National Health Service (NHS) in the United Kingdom

Introduction:

The National Health Service (NHS) offers healthcare to all inhabitants of the United Kingdom (UK) based on their necessity for it rather than their financial ability to pay for it. It is publicly funded and paid for by the British government. The National Health Service (NHS) was established in 1948 with the goal of ensuring that, following World War II, everyone could afford good healthcare through a welfare state system. The NHS provides coverage for a variety of services, including emergency rooms, hospitals, general practitioners, dentistry, and pharmacies. It is increasingly complex within healthcare systems in the UK, therefore, it is vital to focus on a way to maintain and improve the services effectively (McCracken & Phillips, 2017). Over time, the management of the NHS has seen a sea change, with several aspects being added and being removed from the management style of the NHS (Zairi and Jararr, 2001).

The purpose of this report is to look critically at the management of NHS in the context of three major areas; the significance of the role of managers in the NHS, the relation between the managerial and the leadership roles of an individual, using instances from my own experience of working at the University Hospital Southampton NHS Foundation Trust (UHS) and explore the concept of shared leadership, in an attempt to understand if the performance of the teams at UHS can be increased through shared leadership strategies.

My role at the UHS is not a managerial one, hence I will be elucidating on these aspects from an employee’s perspective who has been managed rather than managed themselves. However, I possess the experience of mentoring my professional juniors when I was working on night duties. To assess the accuracy of my managerial qualities, I will be incorporating a leadership test result which I got from my module materials. Presently, I am not managing anyone and my perspectives come from having been managed as a worker. I am a part of a team which has total 37 workers, which is inclusive of 1 band 7, 5 band 6, 23 band 5, 2 band 4 and 6 health care assistants (HCA).

Role and Utility of Managers in the NHS

Managers in the health-care profession are needed to re-establish confidence, re-establish efficient systems, and assure quality during difficult organisational transformations. Today's health-care managers face enormous obstacles, such as complicated organisational structures, new operational and strategic difficulties, rapid change, and a shortage of time. To overcome these challenges, new management leadership skills are required, as well as a renewed focus on traditional skills. In successful management systems, the overriding theme that emerges prominently from these approaches is teamwork, with minimum hierarchy and bureaucracy. A study that looked into examples of TQM applications in health care across Europe backed up the behaviours and themes discovered so far (Adamou and Hale, 2004).

In my organisation, we underwent a significant change in operations due to COVID. Theatre services were changed in order to accommodate the growing number of patients in the wards. The theatres which were previously used for other purposes were repurposes for COVID care and non-COVID critical patients were shifted to other theatres, where beds were arranged to maximise capacity. The theatres were transformed to give priority to the critical care patients and many new roles were assigned in order to fulfil the burgeoning demands of the job. My role in the operations involved making sure that the theatres were prepped and ready according to the relocations operations which were underway. My role included removing materials like consumables, trolleys, equipments and other such things from the theatres, which were not directly relevant for the patients who were to be shifted in that theatre. Because there were several new functions which we were expected to fulfil, we were given training on functions like donning and doffing the PPE kits, and the care that needs to be taken in order to mover critical patients into or from the ICU. In order to reduce the number of people who could be at risk of contractive COVID during procedures like aortic dissection or paediatric congenital, only a skeletal group assisted in operating theatres, and other supporting staff would be waiting outside. We were trained to follow strict instructions in order to prevent any form of cross infection, for example, if any instrument was needed during a surgery which wasn’t present inside the theatre, no one was allowed to go outside to get the instrument. Care had to be taken that instruments were brought in by someone from the outside and that they were sent into the theatre with minimal contact.

Several things have changed in the NHS management throughout the years, including the recruitment of general managers, management expenditures, value for money changes, and management skills training. By the end of 1985, hospitals and health bodies were to have general managers in position from both inside and outside the NHS. Budgets for management were to be implemented alongside tighter financial controls. The NHS Training Authority was founded to expand managerial training, particularly for doctors, with savings from these reforms to be redirected to enhancing patient services. Over the years, several academics have contested the validity of the managerial roles in the NHS and inquired about if there is a problem of excessive management in the NHS (Exworthy et al., 2009; Griffiths, 1983; Brensen et al., 2014).

However, with the spread of the pandemic, the role and significance of management in the NHS has changed to a large extent. Nichols et al. (2020), there was a strong sense of decreased paper work, quicker managerial decision-making, and simpler local approvals procedures at first. During the pandemic, 82 per cent of the respondents indicated that managerial decision-making was more rapid. During the pandemic, there was a strong impression that experienced communicators in NHS organisations were valued more and that communications was seen as a strategic and crucial function. During the epidemic, respondents mentioned attending all Executive Team meetings and having frequent access to key managers. Prescriptions filled online through the NHS app grew by 97 percent, with over 65-year-olds accounting for the majority of the rise. When used wisely, technology has the potential to increase the number of people who use the NHS and their happiness with it, as well as enhance care. This epidemic has highlighted the critical need for improved digital infrastructure, the elimination of paper notes, and the centralisation of patient records in the United Kingdom. More ambitious solutions, such as leveraging artificial intelligence to improve quality of care, rely on mastering these fundamentals (Schamroth, 2020).

The Manager and the Leader: Juxtaposition of Roles

Zaleznik (2014) offers a succinct view of the difference in the roles of managers and leaders. He describes managers value process, want stability and control, and aim to solve problems as rapidly as possible—even if they don't completely comprehend the problem's significance. Leaders, on the other hand, are willing to put up with chaos and lack of organisation in order to have a better understanding of the challenges. Business leaders, according to Zaleznik, have a lot more in common with artists, scientists, and other creative thinkers than managers. To succeed, organisations needs both managers and leaders, but cultivating both necessitates a shift away from logic and strategic exercises and toward an environment that allows creative abilities to thrive. Leaders are superior to managers because the comparisons imply that all managers lack empathy and understanding. It's also plausible to assume that certain circumstances necessitate management while others necessitate leadership, with an invisible barrier separating the two functions. All of this is a bit misleading; one does not go from a leader to being a manager and then back to becoming a leader as a result of promotions (Ellis and Abbot, 2015). Hence there is literature which juxtaposes the role of the leader with the role of the manager, understanding it as one and the same. Azad et al. (2017) discover that the most successful organisations have managers who also embody the role of leader. Due to the reality of actual implementation, determining the truth of the link between leadership and management is challenging. The hiring of professionals who exclusively manage or lead, as defined traditionally, is not feasible in organisations like the NHS. Those who hold administrative roles in a company must possess the qualities, talents, and attitudes that are associated with leading and managing. These qualities are present across the roles of a leader or a manager, and hence the role and skills should be taken into account, not just one of them. Hence, the statement that a manager should be a leader too, is valid. This is because the qualities that should be common between them.

In my place of employment, I was able to fulfil the role of a mentor and simultaneously worked under other people’s leadership. Leadership is something which has been shared in my experience in working at the UHS, whereby if any medical procedure like a surgery needs to be done, every individual has a specific task over which they exert leadership. A significant area where I played both a leadership and a managerial role is when I mentored junior staffs, during my nightly duties in the hospital. The role I fulfilled was making the junior staff aware of the roles and responsibilities which they had to fulfil in caring for and handling the critical patients who were admitted in the theatres. The theatres in which critical patients were kept needed to maintain water tight records and during the nights, the vitals and health stats of the patients needed to be updated. My role also involved training the junior staff about the new policies which need to be followed, especially in the context of the new regulations that have been put forward by COVID. My roles included both carrying out the duties which were assigned to me by my superiors and also assigning certain roles according to my own understanding. Since there was significant work load and it was not possible for me to constantly contact my superiors with small decisions that had to be made, my roles included taking up a leadership role wherever required in order to move things along. A particular example can be used here; one time I had to make a decision about the health of a patient which would typically send me asking for my senior. However, I noticed that the features of the problem which I faced was something I’d already faced with my seniors before, and I clearly remembered the course of action. The action was fairly harmless and I felt I can rely on my previous experience to deal with this problem in a suitable manner. Hence, I went with my instinct and that benefited the patient.

I was also interested in knowing what my leadership style was, as I hope to handle bigger responsibilities someday. The theories which were used to analyse the nature of managerial style and leadership become relevant in the test I took in order to understand my personal leadership style. I discovered, in the context of situational leadership, that my leadership style is a combination of high task, high relationship style and a close second was the participative and democratic style. According to Hersey and Blanchard (1997), a high task, high relationship leadership is referred to as “selling” because with this style most of the direction is still provided by the leader. The leader also attempts through two-way communication and social and emotional support to get the followers psychologically to “buy into” decisions that have to be made. This kind of leadership ability gave me several advantages in the situation of the pandemic that I was working in. Firstly, it saved a lot of time as I was able to connect more easily with the people I was mentoring. Secondly, this was also the approach which was used by my managers when they worked with me, and emotional support combined with open communication helped me work in the uncertain and stressful environment during the pandemic.

Concept of Shared Leadership

When supervisors and subordinates collaborate on a project, shared leadership emphasises equitable information exchange and engagement. Scholars and professionals have been drawn to the idea that leadership emerges through collective cognitions, relationships, and behaviours rather than through an officially selected leader. A variety of words have been used to characterise the process in conjunction with this focus. Distributed leadership is one such concept, which is frequently used interchangeably with shared leadership; nevertheless, despite some debate over the names, both styles of leadership contain the same essential components (Northouse, 2007). However, in my personal understanding, I believe shared leadership to not only be about the sharing of the tasks which are at hand, but also the vision and decision-making abilities. It is important to consider that shared leadership does not only entail the worker doing all the work of the leader, shared leadership means giving the stakeholders and the workers involved in doing the work equal amounts of power with respect to making important decisions.

An important part of the idea of shared leadership which I observed in my work was the attitude of my mentors towards training and mentoring me. Since I spent majority of my professional time being managed rather than managing others, a more significant example of shared leadership would be how my superiors shared their responsibilities with me. This was also a result of the imbalance of supply and demand which was created due to the pandemic and the demand for more health care workers and medical facilities. One of the most pertinent aspect of the shared leadership that I had with my superiors was the common values that we shared. The guidelines which were issued to us from the UHS asked for all the employees to fight against the disease together and to assist each other in their professional endeavours. A good example of shared leadership which I experienced while working would be the team preparing to conduct any form of complicated procedure, whereby they’d need a number of staff to assist. In these scenarios, the ability, the comfort and the availability of each staff member who will be involved in this work will be assessed and only after that the work will be assigned to them.

However, there are certain drawbacks to the general ideal of shared leadership. The inherent complexity of the shared leadership paradigm became apparent as a disadvantage. One of the disadvantages noted is that sharing leadership is the most difficult way to lead, but that it is also the greatest way to lead. Another aspect is about how tough it was for teams to learn how to work together as a team. Their team's structure had become quite sophisticated, and it had not come easily to them. Although these leaders believed in the idea and had had success with it, they also understood that it needed time and effort to make shared leadership work (Herbst, 2019). This was a problem which was faced by the organisation that I had worked with too, whereby at times, the distribution of the decision-making process meant that the accountability was distributed as well. Hence, sometimes it would become difficult to locate one source which would provide with some form of accountability. More disadvantages of shared leadership may include different levels of commitment among co-leaders, as well as different aims, might produce conflict. Disagreements are certain to arise when one partner is committed to boosting the company's future prospects while the other partner is only interested in a salary. Similarly, if one colleague is less capable than the other, the disparity in abilities and duties can lead to resentment, particularly if the renumeration is similar. Co-leaders are seen as a team by employees, so what a partner does impacts on you. If a partner botches a project or, worse, engages in unethical behaviour, the workers will hold others responsible, either for aiding that colleague or for failing to address the issue promptly (Clark, 2012). Fortunately, this particular thing did not take place in my professional space, and all the colleagues who worked with each other had very clearly defined roles. Storey and Holti (2013) elucidate on the necessary conditions to ensure that teams work well with each other and shared leadership is effective, and they discover that developing team dedication and creating a favourable emotional tone or atmosphere are all part of it. This also necessitates demonstrating that both employees and service consumers are respected. By granting autonomy within a framework of principles and goals focused on addressing user requirements, effective leaders foster high levels of employee involvement and engagement. Hence, there needs to be a unanimity with respect to the broad goals of the health care organisation and the smaller operations which are taking place.

Conclusion

The following document expanded on some of the experiences I’ve had in working at UHS and how they fall in the context of the managerial and leadership ideals of the NHS. I discovered that many of the managerial and leadership requirements and definitions have changed with the coming of the pandemic and will continue to change and adapt, but they need to stay grounded in the idea that the main goal is to provide simple and accessible healthcare to all the individuals in the UK.

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Reflection

Although my experience was limited in terms of how I operated as a manager, I feel I was given a good opportunity to develop my managerial and leadership skills and this gave me the opportunity to introspect on my leadership skills further. Based on my test results and interests, I believe I will be able to channel my energies into becoming a good leader and I will try to develop that skill further.

References

Bresnen, M., Hodgson, D., Bailey, S., Hyde, P. and Hassard, J., 2014. Being a manager, becoming a professional? A case study and interview-based exploration of the use of management knowledge across communities of practice in health-care organisations. Health Services and Delivery Research, 2(14), pp.1-138.

Chambers Clark, C., 2003. Group leadership skills. Springer.

Ellis, P. and Abbott, J., 2015. Exploring the differences between leaders and managers. journal of renal nursing, 7(2), pp.96-97.

Exworthy, M., Macfarlane, F. and Willmott, M., 2009. NHS Management: 60 years of transition. London: Nuffield Trust.

Herbst, N., Rios-Collazo, C. and Denison, J., Does sharing leadership actually work? An evaluation of the benefits and drawbacks of shared leadership. Journal of Education, Innovation, and Communication (JEICOM), p.32.

Hersey, P. and Blanchard, K.H., 1997. Situational leadership. In Dean’s Forum (Vol. 12, No. 2, p. 5).

Nichols, B., Underwood, J. and Hollings, J., 2020. The Rapidly Changing NHS. Communication in the age of coronavirus.

Owolabi, D. and Dyson, S., 2021. NHS England. [online] England.nhs.uk. Available at: [Accessed 4 June 2021].

the Guardian. 2021. Covid-19 has shown the NHS can change. Let's turn that to our advantage | Joel Schamroth. [online] Available at: [Accessed 4 June 2021].

Zairi, M. and Jarrar, Y.F., 2001. Measuring organizational effectiveness in the NHS: management style and structure best practices. Total Quality Management, 12(7-8), pp.882-889.

Adamou, M. and Hale, A.S., 2004. Total Quality Management in the NHS in England and Wales: a story untold?. Journal of Quality Health Care, 3(1), pp.12-16.

"Managers And Leaders: Are They Different?". Harvard Business Review, 2021, https://hbr.org/2004/01/managers-and-leaders-are-they-different.

Azad, N., Anderson, H.G., Brooks, A., Garza, O., O’Neil, C., Stutz, M.M. and Sobotka, J.L., 2017. Leadership and management are one and the same. American journal of pharmaceutical education, 81(6).

Northouse, P.G., 2007. Leadership: Theory and practice (p. xxiii). E-Content Generic Vendor.

Clarke, N., 2012. Shared leadership in projects: a matter of substance over style. Team Performance Management: An International Journal.

Storey, J. and Holti, R., 2013. Towards a New Model of Leadership for the NHS.