Collaborative Leadership
One of our key conclusions is that leadership, as a specific dimension of organisational change, needs to be noted and nurtured. This includes leadership at multiple levels - not only at board level but within and across clinical teams, and particularly when setting up new services or instigating new projects.
All systems recognised that the changes being asked of the workforce along with current stresses and uncertainties required a special form of leadership.
Collaborative Leadership is a style of strategy making and decision making that is inclusive, not hierarchical. It has a strength-based coaching ethos and fits well with coproduction when different organizations are bringing leaders to the table to influence and make change. It places an emphasis on the relationships people have with each other and how they can best work together as a leadership team – not on one individual leader.
Why is leadership important?
Effective leaders are able to understand the impact of changes on the people they work with. Ballatt and Campling (2012) talk of collaborative thinking as “one eye on the care task and the other on the wider system” and speak to the importance of leadership. Amid the uncertainties associated with a stressed complex system undergoing transformation, collaborative leadership is key for enabling change to occur.
“So, staff, for a long time, in locality services, have been absolutely terrified of having a death on their caseload. … So, then we end up with staff that are totally paralysed by fear. Therefore, that slows down the whole flow and capacity, because what we should be doing is a piece of work the person knows, transitions back to the community. The GP services, and then comes back if need be.”
Stephanie Rea discusses the importance of leadership in supporting change.
A cyclical understanding of collaborative leadership
This diagram brings together these ideas and depicts a 'cycle' of how collaborative leadership sustains and motivates the workforce. Perhaps the key message is to understand and work with the fears that parts of the workforce may have about change.
Collaborative decision making
The overarching ethos of the CMHF requires a culture that promotes collaboration at all levels of the decision-making process. This runs from decisions about what a person is offered as they come through the front door, all the way through to board-level decisions about what may or may not be funded, and by how much. Complex decisions around risk also feature prominently in systems. Further, a changing system requires decision-making and leadership that promotes growth and motivation among the workforce.
During our evaluations we found evidence of good leaders across many parts of the system at all levels:
Individual practitioners in new teams who were prepared to learn from their fellow practitioners to develop new skills and understand how their colleagues work contributed to close working relationships.
Neighbourhood team managers who were instrumental in helping their teams to make difficult clinical decisions for individuals with complex situations - giving practitioners a feeling of confidence that the system leaders were there to support them.
Senior people in systems who were willing to tackle some very complex cultural challenges, e.g. removing CPA, introducing positive risk management or promoting new ways of thinking about assessment.
What this means in practice is that leaders need to be very present in all parts of the system both during any transformation and when contending with external stresses. For some leaders that means being present in the same building on a daily basis, for others it means being present at team meetings where day-to-day clinical decisions are made. These leaders can come from a variety of backgrounds, such as nursing, medicine psychology and, importantly, from VCSE partners. Increasingly those representing the public are taking on leadership roles.
Leaders with a collaborative approach to decision-making enable others to feel part of the process of change. This means that staff are not told what to do, but rather they are encouraged to try doing things differently. When mistakes occur, they are seen as opportunities for learning rather than a mechanism for blame.
Beccy Wardle reflects on the importance of leadership at all levels of a system.
Leadership and Risk
Leadership that understands the fear of risk and promotes a culture of collaboration and trust enables the system to function more actively. The ability to trust that leaders will support staff at all levels is imperative, especially when things do go wrong.
Historically, concerns about risk and risk management have been dominated by CPA processes present in secondary care mental health services. The CMHF requires a change to the way that risk is managed. With much larger numbers of people coming into services, it is impossible to follow CPA processes for all – nor is it necessary to do so. Long-held cultural beliefs about risk are difficult to overturn and require strong decisive leadership to enable risk processes to change.
Good leadership can promote a positive risk-taking culture in the wider system that encompasses primary and secondary statutory services, alongside VCSEs. Leaders need to be responsible for encouraging staff to understand risk in different ways by working across all parts of the system, enabling a collaborative, good-enough approach to risk taking (link to risk section).
It is important to acknowledge the impact this work has upon the workforce. Working within a context that manages the large amounts of distress that are evident in the public takes its toll, but there are ways to mitigate this impact. Ensuring that practitioners are not completely isolated and offering opportunities for emotional support could be helpful in these environments.
The Care Programme Approach (CPA) has been phased out in most areas. We know that sites are rethinking the role of the care co-ordinator in this new system, but currently have limited knowledge about approaches – we invite contributors to share their experience.
"I'm quite present in the office [...] I'm always willing to have conversations with everyone to support their decision-making, to be decisive in transferring someone over, I support them with complaints. I do think this level of change needs to be supported [...] People need to feel held making these decisions, and I'm certainly not afraid to... to hold people in making those difficult decisions in moving people towards different ways of working."
“Yes, I think it does have an effect on morale because it’s quite an isolating role. Although I do feel like I’m part of a team because I did have other members, we all cover different areas, so there isn’t two mental health coaches for Epping North, it’s only myself. With the rest of my team we do try and meet up where we can. However, that’s just us voicing our concerns amongst each other, taking it forward and having that actioned or having that addressed, there is a gap there.”
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