LEIGH-ANNE VOWLES | 14066114

DEVELOPING A NEW
SERVICE MODEL:
Leadership
and
Team working

“We do not need magic to save the world, we carry

all the power inside ourselves already: we have the
power to imagine better” J.K. Rowling
 DEVELOPING A NEW SERVICE MODEL: Leadership and Team Working

Contents

1. EXECUTIVE SUMMARY ................................................................................. 3

2. Introduction .................................................................................................. 4
3. Background ................................................................................................... 5
4. Scenario ........................................................................................................ 6
5. Concepts ....................................................................................................... 7
5.1 Tuckman (1965) Forming, Storming, Norming, Performing ...................... 8
5.2 Forming .................................................................................................. 8
5.3 Storming ............................................................................................... 11
5.4 Norming ............................................................................................... 11
5.5 Performing ........................................................................................... 12
6. Context ....................................................................................................... 12
7. Characteristics ............................................................................................ 14
8. Challenges .................................................................................................. 16
9. Capabilities ................................................................................................. 18
10. Consequences ......................................................................................... 18
11. Conclusion ............................................................................................... 19
12. Recommendations .................................................................................. 20
13. References ............................................................................................... 21

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1. EXECUTIVE SUMMARY

This report evaluates leadership within the context of a scenario that happened
during the authors work placement within a health and social care placement. The
discussion examines the need for effective leadership with health and social care.
NHS Wales is facing one of the most challenging period in its history with rising
demand from the aging population and the increase in chronic illnesses
compounded by limited resources in an 'age of austerity' - what this translates to is
leaders need to do 'more with less'.

The overarching theme that developed throughout the report is that effective
leaders are visionaries; they possess the qualities that allow them to inspire their
staff to shared goal and collectively working to achieving it. Leaders influence their
staff/followers to achieve a common goal.

NHS Wales is in a period whereby it requires effective leaders to revolutionise and

innovate their current ways of working and not just follow the status quo;
efficiencies need to be made and strong leadership can drive the changes required
and transform services for future generations, in accordance with the Welsh
Governments agenda.

The Warwick 6 C Leadership Framework has been used to structure and organise
the report; therefore, there are 6 sections examining the scenario in accordance to
the model.

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 DEVELOPING A NEW SERVICE MODEL: Leadership and Team Working

2. Introduction
The aim of this report is to gain an insight into the theoretical, policy and practical
issues underpinning contemporary leadership, management and coordination in
health and social care; as required by a practicing or potential leader and
manager.

The objectives of this report are:

§ To discuss the need for effective leadership, management and coordination

within a health care organisation
§ Develop knowledge and understanding of developing and leading teams

§ Critically evaluate the skills, knowledge and attitudes that are necessary to
enhance effective leadership or management
§ Critically analyse management and leadership theory and concepts

The report will evaluate a manager or leader a scenario [3.1] that that occurred
during the authors work placement within a NHS Wales Health board management
department. Evaluation will be structured utilising “Warwick 6 Leadership
Framework” (Figure 1)

Warwick 6 Leadership Framework consists of six elements:

§ Concepts
§ Context

§ Characteristics
§ Challenges
§ Capabilities
§ Consequences

Figure 1: Warwick 6 C Leadership Framework

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 DEVELOPING A NEW SERVICE MODEL: Leadership and Team Working

Concepts













Challenges

3. Background

According to Health Foundation (2016) NHS Wales is “facing the most financially
challenging period in its history”. The challenges face by NHS Wales are threefold:

§ increasingly ageing population

§ an increase in chronic disease

§ developments in technology leading to more complex treatments

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 DEVELOPING A NEW SERVICE MODEL: Leadership and Team Working

Therefore, NHS Wales (2005) recognises that quality leadership is required to

transform healthcare services and ensure sustainability of its services for
generations to come.

The author has undertaken a workplace placement within a divisional

management team (DMT), within a NHS Wales health board (HB). The division is
comprised of 10 directorates operating services across:
§ 2 district general hospitals

§ 2 local general hospitals

§ 10 community hospitals and day care premises

However, because of the recognition of the growing pressures within the system
the health board has developed a new strategic agenda with an objective improve
and transform the way health care is delivered. Therefore, all the ‘Service
Models/Models of Care’ are being updated. The aim is to deliver a more
sustainable system of care but evaluating the way that the system works; effective
leadership is needed to drive the vision forward.

4. Scenario

Whilst on placement the author was involved in a multidisciplinary meeting in

February 2018; the objective of the meeting was to discuss and make decisions

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 DEVELOPING A NEW SERVICE MODEL: Leadership and Team Working

with regards to the new Service Model for the Radiology directorate. The meeting
consisted of management, clinical, nursing and administrative staff totalling around
20 people. The deadline for this stream of work was March 2018 and therefore
with limited time before the deadline it was imperative that decisions were made.
However, throughout the meeting one clinician dominated the conversation talking
over the leader/manager. They stated that the could not envisage change
happening and continually interrupted and challenged any proposed ideas by
members of the group. The meeting was 2 hours in length and the outcome of the
meeting resulted in no decisions being made therefore placing the achievability of
meeting the deadline in jeopardy and effectively wasting time; subsequently
impacting decision making for other interdependent work streams.

The report will evaluate how effective leadership may have resulted in positive
outcomes.

5. Concepts
According to Warwick’s model, ‘concepts’ is about understanding and evaluating
how leadership and management is understood. There is no one universal of what
it means to be a ‘leader’ or ‘manager’. The Chartered Institute of Personnel and
Development (CIPD) (2018) states that although the terms management and
leadership are often used interchangeably. However, there is a distinction to be
made between the two. Although, the CIPD (2016) does argue that individuals
need be effective at both leadership and management to be successful in their
roles and organisations. Gopee and Galloway (2009) state the purpose of
management is to monitor and measure predetermined goals; whereas, leaders
seeks to innovate, develop and inspire proactive change and are visionary.
According to Mullins (2007) leadership is about influence.

Managers plan, organise, coordinate, supervise services and staff within an

organisation.

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Leaders influence the behaviours and actions of others.

5.1 Tuckman (1965) Forming, Storming, Norming, Performing

Tuckman (1965) states that a team needs to progress through four phases’ in
order to deliver results. These phases are: “forming, norming, storming and
performing”. MacKian and Simons (2013) states that a team is a group working
towards a common goal. The goal, in this instance, is deciding how the service
model should be progressed and developed in order to best meet the HB’s and
Welsh Governments vision and providing the best care for the patients. Tuckman
argues that transitioning through the phases will allow the team to develop, accept
challenges, confront problems and provide solutions and therefore accomplish its
goal.

5.2 Forming

According to Tuckman’s theory this phase is about establishing relationships and

recognising a common goal. In this scenario, many of the members of the
group/team hadn’t worked together previously. Tuckman argues that this stage is

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where leaders to identify people’s roles and responsibilities. However, during the
meeting it was clear that the group was unclear of the direction of travel for the
service model and the objectives; furthermore, there was no clarity about was
leading the delivery of the new service model. The divisional manager, whilst being
the top of the hierarchy stated it was for the radiology directorate to decide who
would be leading on the delivery of the model. There was no consensus on who
this person would be within the group and the divisional manager made no attempt
to facilitate the decision. In this instance, the leader adopted a ‘Laissez-faire’
leadership style; according to Lewin (1944) leadership style theory. Lewin
suggests that this style of leadership is about allowing employees to make their
own decisions. According to Lewin (1944) lairssez-faire leaders make no decisions
on behalf of the group. The author suggests that self-confidence could be an
explain the leader's reluctance to challenge the dominant member of the group
and make the ultimate decisions. Ferand et al. (2006) suggests the self-confidence
plays a pivotal role in effective leadership within health and social care; leaders
need to be able to confidently assert themselves when the need arises and resolve
difficult situations.

According to Buch, Martinsen and Kuvaas (2014) Laissez-faire leadership is

destructive. Buch, Martinsen and Kuvaas (2014) argue that this approach this style
of leadership results in role ambiguity, role conflict, conflicts with co-workers.
Schyns & Schilling (2012) state that a laissez-faire leadership approach can be
counterproductive. The author observed that this approach did not produce the
intended outcome and lead to ambiguity around roles and responsibilities in the
project. According to Tuckman (1965) during this phase a team should gain clarity
about roles; this was not achieved. Raelin (2012) suggests that a democratic
leadership allows its employees to make contributions towards decision making;
However, ultimately a democratic leader has the final decision. This style may
have been more appropriate and discussion could have taken place amongst the
group but then when there was no consensus the leader could make the decision
based on the evidence they presented.

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However, there is debate as to if there is one style of management to fit every

situation and therefore, Hersey and Blanchard (1969) advocates ‘situation
leadership’ theory. According to Hersey and Blanchard there are ‘leaders’ and
followers’. Hersey and Blanchard suggest there are four leadership styles that
correspond with the followers ‘maturity’ level or competence to complete a specific
task or goal. The style the leader adopts is determined by the task, relationship
and follower readiness. The positives of adopting this leadership style is that every
situation is unique and the leader can adapt to the situation accordingly. In this
scenario, it may have been appropriate for the manager to make final decisions for
the group as it appeared they were unready and unable to conceive that the goal
needed to be achieved; this may not be the case if given another task so the
leader would have to use their judgment for each situation. Tt was clear from what
the author observed in the meeting that the ‘vocal’ member of the group was
resistant to change and therefore, ‘readiness’ is applicable; whilst they may be
competent and capable of making decisions, if they are not on board with the
leaders vision they may not make decision to progress the task, preferring the
status quo.

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5.3 Storming

According to Tuckman’s theory during this phase teams start voicing their opinions
and because of this conflict may arise within the group. In the scenario, it was
clear that one member of the team was much more vocal than the rest of the
group and dominated the meeting. A lot of the members of the team did not
contribute at all to the conversation; the vocal member was quite aggressive in
tone and very negative about the task. Fenge (2016) states that conflict is a
subjective experience. Therefore, how people interpret conflict is very individual.
However, Fenge (2016) argues that a lack of vision and shared philosophy can
lead to conflict. Cameron et al. (2012) suggests that without a shared sense of
purpose groups may struggle to reach a consensus or understanding of the aims
or objectives of the task. Mullins (2007) suggests that conflict can occur as an
attempt to obstruct the achievement of goals by individual’s resistant to change.

Additionally, according to Ross (2016) proposes building collective resilience is

important for teams. Ross (2016) argues that leaders play a vital part in this
process. Ross suggests that resilience in teams will only develop when members
recognise that they will accomplish more together than individually. Ross argues
that in order to achieve this the team must gain an awareness of the members of
the groups strengths and weaknesses and resolve conflict. However, in this
scenario, it is difficult as many people within the group had never worked together
previously, therefore this was a barrier that needed to be overcome in order to
move forward. Therefore, the author suggests that making introductions and ‘team
building’ may be something to consider when introducing a team for the first time
in future project. Kozlowski and Ilgen, (2006), suggests that ‘team building’ can
lead to enhanced team working and more effective outcomes in projects.
Furthermore, when people get to know each other it may give them more
confidence to speak their opinions and add to the dialogue.

5.4 Norming

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According to Tuckman (1969) that part of his theory is where teams have
established a shared sense of purpose and are able to begin to work toward
accomplishing their goals. In this scenario, this phase was not reached. Deustch
[date] proposes that interdependence theory, whereby a group establishes that
mutual cooperation. However, Deustch suggests that there are three types of
interdependence: positive, negative, and none. Deutsch suggests in his theory that
interdependence can be three types of interdependence: positive, negative, and
none; positive, leads to group collaborating and working towards a common goal.
The author suggests that within this situation the group failed to establish any sort
of interdependence as they were unable to start working together to achieve the
goal of producing a new service model.

5.5 Performing

Tuckman (1969) states this phase is when a team has established a working
relationship and are working and achieving their common goal. The author would
suggest that whilst in some circumstances teams may move through each phase
quickly, this may not always be the case. Effective leaders should recognise that
each of these phases may take time and work to establish. Furthermore, the
author would suggest that this process may not be linear and teams may in fact
move backward through the phases during certain period; therefore, leaders and
managers should be astute and evaluate where they think their team may be in the
phases in order to move them towards performing and putting in place
interventions to achieve this.

6. Context

Over the last several years, within Wales, there has been significant shift of the
focus of health and social care social policy. The agenda is very much focused
on sustainability within the system to achieve wellbeing for Welsh citizen in the
long term. The overarching legislation that set the direction of travel for this new
agenda is the “Well-being of Future Generations (Wales) Act 2015”. This act sets

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out goals, that public bodies, like NHS Wales, have a duty to work towards and
accomplish:

§ A prosperous Wales
§ A resilient Wales
§ A healthier Wales

§ A more equal Wales

§ A Wales of cohesive communities
§ A Wales of vibrant culture and Welsh language
§ A globally responsible Wales

This new agenda with sustainability is driven by the challenges that health and
social care services face. There is increasing pressures within healthcare service;
exponential demand and increasing expectations. Additionally, Wales is currently
in what has been coined as an ‘age of austerity’ – resources are limited and
service need to create efficiencies and transform their ways of working.

Welsh Government (2018) advise that the number of people aged 65 and over is
predicted to increase by 40% between 2016 and 2041. Furthermore, estimates by
Field and Brown (2016) suggest that over 4 million people will have a life limiting
illness within England and Wales, adding further pressures into the health care
system. Jervis (2013) states that the NHS must focus on prevention rather than
cure and revaluate its current model in order to reduce demand. This is exactly
what the new strategy aims to achieve buy promoting health and tackling health
inequalities to reduce the demand and pressure on service. The HB is set a vision
of transforming its service model to encompass these objectives. However, it
requires strong leadership to provide results and there is heavy resistance against
the change. In the scenario, the leader failed to outline to overall vision the revamp
of the service models was aiming to achieve.

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According to NHS Wales (2005) effective leadership is incumbent acting now to

shape the future; being ahead of the curve. However, it could be argued that in the
HB the notion of changing the service models is reactionary rather than proactive.
It is on the back of the legislative changes made by Welsh Government opposed
to the leader identifying the need to improve services.

"High performing leaders act now to shape the future. They are motivated to take
action to achieve a radically different future – one in which health services are truly
integrated and focused on the needs of patients.
Features of this quality include:
• Making the most of current opportunities to bring about improvements that
are of benefit to staff, carers or patients.
• Being able to interpret the likely direction of changes in the health service
and beyond
• Using their insights into the broad strategic direction of health and social
care to help shape and implement the approaches and culture in their
organisation, and to influence
• developments across the wider health and social care context.
• Underpinning their vision and action with a strong focus on local needs.
• Being prepared to undertake transformational, rather than just incremental,
change where this will achieve service improvement."
NHS Wales (2005)

7. Characteristics

The ambitions set out by the Welsh Government can only achieved by effective
leadership by those within the health and social care sector. NHS wales (2005)
recognises quality leadership is needed to drive their vision of transformation
forward; they have suggested the 'Leadership Quality Framework' to distinguish
high performing leaders and manager. The framework (figure 2) states that there

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are fifteen qualities that high performing leaders have, arranged into three areas:
'personal qualities'. 'setting direction' and 'delivering service' - they cover personal,
cognitive and social qualities. NHS Wales (2005) argue that a good leader requires
a holistic approach; these qualities are interdependent on each other, resulting in
high performance. Therefore, whilst someone may have excellent skills in one
area, if they have weaknesses in several of the other areas it may compromise
their ability to lead effectively. NHS Wales (2005) uses this framework to allow
leaders/manager to reflect and assess their weaknesses and address them.

Figure 2: NHS Leadership Quality Framework

NHS Wales (2005)

According to Gopee and Galloway (2009), 'transformational leadership' is debated

to be one of the highly recommended leadership approaches for healthcare.
Kouzes and Posner (2007) suggest that transformational leadership is an
approach where the leader is able to influence their followers without asserting
authority to accomplish their vision. Kouses and Posner (2002) suggest that there
are five unique traits of a 'transformational leader; these are:

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§ Challenge the process

§ Inspiring shared vision

§ Enabling others to act
§ Modelling the way
§ Encouraging the heart

Murphy (2005) advises the transformation leader to see how things could be better
and then influences their follows to share their vision; they are aspirational and
inspirational. However, in this scenario, it could be argued that 'transactional
leadership' was being employed. Shivers-Blackwell (2004) advises transaction
leadership is task focused. Bass and Riggio (2006) state that a transactional
leader fulfils their obligation by fulfilling policies and procedures. In this scenario,
the leader was leading a group to amend the service models not because they had
a vision to revolutionise services but the organisation itself had decided the task
need to be completed. The author would suggest that 'Transactional leadership' is
more aligned to the definition of a 'manager' rather than a leader.

8. Challenges

In the scenario, the challenge for the group was making decisions. Brown (2002)
states that decision making is the process of considering several components of a
situation and then making a selection of how to proceed based on this information.
However, the decisions that would need to be made to complete a new service
model are very complex as it is within a dynamic health care setting; there are
many interdependencies to be considered. However, Hunt (2003) suggest that
complex decision making and problem solving provides an opportunity for team
growth and development. Marriner-Tomey (2003) propose that creative decision
making encompasses five stages:

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Stage 1 – Felt need; there is a need to find creative solution

Stage 2 – Preparation; exploring the options
Stage 3 – Incubation; time to think over potential solutions
Stage 4 – Illumination; the most logical solution emerges
Stage 5 – Verification; implementing solution and testing and monitoring
outcomes.

Evaluating the stages set out by Marriner-Tomey against the scenario the author
would suggest that given the complexity of the decisions being made it would be
unrealistic to make those types of decisions in a 2-hour meeting. Therefore, if
leaders acknowledge that some problems require time to find effective decision
they can plan for this. In this instance, a possibility could have been given the
members of the group as much information prior to the meet in advance for them
to be able to move into stage 2-3. Possibly a 'pre-meeting' or an email outlining the
objective would have moved the group into stage 1 and the realisation that a
creative solution is needed. They would have had time to formulate possible
solutions and when everyone was around the table they could have collectively
explored the options. In this scenario, it was unclear from the initial invite what the
intended purpose of the group would be and there was feeling that there were
people in the room that were irrelevant at that stage of the meeting. The leader
advised that a follow up meeting was to be arranged and outlined the essential
people who would need to be in attendance.

Selart and Johansen (2010) state that there are different styles of 'decisions'; they
argue 'innovative decisions' are those that are made when problems are unusual,
unclear and unprecedented'. In relation to the scenario, the author would argue
that this is the type of decision the group faced as the focus was on rethinking
completely how the service may be run, attempting to break away from the usual
ways of working and the typical 'medical model' of healthcare. However, because
these types of decisions usually involve a greater deal of 'risk', as it is venturing
into the unknown, people are more likely to be resistant to them. However, Gopee
and Galloway (2016) suggest that strong leadership is needed for staff/followers to
'buy in' to the solution; without taking any risks innovation and progression would

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be impossible. However, Sullivan Decker (2005) suggests although risks need to

be taken to drive change, risks should be measured and evidence based.

9. Capabilities

Gorman (2008) suggest that communication is one of the most fundamental skills
required by leaders/mangers. Gornman argues that it is a leaders responsibility to
both communicate with staff and ensure their teams are communicating
successfully. Hamiliton (2014) proses that success leaders must be capable of
effective communication. Gorman (2008) argues that leaders/manager must foster
environments that multidisciplinary team members feel able to communicate
effectively with each other. Gorman (2008) suggest that the dominant model used
is 'debate' and argues that this discourages 'active listening'. Kohpeima Jahromi et
al. (2016) states active listening allows people to process and understand the
information they receive. Gorman suggests that success leaders facilitate dialogue
within their team meetings that allows for active listening and better understanding
between team member and therefore improves outcomes. In the scenario, the
leader/manger allowed one person dominate the conversation and talk over others
when they attempted to speak. Therefore, not the group was unable to
communicate effectively. The author would suggest in this respect the leader failed
to manager failed to manage the meeting successfully and therefore compromised
achieving a positive outcome. However, staff/followers equally have a
responsibility for ensuring the communicate effectively.

10. Consequences

Effective leadership and management in health and social care means that goals
and targets are achieved; teams are successful. The consequences in regards to
poor leadership/management in NHS Wales, is that it will fail achieve its plans for
sustainable development – if service continue to be operated like they have done
traditionally, with increasing inefficacies that service will be unable to meet

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demand. The mounting pressures and increasing demands make it extremely

important that leaders foster positive leadership within their team to ensure goals
are met.

11. Conclusion

This report has evaluated leadership within the context of a scenario that
happened during the authors work placement within a health and social care
placement. The discussion examined the need for effective leadership with health
and social care. NHS Wales is facing one of the most challenging period in its
history with rising demand from the aging population and the increase in chronic
illnesses compounded by limited resources in an 'age of austerity' - what this
translates to is leaders need to do 'more with less'. According to Health Foundation
(2016) NHS Wales is “facing the most financially challenging period in its history”.

NHS Wales is in a period whereby it requires effective leaders to revolutionise and

innovate their current ways of working and not just follow the status quo;
efficiencies need to be made and strong leadership can drive the changes required
and transform services for future generations, in accordance with the Welsh
Governments agenda. Therefore, NHS Wales (2005) recognises that quality
leadership is required to transform healthcare services and ensure sustainability of
its services for generations to come. Welsh Government have set the strategic
agenda for health and social care in Wales and the onus is on leaders to ensure
the goals are met. Strong and effective leadership create the opportunity for these
challenges to be met and overcome. However, poor leadership and without a drive
for change, teams and system will remain the same and this will have disastrous
consequences ultimately as it will be unsustainable.

The overarching theme that developed throughout the report is that effective
leaders are visionaries; they possess the qualities that allow them to inspire their
staff to shared goal and collectively working to achieving it. Leaders influence their
staff/followers to achieve a common goal. Whilst there are many different

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approaches towards leadership and 'leadership theory' and 'leadership styles the
author suggests that in fact, effective leadership is not a ‘one-size fits all’
approach. People and situations vary and it is up to leaders to ensure they engage
in the most appropriate style to suit the situation and achieve the desired
outcomes.

Furthermore, whilst the author notes that there is an abundance of evidence to

suggest the best qualities that leaders possess, as outlined in the NHS Wales
(2005) Leadership Qualities Framework and Kouses and Posner (2002) five traits
of a ‘transformational leader, what is clear is that leaders must recognise and
evaluate their own strength and weaknesses and use these as a development
opportunity to become a successful leader.

NHS Wales and the HB is a dynamic healthcare environment dealing with complex
and challenging problems leaders need to be able to confidently assert themselves
when the need arises and resolve difficult situations. Lack of vision and shared
philosophy can lead to conflict; without a shared sense of purpose groups may
struggle to reach a consensus or understanding of the aims or objectives of the
task. Conflict can occur as an attempt to obstruct the achievement of goals by
individual’s resistant to change. Leaders can facilitate communication to ensure
these is overcome. Leaders play a vital role in the future success of NHS Wales.

12. Recommendations

§ Effective leaders must lend their style to the situation and audience

§ Developing a shared vision within a team in a priority for success

§ Leaders must continually assess and reflect upon their practice, addressing
any perceived weaknesses

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Cameron, A. et al. (2012) "Factors that promote and hinder joint and integrated
working between health and social care services: a review of research
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10.1111/hsc.12057.

Field, R. and Brown, K. (2017) Effective leadership, management and supervision

in health and social care. Learning Matters Ltd.

Gorman, P. (2008) Managing multi-disciplinary teams in the NHS. Buckingham:

Open University Press.

Hamilton, C. (2014)

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Hersey, P. and Blanchard, K. (1969) "Managing Research and Development

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Jervis, C. (2013) Stop saving the nhs and start reinventing it. London: Kinetic
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Kohpeima Jahromi, V. et al. (2016) "Active listening: The key of successful

communication in hospital managers", Electronic physician, 8(3), pp. 2123-
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Kouzes, J. and Posner, B. (2002) The leadership challenge. San Francisco:

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Kozlowski, S. and Ilgen, D. (2006) "Enhancing the Effectiveness of Work Groups

and Teams", Psychological Science in the Public Interest, 7(3), pp. 77-124.
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Lewin, K. (1944) "A Research Approach to Leadership Problems", Journal of

Educational Sociology, 17(7), p. 392. doi: 10.2307/2262546.

MacKian, S., Simons, J.,eds (2013) Leading, Managing, caring: understanding

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Marriner-Tomey, A. (2003) "Guide to Nursing Management (4th ed.)", Journal For

Healthcare Quality, 15(3), pp. 47-48. doi: 10.1097/01445442-199305000-
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leadership in participatory organizational change", Journal of Organizational
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