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Lessons in empowerment

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VOL: 98, ISSUE: 26, PAGE NO: 36

Alan Shaw, FIBMS, BA, is chief biomedical scientist in cytology, the Royal Lancaster Infirmary

Leading an empowered organisation (LEO) is a powerful course for health care managers from all disciplines and at all levels of experience. Focusing on empowerment, dignity and mutual respect, it aims to produce strong and efficient leaders. After attending the three-day programme I have begun to implement some of its ideas in my department. This article is a personal account of my experiences on the course.

Leading an empowered organisation (LEO) is a powerful course for health care managers from all disciplines and at all levels of experience. Focusing on empowerment, dignity and mutual respect, it aims to produce strong and efficient leaders. After attending the three-day programme I have begun to implement some of its ideas in my department. This article is a personal account of my experiences on the course.

The LEO programme
The LEO course was created over several years by the Centre for the Development of Nursing Policy and Practice in Leeds, in association with Creative Healthcare Management (CHcM) in Minneapolis, USA. Diane Miller of CHcM helped to adapt LEO for the British NHS. The course continues to evolve to meet the ever-changing needs of our health care system. The structure of the three-day programme is outlined in Table 1.

Empowerment
The course began with an introduction to the concept of empowerment. In an empowered system staff are given greater control and there is a move away from autocracy towards self-directed teams, where managers influence rather than control. To create such a system you have to decentralise, a process that is supported by responsibility, authority and accountability.

We were asked to recall our own experiences of responsibility, authority and accountability. The rationale was that once we understood our own attitudes and how we could empower ourselves, we would be able to pass the knowledge on and empower members of our teams.

Using a sliding scale - ranging from autocracy at one extreme to self-directed teams at the other - participants were asked to identify their position. Like most people I placed myself in the middle.

We were then asked to consider the organisational changes that would be needed to allow movements in either direction on the scale, and what support would be required for managers to relinquish control over staff. Organisational changes tend to be difficult to bring about, largely because the factors involved are often outside your control. (If you work for a forward-thinking and supportive organisation, you are less likely to be frustrated in this regard.) Several participants felt that they could not bring about change because of a lack of support from their supervisors and/or the reluctance of supervisors to relinquish control.

Leadership issues
Leaders and managers are not the same: a leader can be a manager, but not all managers are leaders. On the LEO course, leaders' roles were identified and the key points of management and leadership behaviour were set out.

Participants were asked to identify their own leadership strengths. I identified my strengths as being approachable, communicative and a team builder. We were then asked to identify areas for self-improvement, leadership behaviour that is supported by our organisations and behaviour that needs to be added to our organisations. The participants expressed a wide range of views, which may have reflected departmental problems more than organisational ones.

Adapting your leadership style
An important element of LEO is flexibility. Your leadership style should not be fixed but should be adapted to different situations. This is known as situational leadership. For example, a new recruit requires different leadership to a person who has years of experience. You should also be willing to change your approach as an individual gains experience. This idea is illustrated by the situational leadership grid (Fig 1). You may begin with a highly supportive and directive 'coaching' style for a new recruit, but once he or she is settled, a 'supporting' style may be more appropriate. A 'delegating' style can be adopted when people are confident in what they are doing.

The grid was taped out on the floor and the participants (split into 'leaders' and 'followers') had to place themselves in the appropriate box for different situations. There was much hilarity as people jostled each other to get in the correct box, only to discover that they had moved into the wrong one and had to move again.

As followers, you could be asked which behaviour your leader could increase to foster your growth. For different levels of skills, you could be asked what style best suited you as a follower or as a leader of those with varying skills.

Building relationships
LEO proposes that successful, healthy working relationships have the following characteristics: trust, mutual respect, consistent and visible support, and open and honest communication. The goal in relationships is to move beyond behaviour that fosters dependency and to develop interdependence.

Trust was described as an emotional bank account. You could make emotional deposits to build trust or emotional withdrawals that erode trust. Examples of emotional deposits include:

- Honesty and openness;

- Loyalty to the absent;

- Kindness and keeping promises;

Examples of emotional withdrawals include:

- Unkindness;

- Arrogance;

- Disloyalty;

- Not keeping promises.

There was a discussion about what constituted healthy and unhealthy behaviour as an individual or as part of a team.

Communication for leaders
All leaders need to communicate and the LEO course includes a section on communication and why many people fail to communicate successfully. By understanding what may prevent successful communication, participants improve their communication skills.

Many people think they are good communicators, but they often make simple errors so communication fails. A common problem is when staff do not do what you think you have asked them to do. In most cases this is because you have not stated your expectations clearly enough. Staff will respond appropriately if they are told exactly what you want from them. This was termed 'articulated expectations'.

Using the simple phrase 'I expect' is extremely powerful. For example, you could say 'I expect the report to be finished by the end of next week', instead of the woolly: 'Could you finish the report some time next week?' People appreciate being told what is expected of them. They know where they stand and have something to aim at. When I began using 'I expect' in my workplace I don't think my colleagues even noticed the way it was put to them. They just accepted the request and got on with it.

The course also identified certain 'killer phrases' that are used to oppose any suggested change, including 'it'll never work' or 'we have always done it this way and never had any problems'. Guidance was given on how to deal with such responses from staff. It takes practice but is worthwhile if you encounter 'killer phrases' regularly.

Making punishment positive
The modern NHS wants people to be encouraged to use their initiative and to come up with new ideas for service improvement. But how can this be done in a culture of blame? Anybody who knows that they will be punished for a mistake is likely to cover it up, and the chance to learn from the mistake and improve the service is lost. The answer is to change the culture to one of 'positive discipline'.

We all make mistakes. In a culture of positive discipline people are encouraged to own up to mistakes and to discuss them openly. This requires good communication channels within the organisation and effective feedback so that the individual concerned does not feel belittled.

Problem-solving
The final section of the course focused on problem-solving, processing and making decisions by consensus. When a problem arises it is far better to get the team to solve it than for the leader alone to solve it. Apart from 'many heads are better than one', it encourages the team to take responsibility rather than sitting back and letting someone else deal with it. With this positive attitude they are more likely to come up with alternative, workable solutions.

This is something that I do at work. If we have problems, I ask the staff involved to find a solution - it gives them ownership of the problem. Staff involvement should be welcomed and not feared. It earns you respect in the long run because the staff feel that they are listened to.

In one session participants asked groups to solve a real problem that they had encountered at work. This was great fun and allowed the participants to practise some of the problem-solving techniques taught on the course. During brainstorming sessions, participants were able to let their imaginations run wild, coming up with some outrageous solutions - which are encouraged by this particular approach.

Implications for the workplace
Although I have given a brief outline of the course content, there is much more to learn from it. You interact with people from other areas of work that you would not otherwise have met and gain insights into their work problems - as well as making new acquaintances.

In my workplace, team problem-solving takes place at departmental meetings. We have introduced 'quality circles', in which junior staff come up with ways to improve quality and involve senior staff only if a procedural change is required or there are costing, staffing, or health and safety implications.

We have developed a no-blame culture and now have a system to log errors and record discrepancies which need to be rectified. Using a formalised communication system, we follow up the discrepancies on a weekly basis until they have been resolved. Error logs can then be audited to identify weaknesses in the system.

All staff, including the most junior members, contribute to the problem-solving process. By empowering staff and keeping communication simple, open and honest, and supporting staff personally or professionally whenever they need it, the department functions very well.

LEO is worthwhile. As an individual I have gained much on many levels and am sure my department is reaping the benefits of my new leadership skills. However, there is always room for improvement.

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