Leadership matters – from bedroom to boardroom

The aged care leadership development project has offered limited value to the sector. Its Leadership Capability Framework misses the mark and has the capacity to mislead, writes Andrew Larpent.

The May-June edition of Australian Ageing Agenda contained an article by Rod Cooke, CEO of the Community Services and Health Industry Skills Council (CSHISC), about the aged care leadership development project. The article and the project it describes is a contribution to what should be a comprehensive discussion across the sector about what constitutes good leadership, how it is exercised and by whom.

However, in my opinion the approach currently advocated by the CSHISC, Aged and Community Services Australia (ACSA) and Leading Age Services Australia (LASA) is flawed and has to be challenged. This matter is important, and it deserves open debate in the sector at a time of fundamental change, and when the services that the aged care sector offer to Australian citizens are under closer scrutiny than ever before.

The Aged Care Leadership Strategy Paper (June 2013) and the more recently published Aged Care Leadership Capability Framework (February 2014) are apparently the result of a consultation exercise conducted across the sector. We are told that more than 400 aged care sector leaders were involved. It would be reasonable to expect therefore that the result would be an analysis that few would take issue with. In looking at the process of consultation questions should be asked about who was and was not consulted and how rigorously those conducting the exercise analysed the views of the sector and its stakeholders. It would be interesting to know how many CEOs and board directors were meaningfully consulted. The analysis as presented raises concerns about both the Strategy and the format of the Capability Framework.

Problematic ‘levels’ of leadership

The approach taken in the strategy paper, and in the framework, is fundamentally flawed. It seeks to compartmentalise leadership behaviours and capabilities into three distinct levels. It starts with Level 3 being “front line” or “first line” managers, Level 2 being “middle management” and Level 1 being senior management “likely to be the CEO”. Why label these so called levels in this way? If levels are to be used, and this in itself raises issues of compartmentalisation and a siloed approach to thinking, education and development, then surely the levels are the wrong way round. “First line” leadership should, by definition, be “Level 1”, and this is not a management level; it is leadership behaviour by the individual employee. Nor should it be implied that leaders develop through three levels only and then stop their development when they become a CEO. The faulty labelling matters because the analysis fails to recognise fundamental aspects of leadership at both ends of the workforce spectrum.

Leadership starts with the individual employee and it is a basic quality that is sought when any newcomer joins an organisation. Leadership development does not start when one becomes a manager. Leadership starts at the bedside. The example set by care staff in terms of personal presentation and conduct of daily activity is where they display leadership behaviour that has the greatest effect on the quality of service and on the quality of life of those they support. This is completely ignored in both the Leadership Strategy and in the Capability Framework.  What “level” of leadership is this? Are we to label this as Level 4? If it is to be so described surely it must be the first level, “Level 1”. This is how such behaviour is recognised as such in most sectors and in society; it is the starting point. Here in Southern Cross Care we have recognised the importance of the development of personal leadership qualities at this first level and have introduced our own framework that addresses cultural and attitudinal issues for personal care workers and trainees. It is our “Care Matters” framework within which personal leadership is taught to staff and required of them as a core component of our workforce culture and our values based approach.

At the other end of the leadership spectrum is an equally crucial component of the mix and that is the leadership responsibility exercised by the board, governors, directors, stakeholders and shareholders of any organisation. It is from the boardroom that the direction and tone of any organisation emanates. This is where the CEO and the executive management team receive their leadership direction and where the culture and ethos of the organisation is focussed and nurtured. Service and corporate failures in health and social care organisations invariably result from failure of, or ineffective, leadership at this level. Activity at this “level” is usually referred to as governance, but it is actually and fundamentally about leadership. It is one of the greatest areas of risk in any organisation. This area gets no mention in the Leadership Strategy paper at all and is barely acknowledged in the Capability Framework. In terms of “levels” where would these levels of leadership lie? If the erroneous logic of the Strategy is followed presumably they would have to be Level 0, Level -1, -2 and so on.

Lack of diversity

There is no mention in either the Strategy paper or the Capability Framework of the huge leadership challenge in the Australian aged care sector presented by our multicultural and highly diverse workforce and client groups. All I could find were a couple of references to language and diversity. This challenge deserves far greater and deeper consideration and adequate reflection in leadership behaviours and development programs. As one senior Southern Cross Care manager said when discussing the papers:

“This appears to be an Anglo European strategy written for an Anglo European audience that does not adequately address the core character and diversity of the aged care workforce.”

There are other areas of weakness in the analysis presented in the Strategy paper. No mention is made of the importance of values based leadership – again an absolutely crucial aspect of human services leadership. Nor is there any attempt anywhere in either paper to relate leadership behaviours to outcomes for the people we support – our residents and community clients. This core reason for which we exist is effectively ignored.

It is asserted that:

“Aged care leaders are predominantly female”.

Where is the evidence for this? Whilst it is likely that most front line managers in aged care services may well be female, it is equally likely that an audit of the membership of aged care boards (the key “level” of leadership) would reveal a substantial majority of white middle class, Anglo European middle-aged men. This is an important aspect of the leadership challenge facing the sector that has to be addressed and must not be perpetuated by default.

There is no recognition anywhere in either paper of the importance of emotional intelligence in the training and development of leaders, or of the concept of emotional leadership as a core component of workforce culture. Coincidentally, the corresponding article in the same edition of AAA on Dr Kerryn Velleman helpfully addressed this important aspect of leadership, but its importance needs to be recognised and reflected in any sector wide policy or framework.

In terms of leadership education and training there is no mention of the need for this to be a core component of every education curriculum for nursing and aged care staff in universities and colleges. This is where professional leadership training needs to start and we must stop assuming that simply by virtue of a university degree a qualified nurse is qualified to lead.

Misses the mark

One is left with the impression that, despite the claims of wide consultation across the sector, the weaknesses in these documents suggest that their authors may have little experience of the subject or the sector on which they have been commissioned to report.  The result is a superficial and a flawed analysis and policy proposition being presented to the sector, which offers limited value. In future exercises of this kind it might be a good idea to employ the services of people who have a deeper understanding of the sector.

In the conclusion section of the Strategy paper the assertion is made that it:

“offers a sustainable, measurable, flexible and effective way of revolutionising leadership development across the aged care sector.”

In my opinion it misses this mark by a wide margin. My fear is that it will not take us very far forward in this important area and that it has the capacity to mislead and establish an incoherent doctrine across the sector.

Maybe the best that can be hoped for is that it will stimulate further debate about leadership in the sector, and if it does this then something useful may flow. It would be unfortunate if this investment delivered nothing of value and if the documents simply joined the piles of other such documents that gather dust on shelves and in filing cabinets. It is doubtful that these papers will get much airtime in boardrooms across the nation as they do not address boards directly, have not engaged them, and have not reflected their pivotal role in leadership culture and development. This is, however, a subject that is crucial for our sector, and to quote a close colleague and admired leader in our field “leadership is what is needed to transform aged care from a cottage industry to a mainstream profession.”

Andrew Larpent is CEO of Southern Cross Care (SA & NT) Inc.

READ NEXT: The Aged Care Leadership Project Committee responds to Andrew Larpent’s critique of its leadership strategy and framework