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How the right leadership can take a trust from challenged to thriving

By Dennis Bacon
24 April 2019

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Dennis Bacon, chief executive of Pulse, which specialises in creating positive organisational cultures, explains why good leadership can be the decisive factor in creating a successful trust

Successful trusts have leaders who regularly refer to their organisation’s vison and articulate it through written and verbal communication in a way that connects with all employees.

They generally possess an innate understanding that effectively bringing a vision to life requires buy-in from everyone and that, crucially, the buy-in means very little unless it translates into the behaviours that drive change.

What while we think and say is of course important, it will always be subordinate to what we do.

To successfully connect, a good NHS leader needs an ability to use plain language and to avoid unnecessary jargon and complexity, which puts so many people off and all too often just serves to confuse. The wise leader instead uses a less is more approach to connecting people to purpose.

Leaders of high performing trusts also tend to build a sense of connection by being visible –unafraid to walk the wards and corridors to engage with staff and patients.

They take complaints seriously and try to see legitimacy in negative feedback, viewing it as an opportunity to learn rather than pull up the drawbridge, prevaricate or adopt a defensive posture.

A good leader will not apologise and promise to learn from a mistake without sincerely meaning it, without having a genuine desire to better the services they provide.

Successful leaders look to share learning from mistakes made with the entire trust workforce, taking a team-based approach to problem solving. All too often we see an ingrained organisation-wide blame culture in the NHS that seeks to find and root out the ‘culprit(s)’ when errors have occurred.

This creates an environment of fearfulness and a reluctance to raise legitimate concerns for fear of the consequences.

In well-led trusts there is an understanding of the difference between a climate in which accountability, openness and candour is encouraged and one where a culture of blame, even bullying, persists – even if this is not always deliberate.

Successful leaders also aim to introduce clear accountability for individuals and teams, articulating high expectations when it comes to professionalism and compassion, while also focusing on improvements.

This means improvements that can realistically be delivered by the workforce; changes that are within their reach to implement.

Setting unachievable goals for transformation only results in ‘learned helplessness’ – a condition that causes a person to believe that the negative situation they are in cannot be altered.

This condition is all too often displayed in poorly performing trusts with significant leadership deficits and little apparent understanding of the negative effects on staff performance and morale.

Such organisations tend to constantly refer to the external pressures that all trusts face – such as increasing demand, limited financial resources, staff shortages, and so on.

The prevalence of such a well-worn narrative – regardless of the fact that it’s true for pretty much every organisation across all sectors – creates a belief that there is nothing staff can do to change things, that they face an overwhelming barrage of problems.

When one inhabits the land of learned helplessness nothing is possible or easy, it seems safer to ‘realistic’ and accept that there’s nothing you can do but keep your head down.

This is a dangerous mode of thinking that will bring about organisational decline rather than positive change. A great leader focuses on what can be done to improve performance and as we all know, we tend to get what we focus on – whether good or bad.

One example of this emerged during a meeting I had with Joe Rafferty, chief executive of Mersey Care NHS Foundation Trust in Liverpool – a mental health trust that covers one of the most socially deprived geographical footprints in the UK.

This was an organisation that lived in the shadow of learned helplessness; its performance reflective of the social deprivation and inequality around it.

Recorded serious incidents, restraint of patients and incidents of suicide were, for example, not uncommon. However, Mr Rafferty thought this should and could be changed.

He embarked on an ambitious and clear vision for the trust, setting aside any notion of learned helplessness to the point where restraint could only be used as a last resort.

A ‘no force first’ policy was introduced, championing de-escalation techniques and a preventative, patient-first agenda. When the approach was tested on three pilot wards, it resulted in a 50% reduction in incidents of restraint.

Mr Rafferty also launched a ‘zero suicide’ policy, an ambitious sign of intent to challenge cultural norms by refusing to accept that incidents of suicide were inevitable.

Mersey Care is now a leading NHS organisation – because its chief executive understood and employed effective culture change, engaging the workforce in this to improve both patient safety and overall trust performance.

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