Jennifer Davies, Business Manager with NHS Education for Scotland and Postgraduate Researcher with the University of Birmingham, calls for notions of distributed leadership to open up the possibility for all health care staff to engage in leadership roles and practices…
‘Don’t ask me I’m just an administrator!’ Sound familiar? This was said to me by one of my team when I asked for her thoughts on the leadership in the department I was working in at the time.
Whilst hearing administrative staff voice their frustrations about not always feeling valued or noticed is nothing new (I have worked in various NHS administrative roles myself for the past ten years) this particular exchange troubled me.
In the NHS there is a lot of talk about leadership – and particularly about leadership being distributed throughout the organisation.
But who is doing all the talking? And who are they speaking about?
So far, despite the rhetoric, these ideas about leadership have centred almost entirely on the clinical professions and those operating within senior levels of health care management. In NHS Scotland, for example, the 25,000 business and administration staff (80% of which are not middle to senior managers) aren’t included. They are a workforce whose expertise and experience is too easily ignored.
Of course, there are many clinical staff who will openly acknowledge that they could not do their jobs without the hard work of their administrative colleagues. But if we look to the NHS strategic and policy documentation the contribution of administrative staff rapidly fades from view, not least because they are hardly mentioned – and certainly not in conversations about leadership.
Where we do find reference to the administrative workforce it is often a focus on the need to remove as many of these jobs as possible in order to ‘reduce costs’. Too often there is a clumsy conflation of administrative work in the public sector with ‘red tape’.
The omission of the NHS administrative workforce from the discussion about distributed leadership is no accidental oversight, but rather the inevitable consequence of embedded imbalances of power which hinder the creation of positive forms of professional identity for these staff. The ‘truths’ which currently circulate about this workforce act to de-legitimatise their inclusion from the very beginning. The nomenclature ‘non-clinical’ and ‘non-professional’ highlights an absence, drawing attention to what these staff are not, rather than what they are, to what they do not do, rather than what they contribute.
The Health Service Journal has recently called for far better recognition of the positive contribution NHS administrative staff make and suggested that services look to more actively include the workforce in service transformation and improvement. Academic studies looking at health service administrative staff are few and far between, but those that do exist (tending to focus on GP receptionists and Medical Secretaries) demonstrate how these roles involve task complexity, emotional labour, and contribute directly to patient safety and wellbeing.
In my workplace I see my administrative colleagues at all levels engaging in what can arguably be described as leadership practices, whether that is initiating improvement projects in their own areas of work, or skilfully influencing clinical and senior managers to implement change. Let’s also not forget that it is often members of these staff groups who have been with an organisation the longest and hold a vast knowledge of the informal channels for making things happen.
If we are serious about identifying what we need from all our public servants in facing both current and future challenges in the NHS then it is time for NHS managers and academics to spend more time behind the ‘front lines’ and extend the leadership talk to those who are fundamental to the provision of safe and effective health services.
Who, after all, are better placed than the administrators to make sense of what distributed leadership might mean for them?