ENVIRONMENTAL FACTORS

Environmental Factors: NHS



Environmental Factors: NHS

Introduction

Over the years, the topic of leadership has inspired voluminous research and discussion about the characteristics and types of leadership and whether leaders are born or made. Less is known about how organizational structure, culture and climate influence leadership behaviour. The goal of this review is therefore to extend understanding of the influence of contextual factors on: power and influence; creativity and innovation; and leadership behaviour. The literature is discussed and reflected on from the perspective of a Physiotherapy Manager within a Children's Hospital NHS Trust.

Discussion

Northouse (2001) defined leadership as “a process whereby an individual influences a group of individuals to achieve a common goal”. There are many different definitions of leadership and controversy over whether leadership is a specialised role or a shared influence process (Yukl, 2002). The view of this paper is that leadership is a widely dispersed activity within organizations and that it resides not only at all levels of the management hierarchy but also among the non-manager members of teams (Hamlin, 2002).

The author's experience of leadership is within the National Health Service (NHS), a large “bureaucratic” organization currently undergoing extensive modernisation. The NHS Plan (DoH, 2000) was published in July 2000 and its vision is to provide fast and convenient healthcare to a consistently high standard. A Modernisation Agency was set up by the government to lead the implementation of the ten-year plan and act as a “centre for excellence” in identifying and celebrating good practice in the NHS environment. The Agency also incorporates the NHS Leadership Centre which aims to “deliver a step change in the calibre of NHS Leadership” and with it a “revolution in health care” (DoH, 2000). Effective leadership is seen as the key ingredient in modernising the health service and providing better patient care and improved working practices for staff (DoH, 2003). Inevitably, the development and behaviour of leaders within the NHS environment will be influenced by the structure, culture and climate of the organization.

Power and influence

The Secretary of State for Health, supported by the Department for Health, is accountable to Parliament for the overall running of the NHS environment in England. The NHS environment has recently embarked on a long-term programme of reform to devolve power and responsibility to the frontline (DoH, 2002a). The main feature has been to give locally-based Primary Care Trusts (PCTs) the role of commissioning hospital and community services. This has also meant creating new Strategic Health Authorities to hold PCTs and NHS Trusts to account, support performance improvement and help Trusts deliver NHS environment initiatives.

This policy of “shifting the balance of power” (DoH, 2002a) created a new system of planning, management and performance assessment that included the possibility of high performing hospitals achieving NHS Foundation Trust status. With this status, comes more money and the reduction of central controls (earned autonomy). In contrast, under-performing organizations face the possibility of franchising. The objective is to create a dynamic system where responsibilities and roles increasingly gravitate to those best able to ...