22 - Leadership, management and service development in rehabilitation practice

Summary

Introduction

This chapter is about leadership, management and service development in rehabilitation services. These issues were not discussed in the first edition of Enabling Recovery. In the intervening years, it has become clear that senior rehabilitation practitioners require specific skills in order to manage, lead and ensure the development of effective services. Psychiatric rehabilitation is in many ways a complex business. By definition, its clients have complex problems that require sophisticated multidisciplinary and multi-agency approaches to treatment and care. In the UK, rehabilitation and long-term care services operate in a marketplace that continues to evolve rapidly and without the benefit of a high-level strategy from government.

Although the distinction between management and leadership is frequently drawn, in reality they are inextricably linked. Leading, managing and developing services require a range of skills and personal qualities. It is a unique individual who has all these necessary skills and qualities, which is one of the reasons why we have management teams to run services and project teams that develop new services. There are, however, some basics: being able to get on with people; a passion about the need to improve services; an understanding of how the money underpinning the current service or a planned development works; and willingness to learn.

Leadership versus management?

Kotter (1990: p. 6) made an influential distinction between leadership and management. His essential thesis was that business organisations in the late 20th century were too concerned about management processes, at the expense of strategic vision and leadership. His conception is easiest to understand in terms of a specific project. This will begin with the creation of an agenda: the leadership task here is to establish direction, the management task to develop a detailed plan and budget. The next task is to develop a ‘human resource network’ for achieving the agenda (i.e. a project team): leadership involves aligning people to new directions, management providing organisation and staffing for the team. Executing the task involves motivating and inspiring (leadership) but also, just as importantly, bringing order to the work of the team and problem-solving (management). When the task is completed, the leader will have implemented and managed change, while the manager will have brought about a predictable and ordered outcome, for example a service that actually works.