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Is it time for a new paradigm in leadership?

Updated: Oct 1, 2023

In the autumn of 2022, I was commissioned to bring focus to the workforce considerations of a musculoskeletal (MSK) care pathway transformation programme across two NHS Trusts and the local primary care sector.


I had already concluded my own secondary research for my MBA and recognised the imbalance in focus on structural ‘quick wins’ at the expense of thoughtful, meaningful and coherent approaches to transformation across a random sample of programmes I was able to consider.


Armed with my own evidence I set out to meet with a broad and diverse range of system leaders to explain my thinking as to how best to deliver the sustained change I had been commissioned to contribute to. In all I met 21 people on a 1-1 basis and was able to share my findings and thoughts.


After about five such meetings I was buoyed by the fact that these very senior, experienced and knowledgeable system leaders each categorically agreed with me. We need to see a far greater emphasis on the accommodation of the role of people in the design and implementation of transformation programmes. My ego was soaring each time my views were endorsed, and I believed I was on the edge of a breakthrough, perhaps one with far reaching implications! But what was this ground-breaking innovation I’d articulated?


Well in fact, it wasn’t anything that special and is something I’ve been discussing my whole career and have been encouraged by the broad and diverse range of people who share such ideas. Fundamentally, this is about relationships, how people are supported to recognise the value and legitimacy of their own contributions and how we create systems that enable them to come together, in safe and equal spaces, to share their knowledge and experience to create new knowledge which can lay the path to change.


I’ll discuss this in greater detail in a future post, but for the purpose of today’s query, let’s get back to the MSK programme. My soaring ego felt wonderful, until I started to question, at about meeting number 7 or 8 why, if everyone agrees with me, aren’t we seeing more leadership activity in this field? Every meeting I had, with leaders from patient representative groups, acute trusts, community and mental health trusts, and primary care settings all agreed that we need to bring greater focus to the role of the people we actually expect to implement the desired changes.


So why weren’t we doing this?


We often think systemically when considering the role of frontline practitioners and managers. That in order to understand practitioner performance we need to look at the systems in which they’re operating and, as leaders, ensure the systems we enable are geared towards effective communications, individual and collective reflection, support, empowerment, wellbeing and the removal of barriers to high quality provision. We understand that transformational leadership is required to transform the provision of practice.


But what transformations are needed to enable this transformational leadership in the first place?


My discussions on the MSK programme highlighted that the limited progress in delivering the much-hyped ‘new ways of working’ and ‘new models of care’ is not due to indifference or a dearth of knowledge. In fact, there was overwhelming enthusiasm for greater recognition and empowerment of the workforce in the process of transformation.


My discussions on the MSK programme highlighted to me that as leaders we ourselves could do with more systemic considerations of the systems that constrain our aspirations for improvement. Perhaps even more fundamentally than this, we may need to explore a completely new paradigm in leadership.

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