coachees went on an internal coaching course run by the health authority. Giddings found this preparation useful. “The workshop gave us a portfolio of skills, and looked at the overall role of a performance coach,” she says. “It was interesting to unpick the difference between management and coaching – although a lot of what we learned wasn’t entirely new to me.”
For Giddings, this clarity helped her to offer the best possible advice and support to her two colleagues once the coaching process began. “The main difference is that as a manager you are coming up with solutions, whereas the coaching role means that you are helping the coachee to come up with solutions themselves.
“You say – this is the ultimate goal – what do you think you need to do to get there? You are the sounding board. And they have to feel comfortable about coming to you when they are really struggling.”
One of the benefits for the coach is the chance to look at organisational issues more objectively, and to step outside the management role they are used to, says Giddings. “I am learning a great deal myself,” she says. “It’s nice to be in a different sort of role, slightly outside the equation. The line manager role is more of a day-to-day responsibility, and it’s good to have dedicated time out to talk one to one and float ideas, and to let people come to you when they are ready, rather than continually monitoring them – it’s luxurious.”
So what are the particular advantages of coaching over more traditional leadership training? One benefit is the flexibility: each coachee can dictate how the training works to a large degree. “At the beginning, we decided how often to meet, set goals and identified what they wanted to develop, what they wanted from me, and how often they wanted us to meet,” says Giddings.
“One of my coachees wanted to meet every six weeks, and we talk for two hours maximum – you always need a time limit with coaching!
The other was more confident and only wanted to keep in touch every eight weeks.” Another advantage is the practical, work-based context of the learning. “The sort of areas this helps with are issues like ‘How do I approach people?’. It may sound fundamental, but applying it to specific situations isn’t always easy. Nursing is a hierarchical structure, and always has been.
“There’s the idea that you can’t even talk to that person without going through so and so first. It’s about modernising the health service. People talk about putting clinicians in the driving seat, but you have to give them the skills to do this.”
Measuring the success of an initiative as “soft” as this one is not easy – but Giddings says that, with detailed feedback from participants about how the process changed their management style, the value of the initiative should be self-evident. “For me, the evidence is the fact that the projects are delivering,” she says. “And I don’t think they would have done without this programme – or certainly not without a lot of angst. One of my coachees has developed phenomenally. Feedback is obviously important – both in terms of feeding into people’s personal development and reporting back to the organisation as a whole, so that we can share examples of best practice.”
Further information
Surrey and Sussex SHA is one of the case studies featured in The Case for Coaching: Making Evidence-based Decisions on Coaching by Jessica Jarvis, Annette Filery-Travis and David Lane, to be published by the CIPD early next year (www.cipd.co.uk/bookstore).