As we move through the post-pandemic phase of nursing leadership, I am prioritising plans for ward and matron leadership development. I have consequently been considering role models who have influenced me: I have once again watched one of my favourite role models, Brian Dolan, talking about leadership on YouTube (Dolan, 2015). Dolan, who is Director of Health Service 360 and an Honorary Professor of Leadership in Healthcare at the University of Salford, starts the talk by reflecting on leadership as a social process, whereby ‘one person influences another's behaviour without the threat of violence’, adding: ‘It's how you do it that counts.’
As nurse leaders, we know that change is constant in health care. Changes can be driven externally, such as in response to the COVID-19 pandemic, or they may stem from our ambitions for continued improvements focused on patient safety, patient experience or staff experience.
We can be confident that leadership initiatives will deliver if they are fully embraced by our teams. However, there is always the possibility of employee resistance. In fact, research from management consultants McKinsey and Co (Ewenstein et al, 2015) shows that 70% of change initiatives fail, often because of employee resistance.
Dolan shares the writing of Buddhist monk Nyoshul Khenpo (2022) who describes his life in a poem titled The Autobiography in Five Chapters, comprising these five stanzas:
- I walk down the street. There is a deep hole in the sidewalk I fall in. I am lost … I am hopeless. It isn't my fault. It takes forever to find a way out
- I walk down the same street. There is a deep hole in the sidewalk. I pretend I don't see it. I fall in again. I can't believe I'm in the same place. But it isn't my fault. It still takes a long time to get out
- I walk down the same street. There is a deep hole in the sidewalk. I see it is there. I still fall in … it's a habit. My eyes are open I know where I am. It is my fault. I get out immediately
- I walk down the same street. There is a deep hole in the sidewalk. I walk around it
- I walk down another street.
When Dolan explores this resistance and failure to change, he reflects on ignorance, denial and comfort in the norm on the part of all of those involved. In addition, he says, if we are not careful, we can allow delaying tactics, such as the pursuit of more evidence, to impede progress, and we also can risk not ‘seeing the elephant in the room’. However, when we start to see the problem as leaders, we unlock the potential to use our knowledge and experience to change behaviours. By being creative, we as leaders can be the catalyst for change.
Drivers for change
Dolan talks about thinking of the world through the prism of another's lens. As one of the most passionate speakers around, he stresses the importance of valuing patients' time and puts the user experience at the centre of all his practice. I have extended this concept to staff experience, and I have found that focusing on the experience of both patients and staff as the driver for change disarms the threat to colleagues.
Dolan shares the powerful quote, which has been attributed to various sources, including Confucian philosopher Xunzi: ‘Tell me and I forget; teach me and I may remember; involve me and I learn.’ Dolan also reflects on how difficult it is for frontline staff to see a clear path through the multiple priorities passed down the line to them, made even more confusing following leadership changes. The new incumbents, keen to make their mark, often ‘drop’ what the previous government, the CEO or local leader had been championing.
This was an interesting point for me as I often reflect on, and use, previous national documents and strategies that, in my view, were extremely well written. For example, I thought that the 2016 NHS England's Leading Change Adding Value was a great framework for leading improvement for all nurses, whatever role they are in. The other NHS resource that I use as a key reference document is the NHS England (2018)Leading Large Scale Change: while the title might put off ward leaders, the toolkit is an excellent resource for nurses at all levels of leadership, bringing together a large amount of thinking, practical tools and approaches that can be used to lead change programmes.
To conclude, Dolan highlights four key elements that are key to leadership:
- Self-awareness
- Influence
- Managing upwards
- Organisational culture.
I would really recommend watching Dolan's talk on YouTube: it will spark reflections and re-energise us into reflecting on some of the brilliant frameworks available to guide us through leading change to improve patient care.