Leadership Matrix

8/13/2019 Leadership Matrix

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Leadership in a matrixA personal view from Ciarn Devane, commissioned by the NHS Confederation

Leadership


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The NHS Confederation

The NHS Confederation represents all organisationsthat commission and provide NHS services. It is theonly membership body to bring together and speak onbehalf of the whole of the NHS.

We help the NHS to guarantee high standards ofcare for patients and best value for taxpayers byrepresenting our members and working together withour health and social care partners.

We make sense of the whole health system, influencehealth policy, support our members to share andimplement best practice, and deliver industry-widesupport functions for the NHS.

www.nhsconfed.org

The voice of NHS leadership

Our work

In consultation with our member policy forum,we have committed to focusing on key issues in2012/13. Our work programmes are designed toensure we are concentrating our efforts where ourmembers need the most support as they strive tomake the required efficiency savings and maintain

and improve the quality of care while implementingthe biggest reorganisation of the NHS in its history.

This report forms part of our work programmeon Supporting a new style of NHS leadership.To read more about our work in this area, seewww.nhsconfed.org/leadership

For more information on our work,please contact:

The NHS Confederation50 Broadway London SW1H 0DBTel 020 7799 6666Email [email protected]

www.nhsconfed.org

Registered Charity no. 1090329

Published by the NHS Confederation The NHS Confederation 2012You may copy or distribute this work, but you must give the author credit, you maynot use it for commercial purposes, and you may not alter, transform or build uponthis work.Registered Charity no: 1090329

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Leadership in a matrix 01

Foreword

The need for exemplary leadership in the NHSis greater than ever. The NHS faces its biggestever challenge of a 20 billion productivityrequirement, the huge pressures facing thesocial care system and the need to drive upquality of care and health outcomes, all setamidst a time of immense change, which willsee a new system in place from April 2013.

In response to this significant challenge, itis clear that there is a desire from leadersacross the system to work closely togetherto build a shared leadership approach, usingand developing a variety of leadership skills.

This paper is the first in a series which willexplore in detail the needs of healthcareleaders in the new system. We have asked

respected and influential leaders from theNHS, public sector, voluntary and privatesectors to share their personal insights intoleadership throughout the run up to the2013 NHS Confederation annual conferenceand exhibition. The series aims to stimulatediscussion about the importance of leadersbeing able to adapt to working in the newsystem by developing new skills, buildingtrust, leading through influence and actingcourageously. We will also discuss what

steps will need to be taken to ensure theseskills are developed for the future.

This first paper, written by Ciarn Devane,draws on his own experiences of working in amatrix system. He calls on NHS leaders to builda different set of core skills, covering conflictresolution and multi-party negotiation in orderto lead through influence. Furthermore, hehighlights the importance of leaders being able

to operate across the breadth of the new systemand he makes it clear that he believes the futuresuccess of the NHS will be heavily reliant on theabilities of its leaders to build trust.

This paper was authored by Ciarn Devane,who has served as Chief Executive of MacmillanCancer Support since May 2007. He also servesas a member of the Cancer Outcomes StrategyAdvisory Board and the National StakeholderForum of the NHS. Ciarn co-chairs the

National Cancer Survivorship Initiative, sits onthe board of the National Council for VoluntaryOrganisations and is a trustee of the MakatonCharity. In January 2012, Ciarn Devane wasappointed as a non-executive director of theNHS Commissioning Board Authority.


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Leadership in a matrix02

What is a matrix organisation?

02

What is a matrix organisation?

Matrix organisations are grid-likeorganisational structures, commonly used inthe management of large projects and productdevelopment processes, drawing employeesfrom different functional disciplines forassignment to a team, without removing themfrom their respective positions. Emerging fromthe aerospace industry of the 1960s, wheregovernment contracts required a project-basedsystem linked to top management, the modelhas since been adopted by many organisations,including several multinationals. It is creditedwith allowing these companies to addressmultiple business dimensions such as function,product and geography, using multiplecommand structures.

The main reasons given for organisationsadopting the matrix model are:

it allows companies to establish economiesof scale

Analyst

Business analyst

manager

Project 1Manager

Project 2Manager

Project 3Manager

Analyst

Analyst

Developer

Development

manager

Chief executive

Developer

Developer

Tester

Quality assurance

manager

Tester

Tester

it allows companies to focus on multiplebusiness goals

it facilitates the management of information

it speeds up the response to environmentaldemands.

The matrix can take many forms, but the

balanced matrix is often described as theclassic model by which the matrix is known.It features employees who are membersof two organisational dimensions and whoreport to two managers. Project managerstake responsibility for defining what needsto be accomplished, while functionalmanagers define personnel staffing andhow tasks will be accomplished.

1 DAnnunzio LS, Sy T. Challenges and strategies of matrix

organizations. Human Resource Planning.


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Leadership in a matrix

03

Moving from hierarchies to amatrix system

The NHS has long been a hierarchical place.Edicts developed by ministers were passedto Quarry House in Leeds. The headquartersof the NHS passed on the instructions to

the strategic health authorities (SHAs), whopassed them on to primary care trusts (PCTs),who told the trusts and practices. Dependingon some combination of grip, capability andwillingness to comply, things happened.

The new world is not like that. In a world ofmatrix organisations operating in a system inwhich there is no ultimate authority, you canbe accountable for delivery, but not own theresources to do so. You might be told some

task is the top priority for your organisation,but find you are working with a colleague froma different component of the system, withoutwhom nothing will happen, but who doesnot have the vaguest reference to it in theirobjectives. And you have no ability to instruct.Leadership is through influence, not authority.It is leadership across boundaries, not onlywithout authority, but without visibility.

Moving from one world to another can be

unsettling. One former NHS chief executive,finding himself in a matrix organisation,declared that, the problem with our matrixis it is not clear which arm of the matrixdominates. Which precisely misses the point.

Moving out of an organisation Henry Fordwould approve of, what support shouldan effective leader be given to operate ina literally anarchic world with no higherauthority to mandate the solution?

Learning from others

Fortunately, matrix working is a well troddenpath. Multinational companies are themost common three dimensional matrix.National managers, product managersand functional managers have to reconciletheir competing objectives to determinethe corporate plan, which integratesdisparate, but equally legitimate, views.

Simon Dingemans, chief financial officer ofthe pharmaceutical firm GlaxoSmithKline,a multinational company which usesthe matrix organisation structure, hasoutlined the key success factors critical todriving greater value for their business.

The multinational lessons fromGlaxoSmithKline (GSK)Simon Dingemans explains: There are threesimple principles that we employ consistently

across the organisation. Firstly, there mustbe clear organisational goals, then clearand stated alignment to those goals by thefunctions within the matrix. This ensuresthat the organisation is focused on deliveringthe right things. Secondly, teams must beempowered to allow decision-making atthe right levels to enable slick and efficientdelivery to the stated goals. Finally, establishednetworks must be created to enable matrixleaders to engage with the right people at the

right times; this is what gets the job done.

Leadership is through influencenot authority. It is leadershipacross boundaries, not only withoutauthority but without visibility


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As leaders, we need to invest time to ensurethat the organisation is set up in the rightway to take advantage of the matrix model.It is important to ensure that responsibilitiesarent blurred, that accountability is clear andthat teams are empowered and supportedfrom the top to drive outstanding results.This is becoming increasingly important to

us as the drug development and regulatorylandscape becomes more complex.

Matrix working is deployed extensively acrossGSK and is regarded as having a very positiveimpact on project teams. Kathy Rouan, amedicines development leader at GSK, outlinesthe benefits, opportunities and challenges thatmatrix working brings for her.

Rather than teams being beholden to

multiple layers of decision-making, we haveput trusted and accountable leaders in chargeof small teams. We have given them budgetand influence over who sits on their teams,and empowered them to make the decisionsnecessary to progress an asset throughthe development lifecycle. Only at majorinvestment decision and value inflection pointsdo we need to seek committee approvals.

I have real support from the top to achieve my

goals. Projects are very important at GSK; this is aclear statement in our strategy and now a robustorganisation is set up behind each project. Everyproject is run by a talented individual who isempowered to deliver. While vision, strategy andalignment are essential to ensure that everybodyis working towards the same goals, it is alsocritical to have the right behaviours in yourmatrix team to deliver on those goals.

The desire to collaborate and communicate,

confidence in making decisions autonomouslyand an ability to genuinely work as part ofa team are vital attributes. We are a small,focused team working towards the same goals,committed to the success of our project.

As a matrix leader, none of my team reportsdirectly to me, but I still view myself as adeveloper of their talent; you have to embracesome of the elements of a line manager toensure people continue to grow and develop.

There are of course challenges. Scalabilityis the most profound test of the model.Developing drugs across multiple countries,involving a growing number of specialisms,is becoming much more complex. As thesize of the portfolio grows, you have to putgreater trust in your teams when youredealing with 30 to 40 projects it can be achallenge to resource them all at the sametime with people at the right level. Thisis where strong line management playsa key role in supporting the matrix.

Simon Dingemans conclusion is thatthe three factors critical to drivinggreater value for the business are:

alignment with a clear goal

the autonomy to make decisions

a managed process of engagement.

He concludes that: It may sound like aclich, but truly empowered people are atthe heart of an organisation of the calibre ofGSK. The matrix environment allows themthe flexibility and the autonomy to deliverresults. Ultimately, allowing our people togive their best is what delivers the medicineswhich improve the quality of patients lives.

Truly empowered people are at theheart of an organisation of the calibreof GSK. The matrix environmentallows them the flexibility and theautonomy to deliver results


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The key insightAs Simon Dingemans describes, the better

multinationals have made an important leapin understanding by realising that you do

not create good matrix working by providing

increasingly clear guidance as to the relative

roles, rights or decision-making powers of

the actors in the drama. The variability in

geography, products and priorities, but above

all in people, makes that futile. Furthermore,

his conclusion implies that those matrix

organisations which do not empower their

people are the least effective, because how

to make a decision is difficult to work out.

The boards of the companies who do this wellachieve two things. First, they make sure each

individual is clear about their overall goals,

and the individual understands that they arethemselves responsible for deciding the method

for accomplishing these goals, within the

confines of the law, ethics and brand. But the

critical step is the recognition that competing

points of view will not reconcile themselves

and what is required is a consciously

designed conflict resolution process, usually

positioned as a planning process which is

able to integrate the different points of view.

This process can best be explained by giving

an example of a typical planning process.

Conflict resolution in practiceImagine we are dealing with a fertiliser

company. At one point in the year, the common

data set on which decisions will be made is

agreed. How many acres of wheat will be sown

in Canada? What will the price of raw materials

be next year? Will Russia be in the market?

Will China be shifting lots of rice at low cost?

The first step of the process then is to agreethe data on which later decisions will be made.The second, later intervention is to agree thedecision criteria and non-negotiable priorities.

Countries which have growing futuredemand for fertiliser will get the first call.Every country will launch the new superfertiliser the lab invented.

Only as a third, separate and facilitatedstep, is the debate held to develop theholistic plan. The rule is that collective

judgement can only be made using theagreed data and agreed criteria.

The advantages are obvious. Separating thesteps and agreeing the uncontentious up-frontbounds the debate, builds relationships andfocuses on the critical. The implication foran organisations leadership is profound. Thebiggest barons do not get their way. It is thosemost skilled at conflict resolution. And thetrue power is with the person who facilitates

the process. As Mike Standing of the MonitorCompany suggests, reducing complexity isimportant, but without the process to integrateand the skills to do so, success is unlikely.

Principles for buildingmatrix organisations

Mike Standing, the senior partner in Europe

of the Monitor Company, gives a moretheoretical view of matrix management, inthe context of NHS reform. He suggests thatmatrix structures are critical to organisationswhich need to build specialist capabilitiesand then integrate these skills and points ofview to achieve their objectives. He highlightsthree principles reflecting the experiences ofprofessional service firms operating matrixorganisations. Although transferring bestpractice from one sector to another can

be problematic, one can see that there areimportant parallels between the challengesfacing these organisations, the solutions theyhave adopted and the issues facing the NHS.


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Lessons from the professional services industry

Build the matrix structure around only two axesThe discipline to limit the number of axesin a matrix structure is challenging becausein many organisations, such as professionalservice firms, there are often more than twodimensions of the organisation which need

to work together. In these firms, regionsor countries are responsible for managingpeople, content units develop new productsand account managers address the needsof customers. As a result, occasionally thesefirms attempt to build matrix structures withthree axes which can increase managementcomplexity, cause poor decision-making andincrease overhead costs. Limiting the numberof axes requires real choices, and a clearunderstanding of where value is created.

All professional service firms require content,but today the critical issue is either applyingcontent to meet the client needs (the roleof the account manager) or maintainingcapabilities and managing the deployment ofprofessional staff (best performed by regionalmanagement). As a result, most professionalservice firms are structured around two axes:clients and regions. Content developmentis integrated into one of the other axis

and does not have the same influence.

One thing to be very wary of is the relativepower of the arms of the matrix. In aprofessional services firm, one can legitimatelysay most value is driven by using ones peoplewell, or alternatively by servicing clientssingle mindedly. One arm of the matrix isparamount. But where the matrix exists not somuch to manage a capability, but to representpoints of view, to have one arm dominate is

to negate the reason for having a matrix inthe first place. In this case, the integrationof the matrix is the defining requirement.

Focus on building processes to support theintegration of the two axes of a matrix structureSuccessful matrix organisations clearly definethe roles, responsibilities and decision rightsof managers in the two axes, which theyreinforce through supporting metrics. Thishelps to ensure everyone has an understandingof how their activities fit into the broaderpurpose and how they connect to other tasks.

More importantly, they also recognise thatdifferent teams have different behavioursand can have divergent views. As a result,in addition to implementing clear decisionrights, they also invest in team alignmentand joint problem solving skills. Onlythrough the combination of clearly designedroles and the development of effectiveteams at the intersection of the matrix canmatrix organisations work effectively.

Build leadership skills to manage andintegrate the axes of the matrix organisationIn professional service firms, senior executivesare expected to have experience in managingboth axes of the matrix client managementand regional management prior to beingappointed to a senior role. Criteria forpromotion place emphasis on the ability towork collaboratively across different partsof the organisation. Building these skillsis critical both to ensuring that the senior

executive can make decisions which maximisethe effectiveness of the matrix, but alsoto making sure they are seen as credibleleaders across the whole organisation.

If there is a robust process, thendeveloping a good plan is notdependent on having uniformlyenlightened leaders who instinctivelydo the right thing


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The new architecture of the NHS

Which leads us to the new NHS architecturein England. Consider how this looks locally.Rather than national managers, productmanagers and functional managers, wenow have clinical commissioning groups(CCGs), health and wellbeing boards (HWBs),

and commission board areas (CBAs). Thefirst has a legitimate clinical view, thesecond a legitimate local one, the lasthas a legitimate duty to drive outcomes.Add in providers, voluntary organisationsand regulators, and the art of multi-partynegotiation becomes a core competenceeach organisation needs to develop.

The new NHS architecture needs to developthe equivalent to our multinationalsplanning process one in which there isa shared understanding of outcomes andpopulation data, where decision criteriaand priorities are developed, and thedisparate views are formed into a plan.

The importance of this process cannot beoverstated. First, a plan which incorporatedthe views of the CCG, HWB and NHSCommissioning Board is likely to be a goodone. More importantly, if there is a robustprocess, then developing a good plan is notdependent on having uniformly enlightened

leaders who instinctively do the right thing.If the process is good, you can get away withhaving a bad national or product managerin the odd place and still have a good plan.With an NHS of about 211 CCGs, 150 HWBs,27 CBAs and several hundred providers, NigelEdwards, the policy expert, would remindus we must not demand a system which

relies on every leader being above average.

Investment in leadersHaving said we must not create a systemdependent on having exclusively great leaders,it would be quite good to have as manyas possible. We need to invest in helpingthe already good leadership in health toadapt to the new world in which authorityis replaced by influence. To some degree,this is about shades of skill. No NHS leader

ever relies entirely on their right to instructor to demand. But the option is there if oneis in the management line. If you are not inthe management line, that option is neverthere, and you can legitimately be ignored.That will be an uncomfortable feeling forthose who are used to authoritative roles.

The voluntary organisation leadershipthrough influenceMy own organisation, Macmillan Cancer

Support, is a good example of leadershipthrough influence. In size, we are one 60th ofthe cancer budget, so while we aspire to do alot directly, much of what we do is to use our100 million of charitable expenditure to helpshape the use of the 6 billion of public moneyspent on cancer. We talk about being a force forchange as well as being a source of support.

In our influencing, we apply some mentalmodels to our work. Management theory talks

about the rational, emotional and politicalaspects of leadership. Within Macmillan, asin all leadership roles, my team and I willmove constantly between all three aspects.

The new NHS architecture needsto develop the equivalent to ourmultinationals planning process one in which there is a sharedunderstanding of outcomes and

population data, where decisioncriteria and priorities are developed,and the disparate views are formedinto a plan


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Therefore, in its influencing role, Macmillanseeks to create and talk about exemplarservices for their own sake, shape the 6 billionof cancer spend, and influence the larger 122billion of UK health expenditure. And withoutthe authority to dictate, we need to do this byconsciously managing how we interact with theother components of the system.

In praise of anarchy

The major distinction between this externalengagement of Macmillan and the internalmatrix organisational issues identified bySimon Dingemans and Mike Standing, is thatin the system there is no higher authority, noultimate boss who will arbitrate or dictate, no

rulebook which can be used by a referee. Thisis the literal definition of anarchy. The upsideis freedom from people telling you what to do.The downside is the inability to get things donewithout the acquiescence or support of others.

But we do notice how we are differentoutside. Internally, we like to believe we arebroadly rational. We use evidence, point toprecedent and align with our strategy routemap. On the other hand, at the end of theday we can cut the conversation, make adecision and tell people to get on with it.

Outside Macmillan, we cannot tell anyoneto do anything. So our evidence needsto be emphatic and our insights new tothe people we are talking to, so that theylearn something which could change theirperception. Our rational leadership needsto be really robust. We speak of thought-leadership as an enabler of trust, sincethat trust is created through the credibilitythat insight gives you, as well as intimacythrough being known, and through a record

of success which addresses perceived risk.

In the absence of political authority, wedeliberately work with others to establishcommunities of influence, the best recentexample being the Richmond Group of leadinghealth charities. The community of influencemodel underlying the Richmond Group isunderpinned by the work of Donaldson, Lankand Maher, with its talk of actively planningthe social life of the document a group

produces, making the invisible examples ofgood practice visible, and bringing people ofdifferent characters together for the long haul.

The Richmond Group came together todrive change through a communicationsplan expressing dissatisfaction with thepresent, in which we felt there was a lack ofparity of esteem for the patient voice in NHSreforms, and presenting an attractive visionwith a consensus definition of high-quality,

patient-centred, cost-effective care and acommitment to support the NHS throughthe pain of transition. In managementwords, our communications plan deliberatelymimicked Beckhards change equation.

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Beckhards change equation

The Formula for Change, which was simplifiedby Kathleen Dannemiller to (D x V x F > R),was originally devised by Richard Beckhardand David Gleicher to provide a model toassess the relative strengths which will affect

the likely success or failure of organisationalchange. The revised formula expressesthe notion that in order for meaningfulorganisational change to take place, thenthe product of Dissatisfaction (D) with thestatus quo, multiplied by the vision (V) ofwhat is possible, multiplied by the first (F)concrete steps that can be taken, must begreater than the resistance (R) to change. Ifany one of these components (D,V or F) isabsent or low, then the overall product willnot be capable of overcoming the resistanceto change and change will not be possible.


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If one skill needed in the complex world of thenew NHS is conflict resolution, the other ismulti-party diplomacy the skill of not onlyresolving issues through an agreed process tocome to the common solution, but doing sowhen the process itself has to be negotiated,when several legitimate views are at thetable and when there is no reason to believe

everyone actually wants an agreement.

Political theoryThe masters of maintaining order in theface of anarchy are of course our politicians local, national and international.Convincing us all to believe in the law, haveconfidence in the pound, or accept shuttingthe hospital ward, is a political skill. Howconflict is resolved in an anarchic systemis the subject of three competing theories

and, in practice, all three play a part.

Realismat a basic understanding would saythat all organisations will behave the sameway in a given situation and that relative powerdetermines the result. So, someone mighthave a nice idea but if they havent got anymoney while someone else does, then thelatter persons idea will win. Realists believe inlarge armies and London teaching hospitals.

Institutionalismsays organisations will poolideas and sovereignty for the greater good if acredible institution exists where complex trade-offs are made and what they lose today will bemade up in the future. Institutionalists believein the United Nations and clinical networks.

Constructivismbelieves we are a productof our past and what happens depends onwho is in charge and where they came from.Constructivists believe in history, culture and

organisational development programmesfrom the NHS Leadership Academy.

The reality, of course, is that all three modelsapply in politics as they will in the new NHS.

Three competing world views co-exist, andsuccess requires accepting the truth in each.The skill will be to know when to apply each oneor, more precisely, how to manage the interplayof all three. This poses several questions, suchas: How do you draw a large foundation trustinto a negotiation, balance their presumedpower and enforce compliance? How will anetwork earn the confidence of the healtheconomy to reconfigure a pathway? How willingrained tribal behaviour be managed?

Building the capabilities of NHS leadersHolding the complexities of an anarchic systemin ones head has not been a requirement ofa typical NHS leader. But it is the experienceof your average local authority chief executive.Dealing with a multi-party council with acabinet structure, trading off the school,the housing association, the police andleisure service, is their bread and butter. It isreasonable to expect the council chief executiveto be good at the health and wellbeing boardprocess and at the Joint Strategic NeedsAssessment (JSNA). NHS managers may notthink in terms of the theory of political relationsbut others around the table will.

Equally, NHS leaders will need to be adept atbuilding cross-boundary teams, at inspiringpeople to follow them based on their thoughtleadership, clarity of vision and credibility. Thisis not new to any of us, but it is different in

degree. Being insensitive to those differenceswill risk failure failure in ones new role andalso failure of the new system.

NHS leaders will need to be adept atbuilding cross-boundary teams, atinspiring people to follow them basedon their thought leadership, clarity ofvision and credibility


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System regulation and system values

There are forces which bind systems together.Regulation is one, and health is a heavilyregulated sector. Despite Harry Cayton, theregulators regulator, wishing for right-touchregulation, we seem to either have too muchregulation, as in multiple regulators visitingthe same provider, or too little, as in the failureof self-regulation by some professions.

The best regulation must be a mix: self-regulation as a way of ensuring professionalstandards; peer review as a learning vehiclefor sharing good practice; minimumstandards and essential rules enforcedby interventionist external regulators.

On top of any system is contract law, whichsays: I want you to do this, it is in thecontract and I can enforce it. In health,this applies to commissioning frameworks,data capture and waiting times. Failureto comply with these means sanctions,publicity and professional disapproval.

Yet the health system, as much as the freemarket system, actually does not rely thatmuch on law or regulation. If you fall backon either of these, you are already in trouble.

Just as a matrix organisation operates oninfluence not authority, a complex systemoperates on trust not enforcement of rules.The test is whether you trust the individual

or organisation to act correctly, not becausethey are regulated, but because you believethey will still act correctly when no one islooking. This is also the real lesson of MidStaffordshire. Frontline supervision shouldbe expected and trusted to behave well, andleadership should act to promote that.

Rules, instinct and behaviour creates trustEd Smith, formerly senior partner ataccountants PwC and now a non-executivedirector of the NHS CommissioningBoard, as well as Pro-Chancellor of theUniversity of Birmingham, points to a WorkFoundation document he and RichardReeves, formerly director of the IntelligenceAgency, produced in which they considerwhole-sector leadership and regulation.

Organisations need to be trusted to succeedand many organisations are losing that trust.Real trust is delivered by self-regulationand by peer regulation. While externalregulation has its place, it risks over-emphasis on the technical rules and crowdsout what are essentially moral principles.

Ed points out that trust is awarded toorganisations which trust themselves, whichare seen to have processes, especially regarding

people, which are trusted internally. Externalreputation and internal people processes aremanifestations of the same thing. Culture,which does include rules, but also instinct andbehaviours, drives this trust. Focus too much onthe rules and organisational integrity loses outbecause the application of the organisationalconscience is compromised. Sadly, whensomething untoward happens and we alldemand that something be done, the defaultis more rules and often the wrong regulation.

The right answer is harder to deploy. Asa leader, the rational rules need to becomplemented by your work on organisational

A complex system operates on trustnot enforcement of rules. The testis whether you trust the individualor organisation to act correctly, not

because they are regulated, butbecause you believe they will still actcorrectly when no one is looking


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instinct and behaviours. If your diary wereanalysed, would it demonstrate a balanceand show that you and your senior teamwere spending sufficient time on peoplestrategies? Would your own behaviours passscrutiny, and are they truly consistent withthe espoused behaviours of the organisation,i.e. your espoused behaviours as a leader?

Moreover, would someone who is notyour appointee, acolyte or accomplice saythe same? The final test is whether youcan show you are driving everything fromcustomer service to patient experience toinnovation to efficiency by putting people andbehaviours at the heart of how you do it.

Ultimately, Ed Smith says the future isabout real trust. It is about knowing youare dealing with Kants honest shopkeeper

who, even when they could short changeyou without you noticing, does not. Withoutthat trust, systems do not work and thenew NHS architecture wont either.

The final test is whether you canshow you are driving everythingfrom customer service to patientexperience to innovation to efficiency

by putting people and behaviours atthe heart of how you do it

Conclusion

So, where does this romp through matrixorganisations, anarchic systems and sectorvalues get us?

For me, three implications stand out. Thefirst is the need for the system to build thecapability to operate in the new way. Anorganisational development interventionwhich is well structured, available to alland consistent over time is required. Itis right for the NHS Leadership Academyto host this for the broader NHS.

Secondly, individual leaders should ensurethey have read around the topic of matrixmanagement and system leadership. Coreskills in the new world, such as conflictresolution and multi-party negotiationskills, will be essential, as competenciesin these skills will define who will succeedand who will not. A reading list is below.

Finally, effective system leaders will need totruly understand the different parts of thesystem. Experience as a provider and as acommissioner should be a requirement ofpromotion in the major system players. All willneed to build trust, which will include buildingtrust in themselves, in their organisationsand in the brand, which is the NHS system.Wide experience will facilitate that trust.

How to deliver this agenda is a topic foranother discussion on another day, but havingthe debate should be an urgent priority.

It may be an exaggeration to say the world willbe wildly different, but as the chief executiveof a matrix organisation, operating in a systemwhere we influence without authority, I knowthat many of those joining Macmillan fromhierarchical organisations failed to thrive intheir roles if they did not develop the new


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skills. The difference is real and is potentiallydamaging to people and careers.

NHS leaders of the future managerial,patient and clinical will be working acrosssystems and organisational boundaries. Patientoutcomes will not be delivered by only workingwell within our own organisations, be it a CCG

or a trust. The duty of care as an employerapplies and all of us have a duty to staff tohelp them succeed. This is never more truethan now, as thousands of our NHS colleaguesseek new roles. Let us hope all parts of the newEnglish NHS invest accordingly.

Ciarn Devane, November 2012

Contributors

Ciarn Devane Chief Executive, MacmillanCancer Support

Simon Dingemans Chief Financial Officer,GlaxoSmithKline

Ed Smith Pro-Chancellor, Universityof Birmingham

Mike Standing Senior Partner, theMonitor Company


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Top ten learning points

1. The success of a matrix organisation is not necessarily based on defining the roles, rightsor decision powers of the actors in the matrix. Instead, it is about ensuring that people areabsolutely clear about their own objectives and ensuring that they have the autonomy to decidehow to meet those objectives themselves.

2. There should be a focus on building processes to support the integration of the axes of a matrixstructure. This ensures that everyone in the matrix understands how their activities fit into thebroader objectives. Furthermore, it means that the different teams can understand the differingviews and behaviors of the other teams.

3. The new NHS architecture needs to develop the equivalent to a multinationals planning process one in which there is a shared understanding of outcomes and population data, where decisioncriteria and priorities are developed, and the disparate views are formed into a plan.

4. Investment is needed to help the already good leadership in health adapt to the new world inwhich authority is replaced by influence. Leaders will need to get used to not being able to usetheir rights to instruct or demand. Instead, they will require the skills to lead through influence.

5. NHS leaders will need to be skilled at multi-party diplomacy, which not only involves coming tosolutions, but which will often involve having to negotiate the process itself.

6. NHS Leaders will need to be adept at building cross-boundary teams, inspiring people to followthem based on thought leadership, clarity of vision and credibility.

7. A complex system like the new NHS will operate on trust rather than enforcement of regulationsor contract law. Frontline staff should be expected and trusted to act well, and leadership shouldact to promote that.

8. Leaders need to put people and behaviours at the heart of what they do, because it is thesefactors which drive trust. Without that trust, systems do not work and the new NHS architecture

wont either.

9. Effective leadership requires real understanding of the different parts of the system. Experienceas a provider and as a commissioner should be a requirement of promotion in the majorsystem players.

10. All the new players in the NHS will need to build trust in themselves as leaders, in theirorganisation and in the brand, which is the NHS.


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Useful resources

Donaldson A, Lank E, Maher J (2011)Communities of influence: improving healthcarethrough conversations and connections.Radcliffe.

Fisher R, Shapiro D (2005) Beyond reason: usingemotions as you negotiate. Viking.

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The NHS is facing its biggest ever challenge, withthe 20 billion productivity requirement alongsidethe huge pressures facing the social care systemand the need to continue to drive up quality of careand health outcomes. In response to this significantchallenge, it is clear that there is a desire fromleaders across the system to work closely togetherto build a shared leadership approach, using and

developing a variety of leadership skills. The need forexemplary leadership in the NHS is therefore greaterthan ever.

This paper, the first in a series which will explorein detail the needs of future healthcare leaders inthe new system, is written by Ciarn Devane. Hecalls on NHS leaders to build a different set of coreskills, covering conflict resolution and multi-partynegotiation in order to lead through influence.


The NHS Confederation

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Further copies or alternative formats can be requested from:Tel 0870 444 5841 Email [email protected] visit www.nhsconfed.org/publications

The NHS Confederation 2012. You may copy or distribute this work, but you must give

the author credit, you may not use it for commercial purposes, and you may not alter,

transform or build upon this work.

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Leadership Matrix