Learning to lead from the front

 Think of a great leader. Thatcher? Mandela? Mother Theresa? It is hard to put into words exactly what it is they have in common; even harder to define exactly what they have to impart about how to be a better occupational health (OH) practitioner.

Yet they are all role models frequently chosen by students undertaking the management and leadership training unit of South Bank University’s OH degree course.

“So many of my students say they don’t know which direction to take in their organisation,” says Chris Candy, a senior lecturer who teaches leadership both at South Bank University and on the Royal College of Nursing’s distance-learning courses. “They are floundering. I suggest they think of someone whose style of leadership they admire, and ask what they imagine that person would do,” she says.

“Then they go back to the place of work and think about the styles and attitudes they would like to develop and we slowly build that up.”

Not every OH education institution addresses the issue of leadership in the same depth. Some might include it as just one learning outcome, rather than a whole course unit, for example; some subsume it in management skills training, others keep it quite distinct. But since leadership skills are a prerequisite of degree courses, according to both the Royal College of Nursing and the Nursing and Midwifery Council’s Standards for Specialist Education and Practice, address it they must.

As OH practitioners move increasingly centre-field in the war against work-related illness and sickness absence, many argue this part of the syllabus is becoming more important than ever. The days when services were managed by doctors and implemented by nurse are over, with more and more services headed up by nurses.

But what are leadership skills in the context of OH, and how do they differ from common-or-garden management skills?

One of the main distinctions identified by leadership experts is that while management is about the nitty gritty of managing a team or a service, leadership is about having a vision. In OH terms, this means seeing how this part of the organisation can add value and inspire practitioners to go to a higher level.

The prevailing academic model of leadership is known as “transformational” leadership, and is based on values such as nurturing, empathy and empowerment. This has largely replaced the “transactional” model, which is allied to old-fashioned command-and-control organisational cultures.

A useful classification of leadership competencies based on the transformational model has recently been put together by the Employers’ Organisation for Local Government. It lists skill sets such as managing change; communicating to different stakeholders; influencing; building networks and partnerships; developing and implementing a strategic vision; and empowering, developing, valuing and coaching people.

It is not difficult to see where the demand for such skills comes in, given the huge challenges for OH professionals outlined by the Health & Safety Commission (HSC) in its new strategy for health and safety in the workplace. At its heart is a great shift from industrial safety to managing illness and absence and facilitating rehabilitation. For OH, this translates into greater proactivity and prevention, a huge expansion in OH’s support role, and the creation of new outlets for OH services.

In the eyes of many seasoned OH practitioners, it adds up to a revolution. “It is almost as if OH is being reinvented,” said OH consultant and former HSC commissioner Cynthia Atwell recently (Occupational Health, June 2004).

Almost everything is up for grabs. Many in the field stress it is essential that OH becomes more high-profile and visible, defines and promotes its own role more clearly and assertively, and educates employees and employers alike about what they should expect from an OH service.

That demands professionals who are able to advocate and influence; inspire and motivate; build bridges and partnerships; create demand for services and then work out a strategy to meet demand.

One of five concurrent programmes of activity by the HSC is to provide a national, independent occupational health and safety support scheme – less than a third of the UK’s 25 million workers currently have access to OH services.

Colleen Bowen, head of the Health & Safety Executive’s OH support policy unit, says: “If we want to expand OH support there is a need to look in more detail at the competencies required beyond traditional clinical skills, such as communication, advocacy and influencing skills, the ability to get people to recognise the benefits of OH.

“The need to address this is starting to emerge as an issue. If the demand goes up for the people with the right sort of skills, the supply may not be there.”

Bob Dunn, senior OH adviser and operations manager at the University of Oxford, believes many educational institutions are not giving these skills the prominence they deserve.

“They are not preparing OH practitioners for the real world,” he says. “There is very little formal training in management and leadership skills on OH courses – they focus on the clinical and public health aspects [of the job] but not enough on, for example, how to manage conflicting demands.

“We are often at odds with the system. The job is to manage the organisational needs and those of the individual concerned – strike the right balance between working within corporate strategy and the overall goals of the organisation and taking care of the needs of the employee.
“It is a case of making a firm foundation where people of all skills and disciplines respect and acknowledge your professionalism. You need excellent communication skills. You have got to be able to take people with you, both within your team and also outside – the personnel department as well as the board or controlling body of the organisation.”

Dunn, who attributes his own leadership abilities largely to 25 years in the Territorial Army, also stresses the importance of people issues within a sizeable OH team. His own style is based on empowering and developing his staff. “I don’t want just their problems, I want them to formulate the solutions as well. You need to encourage people to think. Give your own ideas, but encourage them to find the answer rather than dictate to them.”

Gail Cotton, head of OH services for Leicestershire Fire and Rescue Services who runs a team of 15 practitioners, and is a guest lecturer on the Warwick University OH degree course, stresses to students the importance of understanding the culture of the organisation they are working in, the management style, where they fit into the structure and, therefore, how effective they can be.

“OH is such a diverse service. You need to know who your stakeholders are,” she says. “Who are the people you have to influence and engage with?”

Cotton, who completed a masters degree in business administration (MBA) in the 1990s, believes courses on leadership can only get you so far: it is only through experience that you can learn to apply the theories effectively. “It is about learning management and leadership skills, but then adapting them – being flexible in your approach to people.”

She believes this would not have been possible without the input of mentors throughout her career, often from outside her profession. “Especially as I became more senior, clinical nurse directors were often not the right type of person for this. They could not understand my problems, the issues I was coming up against.

“This is not a sickness service – it is a proactive health management service. My MBA gave me much closer links to managers of external companies, business leaders. This is the only way you are going to divorce yourself [from the day-to-day issues] and step outside the box. I have widened my circle quite a lot, through Chamber of Commerce meetings, for example. It gives you a much better perspective. You have to be looking outward.”

This has become especially important as the OH role has changed, she adds. “My role now is advising managers how to manage and it is only my leadership skills that allow me to do that.”

But not everyone in OH can, or indeed wants to, lead a service. After all, the majority of OH nurses remain sole practitioners. And it is clear that the changes taking place at a national level will require not only more service leaders, but also more foot soldiers who can work on the ground – for example, providing OH support to primary care trusts, carrying out basic functions such as risk assessments and procedural tests for OH services and providing first-port-of-call advice and information for businesses.

“Not every qualified OH nurse is going to be a mover and shaker,” says Anne Harriss, head of OH education at the South Bank University in London. “If we were all trying to be leaders we would pull OH apart. But you can look at leadership at different levels. There is also a place for it in the personal development of people who want to be more hands-on and we don’t want to devalue that role.”

Lily Lim, senior lecturer on the Middlesex University BSc course for specialist OH nursing, agrees that leadership skills are not only necessary for leading a team.

“They can be disguised in all sorts of ways but basically it is covered in various sessions on our course – on personal development, communication and professionalism,” she says. “It is understanding yourself and your personal style, understanding how people tick, how an organisation works. Unless you are developed in this way you will not be able to do the job properly.”

Being able to go into an organisation and gain the confidence of its leaders is essential, and this requires confidence in your own personal power and knowledge, she adds. “In my experience, they may know I am a nurse, but unless they trust me and take what I say at face value, why should they listen to me?”

This is echoed by Candy. “I aim to develop self-confidence, starting from the basic premise that anyone can learn it. It is about knowing your expertise is valued and needed. That you can give advice no-one else can give. That is positional power, possessing the ability to lead on your subject.”

The ability to negotiate, to influence, to be political and to develop working partnerships is essential at all levels, she believes.
“We introduce the political element early on in the course,” Candy says. “If you are not willing to stand up and shout for what is right, you are lost.”
Lim, a former chair of the Association of OH Nurse Educators, also stresses the importance of “the political side of things, making contacts with professional groups, liaising with specialist journals like Occupational Health”.

In other words, networking.

Cotton agrees: “Networking is how you continue to develop your leadership skills – and you never stop developing.”

Candy teaches the importance of public speaking and presentation skills, too. “This is very important for developing the ability to lead on OH. Some new students look terrified at the thought of it, but after a year learning presentation skills they are more relaxed. You may be speaking to an audience of hundreds or just three people in a meeting, but it is a skill you have to acquire at some level.”
There remains one final, nagging question. How does Candy square her teaching of a nurturing, empowering, empathic style of leadership with the popularity of Maggie Thatcher as a role model?

“I think it is because of the perception of Thatcher as an isolated woman doing a demanding job on her own. This strikes a chord with many students. It is not about her politics, but her mode of delivery – she was able to achieve a great deal through the force of her personality.”


How to improve your leadership skills

-Find a role model – someone you have worked with, or a national or international figure, and ask what aspects of their leadership style you admire and why, and how you might incorporate these into your own style

-Understand the culture of the organisation you are working in, the management style, where you fit into the pecking order and who you need to engage and influence to get things done

-one your communication skills – you have to be able to inspire, motivate, take people with you

– Get a mentor – ideally someone in the wider business community, who can help you step outside day to day issues and develop more ‘blue sky’ thinking

– Work on your emotional intelligence – do you understand your own personal style, how you tick, how others tick? Can you adapt your style to suit the situation?

– People management skills are all important – you need to be able to empower, develop and nurture others

– Develop your self-confidence – believe you are providing something no-one else within the organisation can

– Don’t be afraid to be political, to stand up for what you believe is right

– Network from the word go – contacts both inside and outside OH will help you develop new partnerships and will be a constant source of new ideas

– Practice your public speaking and presentation skills – these are essential whether you are talking to three or 300 people

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