Leadership Management & Coordination

in Health and Social care

The student will be required to produce a 4500-word report on an issue the student

will have observed on placement Learning Experience.

Learning outcomes:

The student will be able to:

1. Critically analyses pertinent management/leadership theory and concepts.

2. Critically evaluate the skills, knowledge and attitudes that are necessary to

enhance effective management in the complex and dynamic environments of health

and social care agencies.

Title: Managing change that the student observed

while on placement.

Aim: To critically analyse how her manager at a third sector organisation in

South Wales handled taking over a new contract of supporting four individuals

with learning disabilities in a supported living environment. Then the author will

also detail the efficiency of leadership style that the manager used in handling

the situation.

Report to:

Name of the Module: Leadership, Management and Co-Ordination

in Health and Social Care

Code of the Module:

2. Content Page:

Front Page …………………………………………………………………………………. 1

Abstract …………………………………………………………………………………… 3

Introduction …………………………………………………………………………… 3 - 5

Analysis (using Warwick 6 Cs Framework) ..……………………........................ 5- 15

Leadership style……………………………………………………………………… 15

Conclusion ….………………………………………………………………………... 15 -16

Recommendations ……………………………………………………………………… 16

References ……………………………………………………………………. …17- 20

Appendix………………………………………………………………………………… 21

3.0. Abstract

This report is about how the author’s manager while on placement handled a

transition of taking over a home from another organisation. The organisation

that the author went to is based in South Wales although its headquarters are

in England. The names of organisations and names of people involved have

been withheld due the Data Protection Act 1998(Government UK (2015).

4.0. Introduction

4.1.1 This report is going to be about how a manager in a third sector based

in South Wales managed change situation that the student observed while

she was on a six-week placement. Managing change refers to a form of

management control which involves applying systematic management

interventions that require individuals to get involved in order to acquire desired

outcomes that are compliant with the strategy of the organisation (Hall, 2013).

This organisation had just taken over a home which another organisation had

lost in a contract because of not complying to requirement of Care Council

Wales. (The organisation where the student went for placement will be called

D and the one that lost the contract will be called R in this report). Change

goes on to continuously influence the management landscape as all

organisations respond to external and internal forces to offer what is expected

of them from the stakeholder. It can also be said that organisations are

always managing change as they respond to changing business situations

(Hall and Rees 2010). Managing change is vital but is also a very challenging

process (Lee, 2013).

4.1.2 The organisation where the student went for placement offers services

that are evidence research-based, outcomes-focussed to people with a range

of learning disabilities and autism (D, 2016) (see appendix). They provide

supported living and outreach services in South Wales. Learning disability

refers to a state when someone’s mind is stopped or interrupted in developing

or the development was incomplete which includes impairment of intelligence

and ability to interact in a normal or usual way in society (Grant, et al. 2010).

Autism is a development disability that lasts through out one’s entire life, it

affects communication and difficulty in forming relationships with other

individuals in society. Autism is also referred to as a spectrum because

symptoms of individuals who have it differ and vary from mild to severe

(Nursing Standard, 2014). In Wales the number of people with learning

disability on registers was 150,010 out of whom 86 percent were staying in

the community while 14 percent were staying in residential places (Welsh

Government, 2015). In the United Kingdom, about 700,000 people are affected

with autism which implies that 1 out of 100 are affected (The National Autistic

Society, 2016).

4.1.3. In order to acquire the information used in this report the author referred

to the University website, clicked at Find it, then Article search then typed in

the key words such as leadership, learning disability, communication then

clicked at search. Several journals appeared on the screen but the author

limited them by selecting only peer reviewed journal articles that were less

than five years old. The author also got information from recent government

websites, books were used in collecting information. Nevertheless, old

sources were also used when the author found them still relevant.

4.1.4. In this report the student will evaluate how the manager managed the

situation, meetings that were held, challenges that were met by staff from

organization R and the manager who led the change. Armstrong (2012), is of

the view that a manager is person who organises their junior employees time

within their work place to get the objectives of the organisation. While Gopee

and Galloway (2013) propose that a manager is someone employed

particularly to ensure that objectives of their organisation are successfully

reached. Leadership and management styles that the manager applied will be

discussed in details.

4.1.5. Although there are several leadership frame works such as Dunham

and Pierce's (1990) Leadership Process Model I am going to use Warwick

six c leadership framework as it is more applicable to this report (Hartley and

Benington, 2010 and Mind Tool, 2016). It is a framework that offers lens which

can be used to analyse the leadership literature and general review of main

elements that affect leadership process and after-effect. The framework is

able to categorise certain features of leadership together so that more light

can be shaded on acquiring an understanding of results that are theoretically

appealing and are useful in practical way. The six c’s of the framework are

concepts, contexts, challenges, capabilities and consequences (Hartley and

Benington, 2010).

4.2Analysis (using Warwick 6 Cs Framework)

Concepts4.2.1. The Warwick leadership framework refers to conceptual approaches of

leaders that are about individual qualities of a leader, the position a leader

plays in an organisation and leadership as a social process (Hartley and

Benington, 2010). Some of the qualities of a leader that are referred to as

conceptual skills are vision, being able to motivate, being able to make

decisions, creative, being committed, determined and persistence, wisdom,

critical thinking and having a desire to lead (Ricketts and Ricketts, 2010).

Although there many definitions of leadership the author is will use the

definition of Goodwin, (2006) as it suits more into this assignment, which

states that leadership is a powerful process of going after a vision of change

where a leader has support from two major groups. The manager who was

leader in the situation, has been in the position for over 25 years. She was

able to motivate, make decisions, creative as she came up with some new

developments to be made, committed and determined to see the change take

place successfully.

4.2.2. Hartley and Allison, (2000) also had an idea that leadership has three

perspectives which are person, position and process. Here leadership is not

seen on basis of a person’s characteristics but what takes place between

leaders and the ones they influence. The three approaches that Hartley and

Allison, (2000) came up with about leadership are going to be detailed here.

In conceptual approach of qualities, a leader has been explained in terms of

an individual’s characteristic and the way he or she behaves.

4.2.3. The first conceptual approach explains the qualities of a leader,

the way they behave and their attitudes. It is about a person’s qualities

or characteristics, skills one learns, abilities and about standards of

person effectiveness (Hartley and Benington, 2010). In the situation

described the manager had qualities and skills she had learnt and was

able to comply with the standards required as mentioned in the

previous paragraph.

4.2.4. A second conceptual approach refers to position held in the

work place in terms of formal organisational leadership job, place,

power, expert position one has. Here features of a leader refer to status

or profession or the authority one has. These are usually linked to

senior jobs and associated with effectiveness of the organisation

(Hartley and Benington, 2010). Referring to second approach, the

manager was already in a management position for many years.

4.2.5. The third one is the conceptual approach, which refers to

leadership as a social process that is explained in terms of social

interaction with those that follow a leader, while it was emphasized that

social influence uses communication and being empathetic to some

people while putting others in control and coaching. Its features are

relational motivational skills and influence on subordinates (Hartley and

Benington, 2010). Then referring to third one, the manager that was

observed, had held several meetings where she communicated with

families and service users with and without the organisation R. She

continued to have one to one meeting and team meetings with support

workers that she took over in order to know how they were doing and

to find out ways of helping them make effective changes. The planning,

development and delivery of services in social care becomes more

effective to meet complex needs of client by involving them and their

carers (Hafford-Letchfield, 2009).

4.2.4. For leadership to be effective it is important for individuals to work as a

team in order to offer better services (National Health Services, Leadership

Academy 2011). Change that is done collaboratively or in a group is perceived

to be more efficient than a change done by a sole person. McColgan, (2012)

states that when a leadership style fosters two-way interaction and other

people’s views this encourages engagement and partnership working which

are vital aspects for effective change management. In this particular situation

the manager was observed working with social workers, physiotherapists,

district nurses, general practitioners, dieticians and occupational therapists in

order to meet the complex needs of clients she had taken over.

4.2.5. Sometimes in health and social services changes take place so

quickly, managers are pressurised to make decisions quickly because of time

limit and depending on the situation they are dealing with. These rushed

changes are done without consulting and involving staff. However, for a

change to be successful, staff have to be consulted and participate. It is

important for leadership to be directional and supportive when there is less

time situations of change management. Although staff cannot determine

which changes they want to take place but should be given reasons to why

the changes are to happen and good leadership style determine how

employees respond and agree to the new changes (McColgan, 2012). In this

situation the manager gave staff clear information on the roles they were

taking over, responsibilities, vital policies and procedures of her organisation

which is in compliant with the code of practice for employers (Care Council

Wales, 2016).

4. 3. Characteristics

4.3.1. Leadership characteristic are classified into formal, informal, direct,

indirect, clinical, non-clinical, individual and shared various bases of power.

The focus of characteristics is on power and resources. The characteristics of

a leader are influenced by the organisation or external networks, support

given to them increase or decrease their leadership. Leadership

characteristics are never the same, they just depend on one’s roles. It is

necessary for the development of leadership activities to be organised

towards and resources of leaders. Before developing a person, it is necessary

to think about which person to developed, the potential part they can play for

the work place. Leaders are various sources and processes of influence, so it

is essential for the development to be done in suitable way (Hartley and

Benington, 2010).

4.3.2. Trait theory tries to list all remarkable characteristics leadership should

consist of, in order to be effective. This theory also tries to pinpoint some

characteristics that are linked to leadership effectiveness and associate those

traits to some effective criteria. According to the traits theory, some leaders

are born with traits of leadership. The traits that are linked to trait theory are

intelligence, personality, communication skills, physical and being able to

supervise (Bertocci, 2009).

4.3.3. The manager did not have all the traits mentioned in this theory but she

is intelligent, able to supervise and was able to communication effectively. She

demonstrated this by being able to find solutions to issues that were faced

during the change process, supervising staff to make sure that they provide

quality care and communicating to clients, staff and other agencies.

Communication between clients and practitioners is a concurrent two-way,

interpersonal occurrence (D’Agostino and Bylund (2011). Communication is a

process where two or more people exchange thoughts or information in order

to come to understanding and needed action (Priya, 2009). Communication

skills are very vital for people who are in leadership roles (Lubinski and

Hudson, 2013).

4.3.4. Brownell (1992) and Scudder and Guinan, 1989) proposed that

interpersonal communication is a skill that is very important for the success of

leaders although most managers at the entry level do not have them (English

et al., 2007 and Hodges and Burchell, 2003). While, Laver and Lancaster

(2010) state that interpersonal skills enable people to interact with another

individual, allows them to communicate more effectively. Good communication

skills are important for people who work in health and social care. The

communication skills that are required by staff in health care include: listening

and to check if the person one is talking to has understood, ability to flow well

in a conservation, to understand cultural differences, be able to keep

conversation flowing, understand interaction cycle, to know how to ask

questions, understand non-verbal message and to communicate back (Laver

and Lancaster, 2010).

4.3.5. If communication is effective then clients and practitioners will

experience better outcomes, for clients the benefits such as being more

satisfied and improved well-being. For practitioners, effective communication

assists them to accurately find out client’s problems, improves their

confidence and reduces their distress (Pitceathly, 2002 and Cegala and

Lenzmeie, 2002 cited in Ditton-Phare, 2015). Effective supervision needs

differing degrees of leadership because job responsibilities often change. It is

a responsibility of a supervisor to motivate staff in order for them perform

effectively (Morrison, 2012). Although the manager observed in the situation

had good communication skills, she was good at understanding culture

differences of both staff and clients that she worked with. Although she still

struggles to understand the needs of her clients as one of them does not talk

and others have learning disabilities so they cannot communicate their needs

effectively.

4.4. Contexts

4.4.1. Contexts involve addressing problems in the society and are linked to

policies (Hartley and Benington, 2010). It is necessary for people to divert

from considering that leaders are separate from their contexts to considering

about leadership within contexts that are always changing and able to adapt

to a system that is connected to each other (Hartley and Benington, (2011).

The context in this situation is that life span of people with learning disability

has increased. It is hoped that the population of people with learning disability

who are of age 50 or more who will be using social care services will rise by

30 percent by the year 2030. It is also hoped that the number of people who

are more than 80 years with learning disability who will be using social care

services will raise to 162 percent. People with learning disability have various

needs so this is a big change in the age profile of individuals and the services

they need. (British Institute of Learning Disabilities (BILD), 2014).

4.4.2. The Welsh Government is committed to making the lives of people with

learning disabilities better because they identified them to be vulnerable

(Welsh Government, 2011). Under the Equality Act 2010, those that provide

services have to offer equal access to people who have or have had a

disability (Government UK, 2013). According to the Statement on Policy &

Practice for Adults with a Learning Disability, the Welsh Government, seeks to

assist people to have full and inclusive lives. There is a need to pay attention

to maximising people’s ability to be independent and put away financial,

economic and social barriers (Welsh Government, 2011).

4.4.3. The organisation being discussed in the situation is one of the largest

non-profit organisation in the United Kingdom that supports people with

learning disabilities, autism, challenging behaviours and complex needs (D,

2016 a) (see appendix). So the organisation is assisting in meeting the needs

of people mentioned above. Some of services they provide include: personal

care, dressing, assist them to improve the skills such as cooking and assisting

service users to integrate in the community by independent and supported

living

4.4.4. The changing context places the community and governments with

complicated issues, so leadership cannot be limited to working in one agency

but has to work across other networks (Hartley and Benington, 2011). It is

necessary for leaders to have skills for mobilising hierarchies, markets and

different sectors that they work with, based on particular context and the crisis

(Benington 2011). Some principles have to be applied for an organization

change to be effective like thoughtful planning and sensitive implementation,

seeking information from individuals who will be affected by the changes and

giving them a chance to be part of the change process (Passenheim, 2010).

4.4.5. The manager who was leading the change followed these principles

because she planned how the change would take place, what her

organization wanted from the change and how it would be achieved. She also

implemented the changes by putting in place policies and procedures the staff

she had taken over had to follow. She also sought information from both

service users and support workers which illustrates her competence.

4. 5. Challenges

4.5.1. Though leadership is taken to be a vital activity on its own and right ,

more writers and those that make policies want to know the aims and purpose

for leadership. The difference between technical and adaptive issues is

influencing leadership literature (Heifetz, 1994). Heifetz characterisation of

leadership is based on what a leader or leadership is attempting to

accomplish. Technical issues are the ones that people have gone through

before, whose causes are well known, which already have a way of being

sorted, which can be sorted by a certain agency or there is a service for it

already in place. Although technical problems can be complex but they can

be solved by services in place (Hartley and Benington, 2011). For example, A

technical problem at the organisation D after the takeover was that of not

putting on aprons and gloves. The new employees knew about putting on

personal protective equipment (PPE) after reading policies and policies of the

new company and the training in health and safety regulations but the

challenge was to implement it and put the regime in practice.

4.5.2. However adaptive issues are characterised by not having knowledge or

disagreement cause of the issue or solution to it. It is necessary to try to solve

the issue by changing their values, attitudes or the way they behave.

Sometimes the people trying to solve a problem and other people may also

contribute to the issue knowingly or unknowingly. It is essential for leaders

that operate with or within networks of service provision to encourage better

person centred, coordinated, tailored to needs of a person, carer and family

(Hartley and Benington, 2010 and Hartley and Benington, 2011).

4.5.3. One of the challenges faced by the manager observed in the situation,

was that organisation R did not want to handover the paper work they were

using. This would make it very difficult for the organisation taking over. The

staff from organisation R did not want comply with the new policies and

procedures when they felt it was not suitable for them. The manager in the

situation observed felt stressed as she was not receiving enough support from

her seniors yet she was expected to make it work. Stress refers to the

unfavourable reaction individuals get when they are under much pressure or

have too many demands (Health and Safety Executive, 2012).

4.5.4. All the above can be classified as adaptive issues that the manger had

to deal with. She dealt with first one by negotiating more with the former

organisation and involving her seniors. She had deal with the staff not wanting

to comply to the organisation D’s policies by informing them how important it

is to follow the policies and procedures. According to the Code Practice for

Social Care, employers have to put in place written policies and procedures

for their employees (Care Council Wales (2016). The manager was also

supervising staff in order for her to manage the change effectively, she deal

with their values, beliefs and the way they were working. As most of the

employees she had taken over had worked for that organisation for long they

had picked up some bad practice which they now believed was right but had

to be changed. An employer has to effectively manage and supervise

employees to work effectively, have good conduct and they have to be

supported to address areas where they are not working well (Care Council

Wales, 2016). In order to deal with the stress, she was going through, she

sought for supervision from her seniors in order to keep going.

4.6. Capabilities

4.6.1. The skills that make leadership to be effective or not include: mindsets

and behaviors (general competencies, emotional intelligence, leadership,

having knowledge politically) (Hartley and Benington, 2011). Emotional

intelligence refers to being able to establish, incorporate, understand and for

one to reflectively manage their own and others feelings.

4.6.2. Leadership and management skills are very important qualifications for

care professionals to have in whatever role they play. These skills are very

vital whilst providing care in addition to managing change (Gopee and

Galloway (2013). These are usually referred to as competencies though here

they are called capabilities. However, there is an argument that emotional

intelligence is narrow but it would be better to think about it as emotional labor

that leadership goes through (Askenasy and Humphrey, 2011). In the King

Fund report, the authors came up with other concepts of leadership

capabilities and competence that is learnt but not taught, qualities of practical

wisdom and making decision in a complicated situation (Hartley and

Benington, 2011).

4.6.3. Qualities of a good leader are: thinking ahead and thinking of ways in

which things would have been done in another way and how they could be

made better next time. By being a role model whom other people can follow.

one who focuses on client or patient which means that he or she involves

clients and respects their views. Takes responsibility unto themselves to

initiate change when there is an issue or challenge. Takes step to challenge

poor standards. Has to be able to solve problems and be resourceful. Has to

be good at communicating with patients and health and social care

professionals in order for care to go on and empower other people. Has to

take note and reward care that is good and give feedback that is positive

(Gopee and Galloway (2013). The manager observed, was able to lead by

example as she followed the policies of work place while at work place. She

involved clients’ views and respected their views at all times by

communicating to them or speaking to people who know them better. She

also worked with other professionals and support workers in order to meet the

needs of the clients.

4.6.4. The skills approach focuses on abilities and skills that a leader needs to

achieve as time goes on instead of personal traits that one is born with.

Robert Katz (1955) proposed that effective leadership requires personal skills,

technical skills and being able to work with individuals which is human skills

(Grout and Fisher, 2007; O'Brien and Hauser, 2015).

4.6.5. The skills approach was modified to capability model of leadership

which pinpointed elements of leadership which are: performance; ability to do

something effectively; quality or characteristics of a person, leadership

outcomes; social skills and awareness. The model is of the view that the way

the leader performs depends on how competent they are, which is affected by

the leader’s experiences, attributes and situation in which they work (Grout

and Fisher, 2007). The performance of the manager who is being evaluated.

depended on her experience, knowledge, competence as a manager to

manage the change.

4.7. Consequences.

4.7. 1. Consequences of leadership illustrate its effect on individuals and

systems (Hartley and Benington, 2011). The manager leading the change

wanted the two individuals who are mobile to be more independent. Risk

assessment will be done to enable them to do more activities on their own.

She wants the lady who was hoisted by one person to be hoisted by two

people. All the above have been made come to reality and risk assessments

are in place to all that happen. So although the transition is still going on but

there are outcomes that have been achieved. She also contacted the

community occupational therapist and physiotherapist to go to the individual’s

home and assess her for a new hoist that could take her to the bath room

without passing the corridor as she shares a house with men. They came and

assessed the situation of the individual and went to apply for funding in order

to make adaptations to the service users home. Scott and Spouse, (2013)

state that it is essential for an assessment to take place immediately in health

and social care environment to avoid putting clients to risk. Under the Social

Services and Well-being (Wales) Act 2014, the needs of an adult have to

assessed for the care and support (Welsh Assembly Government, 2014).

4.7.2. For leadership to be effective it is essential for individuals to work as a

team in order to offer better services (National Health Services (NHS)

Leadership Academy 2011). Change that is done collaboratively or in a group

is perceived to be more efficient than a change done by a sole person. When

a leadership style fosters a two-way interaction and other people’s views this

encourages engagement and partnership working which are vital aspects for

effective change management. Even if collaborative working is accepted as

good practice but it is argued about and have to be presented at the agreed

time. Social Services and Well-being (Wales) Act 2014, promotes co-

production and integration which will enable practitioners assess care and

carer support needs of people in the community which enable them to find the

services required (Welsh Government, 2015).

4.7.3. The views and how effectiveness is measured are determined by what

people consider to be the cause, the consequence although at times it may

not be true. Goals are not easily achieved because various stakeholders may

also have various perceptions about the value and how effective the actions

have been (Hartley and Benington, 2011).

4.7.4. The leader of change has to monitor activities and outcomes achieved,

ensuring that the care provided is of quality standard or make changes if

necessary (Gopee and Galloway (2013). So this was in line with what the

manager did, so it can be concluded that she was effective she succeeded in

achieving the outcomes her organisation was interested in although one is still

in the process.

4.8. Leadership style.

The style the manager that was observed in the situation used was

democratic, she always consulted support workers while making decisions

where it was appropriate. She held several meetings with staff to discuss on

changes that were necessary to make. A democratic leader gets information

from employees and involves them in making decisions Each staff in the team

are treated individually and respected, there is openness and trust among the

group (DeWit and O'Neill, 2013). The student observed that although each

member was respected as an individual by the manager who was being

observed but the employees from the old company had not gained her trust

and were not very open to the new manager. A democratic leader has to be

part of the group he or she is leading not more important than the people he is

leading and has to be responsible for their actions (DeWit and O'Neill, 2013).

5.0. Conclusion

In this report, Warwick 6 C’s leadership framework has been used to evaluate

how a manager in a third sector organization managed a change in a home

that she took over . The observation was done while the author was on

placement. Management includes planning, directing or guiding and

supervising or monitoring work done or being done to achieve goals and

objectives (Gopee and Galloway, 2013). The manager that was observed in

the situation planned, directed, monitored and supervised what was done in

order the get the goals and objectives that were aimed for. She also evaluated

the work done. In health and social care, a manager has to use expert skill to

get client’s outcomes such as managing and putting into practice person

centered packages of care or making sure high quality care is provided

(Gopee and Galloway, 2013). The manager also used expert skills to put in

place packages of care that centred around clients and made sure that the

care provided is line with policies and procedures of the organisation. The

author included that the skills, knowledge the manager used to handle the

situation. She also mentioned the challenges faced by the manager while

managing the change. As there are always challenges while managing

change, the student came to conclusion that the manager she observed used

a democratic leadership style as she got information from stuff, involved them

and made decisions with them at team meetings. She also treated support

workers individually and treated herself not more important than people she

delegated.

6.0. Recommendation

The professionals working with people with learning disabilities need to get

more training on how to meet the needs in this group of clients and service

users.

6.1 Although there are policies and legislation about people with learning

disabilities they are still being discriminated or not accessing services as other

people do. So policy makers need to include them more and even enforce

their inclusiveness so that the gaps are closed.

6.2. More work needs to be done on how to communicate to people with

learning disabilities more effectively as professionals rely on what the

individuals’ families or support worker tell them in cases where the individual

cannot talk. Some times what they say may not be what or how the individual

feels which may lead to wrong diagnosis.

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Appendix

D -stands for Dimensions.