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  • Kasia Muszynska

Why does the NHS need ambidextrous leaders?

Last week, after much anticipation, we finally got our hands on the new, long-term NHS plan, which sparked a lot of debate immediately upon its release.


Leaving aside the question of balance between its ambition and realism in light of staffing shortages and other challenges, which has plagued most of the debates, it was interesting to see a vision of the future based on introducing innovative technology on the one hand and optimising the quality and efficiency of systems and services on the other.


Whilst the combination of two makes sense, the question is: are the NHS leaders prepared to do both?


In the recent years, there has been much talk about digitising and modernising the NHS and equally, there’s been much talk about quality improvement in care. Amongst the many initiatives focusing on one or the other, I have seen little which would combine the two – conceptually or practically – and for good reason as they require very different mind-sets, preferences and skill sets from the NHS leaders and managers.


Introducing new solutions requires the ability to take risks, to think out of the box and into the future, to be open to experimentation. Quality improvement, on the other hand, requires an attentive, data-driven, methodical approach to examining the system and its processes, focused on optimising, tightening and streamlining. Usually, leaders have a natural preference for one or the other: visionary, forward thinking or patient perfecting of the existing.


A leader who can hold both mind-sets and develop them together simultaneously is an ambidextrous leader. A leader, capable of incrementally growing and money-saving, eliminating waste and plugging gaps, while making investments in technologies which might or might not pan out.


The new plan for the NHS, leaving the staff conundrum and political ramifications aside for a moment, needs ambidextrous leaders. Otherwise, what good is taking a leap into digitalised service delivery and patient self-management if it is not grounded in a well-staffed and smoothly run care system? Any healthcare technology will always need to be embedded in a wider patient pathway and a robust system. Conversely, what good is only investing in existing service improvements and remaining behind times in providing patients with technology which could dramatically improve their quality of life and save the NHS time and money?


The NHS needs ambidextrous leaders. Yet, with the exception of few guidelines on change delivery, I have not seen much advocacy, guidance training or support in the realm of ambidextrous leadership in the NHS. Whilst the dichotomy of leadership vs. management seems more and more popular and exploited in the NHS discourse, it is an entirely different cup of tea. There is little on identifying and honing the particular traits and skills which facilitate a vision holding both today and tomorrow, progressive and rapid, measured and risky, incremental and disruptive innovation. There is little on developing distinct, and often seemingly contradictory, rationales, structures, processes, budgets and success measures to suit both purposes.



Obviously, there is much, much more to the feasibility of the new plan than whether or not there is ambidextrous approach to leadership and management in place. Perhaps though, it is a useful concept to think about what mind-sets and strategies are needed, if even part of the proposed changes are to be put in place.

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