Optimising Leadership within the Intellectual Disability Service Delivery System

Brendan Broderick draws distinctions between the visionary perspective of leadership, and the implementation aspect, between the family's and the service's viewpoints, and the dynamics of culture vs those of strategy...

  • This paper focuses on how to make good leadership happen.
  • Leadership is to be found at all levels, not just in people with leadership roles.
  • There is evidence the Health Sector has the potential for healthy change in some areas but not in others.

Reference to leadership increasingly arises in the context of managing change.  The focus in this paper is primarily on the implementation aspect of leadership. There is also of course the visionary, identifying-new-horizons aspect of leadership. However, at this point in the evolution of intellectual disability services in Ireland, there is no dearth of vision per se. The hallmarks of an ambitious and desirable future for citizens with an intellectual disability are well profiled – although much remains to be done, to deepen the understanding of self-direction; inclusion; the need to invest in building opportunity-rich roles, as opposed to focusing on activity schedules; and what constitutes family-centred practice as opposed to clinician-centred practice. Effective and faithful implementation of the main policy objectives is proving elusive: “springing” people from congregate care settings to build the foundations of (supported) self-directed, inclusive lives; developing models of individualised rather than group supports.

Leadership as action-oriented implementation involves doing things differently – interrogating embedded assumptions, innovating new responses, modelling new levels of responsiveness and seriousness of intent to address core purpose. Doing whatever it takes to land what is needed is a critical expression of leadership. A preoccupation with outcomes, goals, and delivery is its hallmark. The contrast is with those who are satisfied going through the motions of process (Might the appetite for elaborating process chains be a way of minimising the threat to the status quo, by introducing a focus on plausible, publicly-justifiable, long-fingering activity rather than effective action?).

 

Discussion of leadership often defaults to a focus on individuals in leadership roles. The assumption that leadership is all about “the person at the top” is strongly embedded. Certainly there are readily identifiable charismatic leaders who head up organisations. There are also effective heads of organisations that deploy more low-profile styles of projecting purpose and seriousness of intent. The comforting reality is that leadership activity and energy are to be found at all levels.  While the person at the top does not need to be the source of all significant leadership ideas and activity, it is critical that he or she has the sensors to recognise leadership initiative in action, and the commitment and personal capacity to validate and safeguard organic expressions of leadership.

Leadership and change are often seen as best secured through command-and-control approaches, as exemplified in the current orientation to governance within the Irish health sector. The tendency seems to be towards a separation of powers, where the board is at the top of the pyramid and takes responsibility for setting direction, strategic objectives and the policy context, while the rest of the organisation prepares operational plans, budgets, and audit cycles to ensure that the organisation is on track. Effective boards are viewed as those who are in control of what is happening within the organisation. Compliance, order, predictability and control are prized over any other features. Our organisation has recently been the subject of a governance review, the focus of which was exclusively on “the control environment”.

Compliance with public sector pay, procurement processes, and internal audit was the near-exclusive preoccupation. When asked if the organisation’s record of progressing health-sector policy objectives would form part of the review, the response was that this was a marginal consideration and need not feature. Within this governance-as-compliance worldview, curiosity, courage and creativity are deemed superfluous, perhaps aberrant. Arguably this trinity of attributes lies at the core of effective leadership. Any paradigm of governance, which fails to recognise their centrality, must inevitably sponsor a hollowed-out form of organisational performance.

If leadership energies are to be catalysed and harnessed in this sector, we need a fit-for-purpose model of governance, one that places performance, not conformance, at its centre. Might we have mis-applied a model of governance that fits, where the core purpose is to optimise the manufacture of standardised products to a sphere whose core purpose entails the development of individually-tailored (i.e. non-standardised) responses within a context of personal relationship? Perhaps the non-recognition of the distinction between complicated (where precision and standardisation of performance is critical, e.g. intensive care medicine, aeronautics), and complex environments (where non-standardised performance drawing on insight and judgement is key), lies at the heart of this confusion.

Alternative models of governance are available (e.g. Sable and Seitlin’s experimentalist governance) which, if applied in this sector, could release and potentiate leadership energies and significantly contribute to closing the policy-implementation gap.   The cardinal features of this approach are:

  1. The centre sets broad provisional framework goals and local units are allowed discretion to pursue these goals in their own way (rather than being enjoined to pursue precisely-defined goals in lock-step compliance with prescribed process flows);
  2. As a condition of the autonomy given to them, local units must report on their performance, participate in peer review and take corrective actions (incorporating learning from higher-performing peers).

The approach is underpinned by the view that fixed rules written by a hierarchical authority become obsolete too soon to be enforceable on the ground.

Effective leaders know that culture eats strategy for breakfast – and that culture is what takes root, grows, and flourishes in the informal spaces and channels.  Effective leaders intentionally work these channels.  They do not naively place their trust and confidence in formal structures, procedures, or communications.   They recognise that the echoing and circulatory dynamics within the informal zone are more powerful and compelling than official declarations and centrepiece events.  Delivering significant change and re-focussing of core purpose in complex environments (ones which can only be successfully navigated drawing on insight and judgement) have to contend with strong systems dynamics.   People working within the system need to “get it”, i.e. the nature and value of what it is that the leader is trying to land.   When people “get it” the formidable braking power of resistance begins to slacken and release. New and powerful energies are activated. Progress accelerates, moving from slow linear advance to step change.

Effective leaders know that these kinds of change dynamics are not brought into play by perfecting the separate components of the organisation. A combination of perfecting procurement processes, finessing one’s complaints procedure, and enhancing compliance levels with audit cycles is unlikely to add up to any significant breakthrough in respect of vision or core purpose! Effective leaders do not invest in rationalist but illusory beliefs that the best way to optimise the whole is to optimise the individual parts. They recognise that an optimising-the-parts mindset can readily sub-optimise the performance of the whole, that the focus needs to be on optimising the relationships between the parts.  Again, informal channels and informal modes of engagement are the most effective and efficient approaches for promoting “get it” buy-in. Informal should not be read as casual or loose. Informal modes of engagement can be deeply intentional.

Attributes which characterise the intellectual disability service landscape in Ireland, are:

  1. A stable workforce, i.e. low “churn” of employees. Long-term, long-haul relationships between local staff and managers are a salient feature;
  2. Public sector-type employment contracts. There is a strong legacy of social partnership ethos in the management of health services – arguably employee rights are more strongly entrenched in law and in practice than those of service users or their families;
  3. A weak orientation to and appetite for individual performance management.

Name-checking these features should be read as neither endorsement nor criticism. The intention is to differentiate this environment from more short-term, private sector-type, “competitive” employment contexts. Leadership and change models being recommended for application in this sector need to be ecology-proofed before being introduced. “Kick-ass”, commando-style leaders of the heroic ilk are likely to find that this habitat is not compatible with their long-term sustainability. Something more subtle, sophisticated and adapted is required. This latter statement should not be read as a pessimist’s charter, however. When one looks across the landscape of intellectual disability services, one finds a broad range of performance. Significant leadership and change is being realised in some parts of the landscape, with little indication of engagement or delivery in other parts. This evidence-base supports the proposition that even this highly-protected environment can accommodate significant leadership and change initiatives. The key to replicating and extending better performance is to harvest and apply the environment-specific learning from available positive exemplars.

Author Bio

Brendan BroderickBrendan Broderick is CEO of the Muiriosa Foundation, Moore Abbey, Monasterevin, Co Kildare.

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