Intended for healthcare professionals

Letters

Values and leadership

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7390.657 (Published 22 March 2003) Cite this as: BMJ 2003;326:657

Leadership is failing to adhere to values in the NHS

  1. Pramod P Bapat, consultant anaesthetist (pbapat{at}hotmail.com)
  1. Arrowe Park Hospital, Upton, Wirral CH49 5PE
  2. Values Partnership, London NW3 2JY
  3. Aga Khan University, PO Box 3500, Stadium Road, Karachi 74800, Pakistan

    EDITOR—Pendleton and King are wrong to think that values from the commercial sector could be applicable to the healthcare sector.1 The basic difference between commercial sector and healthcare sector is that commercial companies value their staff on the basis that they will generate more cash, and reward them in the form of bonuses, higher salaries, or other perks.


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    The healthcare sector does nothing of the sort. It depends on the caring and conscientious workers to do their best for the patients and derive satisfaction from it. Instinctively, all humans like to be valued and recognised, and if workers are not valued then no amount of leadership would enthuse them into performing at their best. This recognition does not have to be only of a financial nature. In the past it came in the form of considerable autonomy and respect for people's hard work.

    Excessive politicisation and managerial control has taken away a lot of staff's professional freedom, and morale is at an all time low. Another problem with the NHS is that most of its leaders have a conflict of interest. The number of medical or clinical directors or doctors in managerial positions who also have a thriving private practice may serve as an example. Most would be considered to have a vested interest in reducing the efficiency and output of the NHS. Such people cannot command respect from their colleagues. Successful leaders lead by example. What sort of example do these leaders set?

    I think that every NHS worker knows what values they are supposed to believe in and strive for. It is the leadership that is failing it by not setting the right example.

    Footnotes

    • Competing interests None declared.

    References

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    Chief executives need to participate in conversation on values and live them

    1. Miles D A Protter, managing partner (miles{at}thevaluespartnership.com)
    1. Arrowe Park Hospital, Upton, Wirral CH49 5PE
    2. Values Partnership, London NW3 2JY
    3. Aga Khan University, PO Box 3500, Stadium Road, Karachi 74800, Pakistan

      EDITOR—My consultancy, the Values Partnership, will be working with some NHS organisations on leadership development and change. Pendleton and King articulate well the enormous benefits of aligning an organisation around a shared set of values.1 In our work with companies we have found that this alignment is the fundamental lever for driving change.

      Without it, the only tools are manipulation, force, or domination, explaining the conflict that many organisations currently experience in trying to drive change. Three additional points are drawn from our experience.

      Firstly, most NHS employees are personally aligned with the ultimate aims of the organisation, but this commitment seems to be manipulated by management. Basic factors such as trust and relationship are missing.

      Secondly, the only way management and clinicians are going to find ways to deliver quality care for patients while adhering to budgetary constraints and hitting Whitehall targets is through alignment on higher level values and vision. Everyone is on the same side; problems become shared issues; and collaboration can happen. We have done this with clients many times, and it works.

      Thirdly, the chief executive is critical in driving this process. Without a chief executive willing to participate in the conversation on values, to communicate the values, and to live them in his or her daily life, nothing will happen. We have seen many initiatives such as this one fail because management try to “do” values on the rest of the organisation without personally getting into the conversation seriously.

      This values led approach to change is validated by the results of our clients and no doubt those of the authors, and proved by a lot of management research. 2 3

      Footnotes

      • Competing interests None declared.

      References

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      Global leadership is in disarray

      1. Zulfiqar Ahmed Bhutta, Husein Lalji Dewraj professor of paediatrics and child health (zulfiqar.bhutta{at}aku.edu)
      1. Arrowe Park Hospital, Upton, Wirral CH49 5PE
      2. Values Partnership, London NW3 2JY
      3. Aga Khan University, PO Box 3500, Stadium Road, Karachi 74800, Pakistan

        EDITOR—The controversy about the BMJ's cover of 7 December may have detracted from the basic issue of the need for charismatic global leadership in health, as mentioned in the article by Pendleton and King. 1 2 Hitler and Stalin, despicable as they were, were leaders of their times and had considerable following in their constituencies. That their brand of “leadership” wrought havoc on mankind in general and their subjects in particular is also a fact of history. The point is that nations often have tragedy thrust upon them through the acts of tyrants and bigots. In contrast, the vision and courage of leaders such as Gandhi and Mandela can offer hope and point a way forward in the darkest of times. The above analogy does reflect the way in which many health systems are structured and operate under dictators and despots.

        Despite a steady stream of scientific discoveries, as well as progress in genomics and biotechnology, global health is in disarray today. Not only is inequity widespread and increasing, but in many parts of the world HIV, multidrug resistant tuberculosis, and malaria are wiping out an entire generation. Apart from lack of resources in many parts of the world, morally bankrupt, corrupt, and inept leaders (both politicians and bureaucrats) are responsible for many of the health problems. This crisis of leadership is by no means limited to developing countries.

        It is also sobering to note that, in the aftermath of 11 September, the world has spent much more on arms and preparing for war than in supporting development and promotion of global health. Today the sick and impoverished of the world need a leadership in promoting global health and development that draws from the vision and courage of Gandhi and Mandela. If it takes a cover to shock us into introspection, so be it.

        Footnotes

        • Competing interests ZAB works with leaders in public health and may be banned from their company as a consequence of this letter.

        References

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