The dramatic lurch to ‘command and control’ leadership during the COVID-19 pandemic and its aftermath has seen commentators asking whether ‘heroic leadership styles’ might linger, affecting the long-term culture of the workplace (Hulks, 2020). Those who work in ambulance services generally favour a hierarchical and broadly directive style of operating (Wankhade et al, 2015). Therefore, a step-change away from direction and advice might present a more significant psychological challenge to the ‘hard-wiring’ of many senior ambulance staff. This ‘cultural chasm’ is surely a significant matter if one of the single most important things leaders do is to create and manage culture.
A leadership style that is overly directive and centred on advice-giving works well in emergency situations or when the environment or task is unfamiliar. However, if this becomes a dominant and pervading culture, it is unlikely to sustain good relationships and is likely to contribute toward a ‘dependency culture’. The natural desire to innovate and strive for improvement will be impeded, as professionals learn to await repeated instruction before acting. A symptom will be more frequent ‘escalation’ of routine tasks that should comfortably be within the scope of the role.
This thinking appears to be in keeping with national policy on NHS workforce development, as NHS England's plan is to recruit but more staff than is needed to ensure that the NHS is the ‘best place to work with positive cultures and leaders who develop, support and engage their workforce to improve’. But what do senior staff need to be conscious of when attempting to deliver this?
A classic piece of work explaining the difference between ‘management’ and ‘leadership’ might provide a clue. Handy (1993) argued that management was about direction, mentoring and managing risk through clear process and procedural design. This sounds like an essential role in ambulance services. A totally different prescription is offered when it comes to leadership, as this is about enabling people to calculate and take risks, engaging and encouraging them to think creatively and to challenge the existing way of doing things. Leadership, unlike management, is said to be about coaching and delegating (Handy, 1993). A fundamental lack of understanding about these differences is commonly found in the NHS, causing confusion or even conflict. A number of NHS organisations continue to pour petrol on this confusion by treating the word ‘management’ as a toxic term, often eliminating it from the organisational lexicon and instead, promoting ‘leadership programmes’ that, ironically, broadly consist of and promote a management-based ethos.
So, the challenge for leaders in the ambulance sector is to recognise that they contribute to the pervading culture through their own behaviours and approach. To heal the ‘cultural chasm’ exacerbated by the pandemic, senior staff will need to learn to ‘let go’ of the safety blanket of heroic leadership and embrace the skills required to coach or delegate to what is, after all, a technically competent and professional workforce. The further challenge for those providing regulatory oversight of course, is whether they are prepared to provide the support and air-cover required for what is now a seismic change of culture.