Exploring transformative engagement of managers, clinical staff and patients

Policy directives and the new NHS constitution require managers and leaders to adopt strategies that motivate and encourage teams to work collaboratively with staff and patients. These innovative ways of working are seen as a means of improving the quality and coordination of patient care, thus impacting on the patients’ experience.
Despite this focus, the evidence of what constitutes and therefore what can deliver effective collaboration between managers, staff and patients is sparse. This study identifies a conceptual model of effective management strategies and behaviours that will assist in achieving partnership and collaborative working.
This research is based in the real world which is complex and uncertain. The study uses an explorative framework and gains insight from a number of different perspectives. The methodological approach is a qualitative case study. Data was collected from an NHS Trust based in Wales and a District Health Board in New Zealand. Data was collected through document analysis and semi-structured interviews.
The findings support a move from a managerialist approach (where managers are target driven, transactional and administer activity) to a more reflexive, egalitarian, transformational approach that can be adapted to cope with complex environments and function successfully in the zone of chaos (where problems are ill defined and messy). The ability of a middle manager to interpret context and operate a balanced approach would appear to be key to navigating a constantly changing and negotiated environment. This study supports adoption of a servant leadership model and proposes guidance for middle managers undertaking change. The guidance proposed is a move away from the dominant doctrine of managerialism and describes the principles for working collaboratively with front-line staff in the NHS and the New Zealand health system.