Abstract
This paper considers the rise of ‘leadership’ in discourses relating to the British health service, and the application of the term to increasingly heterogeneous actors. Analysing interviews with NHS chief executives from the late 1990s, and key policy documents published since, we highlight how leadership has become a term of choice among policymakers, with positive cultural valences which previously predominant terms such as ‘management’ now lack. We note in particular how leadership is increasingly conferred not only on those in positions of formal power but on frontline clinicians, patients and even the public, and how not just the implementation but the design of policy is now constructed as being led by these groups. Such constructions of the distribution of power in the health service, however, contradict the picture drawn by academic work. We suggest, therefore, that part of the purpose of leadership discourse is to align the subjectivities of health-service stakeholders with policy intentions, making their implementation not just everyone’s responsibility, but part of everyone’s sense of self. Given the realities of organizational life for many of the subjects of leadership discourse, however, the extent to which leadership retains its current positive associations and ubiquity remains to be seen.
Highlights
„Leadership‟ has been the focus of increasing attention for both policymakers and academics
In the private and public sectors, leadership has become more than merely a function within management: it is constructed as something to be enacted by employees across an organization, not just those at the apex (Bryman, 1999)
We ask: what are the consequences—for individual healthcare staff, and for healthcare policy and practice as a whole—of labelling things „leadership‟? In doing so, we draw on empirical fieldwork conducted with National Health Service (NHS) managers in the 1990s, and key policy documents produced from the late 1990s to the present
Summary
„Leadership‟ has been the focus of increasing attention for both policymakers and academics. The idea that leadership is universally beneficial seems holds for most studies of leadership in health Reviewing this field, Gilmartin and D‟Aunno (2007) draw attention to several distinctive aspects of healthcare delivery (e.g. the existence of “powerful professionals, especially physicians, who dominate many aspects of day-to-day work in healthcare,” p.390)—distinctive features of healthcare which, they contend, add complexities to attempts to transfer leadership theories from elsewhere. We note an expansion in the ways in which the term „leadership‟ is applied in the policy literature, as an attribute not just of formal leaders/managers, but to an increasingly plural set of stakeholders, including clinicians and even patients and the public We illustrate how this policy focus on leadership might be understood as seeking to affect the work and even the subjectivities of health-service professionals and other actors (such as patients and the public). We suggest that claims made by health policy about the engagement of professionals as leaders in the design and delivery of reform are best understood as efforts to reconstitute these actors‟ subjectivities: a co-optive means of „governing at a distance‟ that complements more coercive modes of rule such as performance management and associated surveillance regimes
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