Leadership Management & Coordination

in Health and Social care

The student will be required to produce a 4500-word report on an issue the student
will have observed on placement Learning Experience.
Learning outcomes:
The student will be able to:
1. Critically analyses pertinent management/leadership theory and concepts.
2. Critically evaluate the skills, knowledge and attitudes that are necessary to
enhance effective management in the complex and dynamic environments of health
and social care agencies.

Title:

Managing change that the student observed

while on placement.

Aim: To critically analyse how her manager at a third sector organisation in

South Wales handled taking over a new contract of supporting four individuals
with learning disabilities in a supported living environment. Then the author will
also detail the efficiency of leadership style that the manager used in handling
the situation.
Report to:
Name of the Module: Leadership, Management and Co-Ordination
in Health and Social Care
Code of the Module:

2. Content Page:

Front Page . 1

Abstract 3
Introduction 3 - 5
Analysis (using Warwick 6 Cs Framework) .......................... 5- 15
Leadership style

15

Conclusion .... 15 -16

Recommendations 16
References . 17- 20

Appendix 21

3.0. Abstract
This report is about how the authors manager while on placement handled a
transition of taking over a home from another organisation. The organisation
that the author went to is based in South Wales although its headquarters are
in England. The names of organisations and names of people involved have
been withheld due the Data Protection Act 1998(Government UK (2015).

4.0. Introduction
4.1.1 This report is going to be about how a manager in a third sector based
in South Wales managed change situation that the student observed while
she was on a six-week placement. Managing change refers to a form of
management control which involves applying systematic management
interventions that require individuals to get involved in order to acquire desired
outcomes that are compliant with the strategy of the organisation (Hall, 2013).
This organisation had just taken over a home which another organisation had
lost in a contract because of not complying to requirement of Care Council
Wales. (The organisation where the student went for placement will be called
D and the one that lost the contract will be called R in this report). Change
goes on to continuously influence the management landscape as all
organisations respond to external and internal forces to offer what is expected
of them from the stakeholder. It can also be said

that organisations are

always managing change as they respond to changing business situations

(Hall and Rees 2010). Managing change is vital but is also a very challenging
process (Lee, 2013).

4.1.2 The organisation where the student went for placement offers services
that are evidence research-based, outcomes-focussed to people with a range
of learning disabilities and autism (D, 2016) (see appendix). They provide
supported living and outreach services in South Wales. Learning disability

refers to a state when someones mind is stopped or interrupted in developing

or the development was incomplete which includes impairment of intelligence
and ability to interact in a normal or usual way in society (Grant, et al. 2010).
Autism is a development disability that lasts through out ones entire life, it
affects communication and difficulty in forming relationships with other
individuals in society. Autism is also referred to as a spectrum because
symptoms of individuals who have it differ and vary from mild to severe
(Nursing Standard, 2014). In Wales the number of people with learning
disability on registers was 150,010 out of whom 86 percent were staying in
the community while 14 percent were staying in residential places (Welsh
Government, 2015). In the United Kingdom, about 700,000 people are affected
with autism which implies that 1 out of 100 are affected (The National Autistic
Society, 2016).

4.1.3. In order to acquire the information used in this report the author referred
to the University website, clicked at Find it, then Article search then typed in
the key words such as leadership, learning disability, communication then
clicked at search. Several journals appeared on the screen but the author
limited them by selecting only peer reviewed journal articles that were less
than five years old. The author also got information from recent government
websites, books were used in collecting information.

Nevertheless, old

sources were also used when the author found them still relevant.

4.1.4. In this report the student will evaluate how the manager managed the
situation, meetings that were held, challenges that were met by staff from
organization R and the manager who led the change. Armstrong (2012), is of
the view that a manager is person who organises their junior employees time
within their work place to get the objectives of the organisation. While Gopee
and Galloway (2013) propose that a manager is someone employed
particularly to ensure that objectives of their organisation are successfully

reached. Leadership and management styles that the manager applied will be
discussed in details.

4.1.5. Although there are several leadership frame works such as Dunham
and Pierce's (1990) Leadership Process Model I am going to use Warwick
six c leadership framework as it is more applicable to this report (Hartley and
Benington, 2010 and Mind Tool, 2016). It is a framework that offers lens which
can be used to analyse the leadership literature and general review of main
elements that affect leadership process and after-effect. The framework is
able to categorise certain features of leadership together so that more light
can be shaded on acquiring an understanding of results that are theoretically
appealing and are useful in practical way. The six cs of the framework are
concepts, contexts, challenges, capabilities and consequences (Hartley and
Benington, 2010).

4.2 Analysis

(using Warwick 6 Cs Framework)

Concepts
4.2.1. The Warwick leadership framework refers to conceptual approaches of
leaders that are about individual qualities of a leader, the position a leader
plays in an organisation and leadership as a social process (Hartley and
Benington, 2010). Some of the qualities of a leader that are referred to as
conceptual skills are vision, being able to motivate, being able to make
decisions, creative, being committed, determined and persistence, wisdom,
critical thinking and having a desire to lead (Ricketts and Ricketts, 2010).
Although there many definitions of leadership the author is will use the
definition of Goodwin, (2006) as it suits more into this assignment, which
states that leadership is a powerful process of going after a vision of change
where a leader has support from two major groups. The manager who was
leader in the situation, has been in the position for over 25 years. She was
able to motivate, make decisions, creative as she came up with some new

developments to be made, committed and determined to see the change take

place successfully.

4.2.2. Hartley and Allison, (2000) also had an idea that leadership has three
perspectives which are person, position and process. Here leadership is not
seen on basis of a persons characteristics but what takes place between
leaders and the ones they influence. The three approaches that Hartley and
Allison, (2000) came up with about leadership are going to be detailed here.
In conceptual approach of qualities, a leader has been explained in terms of
an individuals characteristic and the way he or she behaves.

4.2.3.

The first conceptual approach explains the qualities of a leader,

the way they behave and their attitudes. It is about a persons qualities
or characteristics, skills one learns, abilities and about standards of
person effectiveness (Hartley and Benington, 2010). In the situation
described the manager had qualities and skills she had learnt and was
able to comply with the standards required as mentioned in the
previous paragraph.
4.2.4.

A second conceptual approach refers to position held in the

work place in terms of formal organisational leadership job, place,

power, expert position one has. Here features of a leader refer to status
or profession or the authority one has. These are usually linked to
senior jobs and associated with effectiveness of the organisation
(Hartley and Benington, 2010). Referring to second approach, the
manager was already in a management position for many years.
4.2.5.

The third one is the conceptual approach, which refers to

leadership as a social process that is explained in terms of social

interaction with those that follow a leader, while it was emphasized that
social influence uses communication and being empathetic to some
people while putting others in control and coaching. Its features are

relational motivational skills and influence on subordinates (Hartley and

Benington, 2010). Then referring to third one, the manager that was
observed, had held several meetings where she communicated with
families and service users with and without the organisation R. She
continued to have one to one meeting and team meetings with support
workers that she took over in order to know how they were doing and
to find out ways of helping them make effective changes. The planning,
development and delivery of services in social care becomes more
effective to meet complex needs of client by involving them and their
carers (Hafford-Letchfield, 2009).

4.2.4. For leadership to be effective it is important for individuals to work as a

team in order to offer better services (National Health Services, Leadership
Academy 2011). Change that is done collaboratively or in a group is perceived
to be more efficient than a change done by a sole person. McColgan, (2012)
states that when a leadership style fosters two-way interaction and other
peoples views this encourages engagement and partnership working which
are vital aspects for effective change management. In this particular situation
the manager was observed working with social workers, physiotherapists,
district nurses, general practitioners, dieticians and occupational therapists in
order to meet the complex needs of clients she had taken over.
4.2.5. Sometimes in health

and social services changes take place so

quickly, managers are pressurised to make decisions quickly because of time

limit and depending on the situation they are dealing with. These rushed
changes are done without consulting and involving staff. However, for a
change to be successful, staff have to be consulted and participate. It is
important for leadership to be directional and supportive when there is less
time situations of change management. Although staff cannot determine
which changes they want to take place but should be given reasons to why
the changes are to happen and good leadership style determine how
employees respond and agree to the new changes (McColgan, 2012). In this
situation the manager gave staff clear information on the roles they were

taking over, responsibilities, vital policies and procedures of her organisation

which is in compliant with the code of practice for employers (Care Council
Wales, 2016).

4. 3. Characteristics
4.3.1. Leadership characteristic are classified into formal, informal, direct,
indirect, clinical, non-clinical, individual and shared various bases of power.
The focus of characteristics is on power and resources. The characteristics of
a leader are influenced by the organisation or external networks, support
given

to

them

increase

or

decrease

their

leadership.

Leadership

characteristics are never the same, they just depend on ones roles. It is
necessary for the development of leadership activities to be organised
towards and resources of leaders. Before developing a person, it is necessary
to think about which person to developed, the potential part they can play for
the work place. Leaders are various sources and processes of influence, so it
is essential for the development to be done in suitable way (Hartley and
Benington, 2010).
4.3.2. Trait theory tries to list all remarkable characteristics leadership should
consist of, in order to be effective. This theory also tries to pinpoint some
characteristics that are linked to leadership effectiveness and associate those
traits to some effective criteria. According to the traits theory, some leaders
are born with traits of leadership. The traits that are linked to trait theory are
intelligence, personality, communication skills, physical and being able to
supervise (Bertocci, 2009).

4.3.3. The manager did not have all the traits mentioned in this theory but she
is intelligent, able to supervise and was able to communication effectively. She
demonstrated this by being able to find solutions to issues that were faced
during the change process, supervising staff to make sure that they provide
quality care and communicating to clients, staff and other agencies.
Communication between clients and practitioners is a concurrent two-way,

interpersonal occurrence (DAgostino and Bylund (2011). Communication is a

process where two or more people exchange thoughts or information in order
to come to understanding and needed action (Priya, 2009). Communication
skills are very vital for people who are in leadership roles (Lubinski and
Hudson, 2013).
4.3.4. Brownell (1992) and Scudder and Guinan, 1989) proposed that
interpersonal communication is a skill that is very important for the success of
leaders although most managers at the entry level do not have them (English
et al., 2007 and Hodges and Burchell, 2003). While, Laver and Lancaster
(2010) state that interpersonal skills enable people to interact with another
individual, allows them to communicate more effectively. Good communication
skills are important for people who work in health and social care. The
communication skills that are required by staff in health care include: listening
and to check if the person one is talking to has understood, ability to flow well
in a conservation, to understand cultural differences, be able to keep
conversation flowing, understand interaction cycle, to know how to ask
questions, understand non-verbal message and to communicate back (Laver
and Lancaster, 2010).
4.3.5. If communication is effective then clients and practitioners will
experience better outcomes, for clients the benefits such as being more
satisfied and improved well-being. For practitioners, effective communication
assists them to accurately find out clients problems, improves their
confidence and reduces their distress (Pitceathly, 2002 and Cegala and
Lenzmeie, 2002 cited in Ditton-Phare, 2015). Effective supervision needs
differing degrees of leadership because job responsibilities often change. It is
a responsibility of a supervisor to motivate staff in order for them perform
effectively (Morrison, 2012). Although the manager observed in the situation
had good communication skills, she was good at understanding culture
differences of both staff and clients that she worked with. Although she still
struggles to understand the needs of her clients as one of them does not talk
and others have learning disabilities so they cannot communicate their needs
effectively.

4.4. Contexts
4.4.1. Contexts involve addressing problems in the society and are linked to
policies (Hartley and Benington, 2010). It is necessary for people to divert
from considering that leaders are separate from their contexts to considering
about leadership within contexts that are always changing and able to adapt
to a system that is connected to each other (Hartley and Benington, (2011).
The context in this situation is that life span of people with learning disability
has increased. It is hoped that the population of people with learning disability
who are of age 50 or more who will be using social care services will rise by
30 percent by the year 2030. It is also hoped that the number of people who
are more than 80 years with learning disability who will be using social care
services will raise to 162 percent. People with learning disability have various
needs so this is a big change in the age profile of individuals and the services
they need. (British Institute of Learning Disabilities (BILD), 2014).
4.4.2. The Welsh Government is committed to making the lives of people with
learning disabilities better because they identified them to be vulnerable
(Welsh Government, 2011). Under the Equality Act 2010, those that provide
services have to offer equal access to people who have or have had a
disability (Government UK, 2013). According to the Statement on Policy &
Practice for Adults with a Learning Disability, the Welsh Government, seeks to
assist people to have full and inclusive lives. There is a need to pay attention
to maximising peoples ability to be independent and put away financial,
economic and social barriers (Welsh Government, 2011).

4.4.3. The organisation being discussed in the situation is one of the largest
non-profit organisation in the United Kingdom that supports people with
learning disabilities, autism, challenging behaviours and complex needs (D,
2016 a) (see appendix). So the organisation is assisting in meeting the needs
of people mentioned above. Some of services they provide include: personal

care, dressing, assist them to improve the skills such as cooking and assisting
service users to integrate in the community by independent and supported
living

4.4.4. The changing context places the community and governments with
complicated issues, so leadership cannot be limited to working in one agency
but has to work across other networks (Hartley and Benington, 2011). It is
necessary for leaders to have skills for mobilising hierarchies, markets and
different sectors that they work with, based on particular context and the crisis
(Benington 2011). Some principles have to be applied for an organization
change to be effective like thoughtful planning and sensitive implementation,
seeking information from individuals who will be affected by the changes and
giving them a chance to be part of the change process (Passenheim, 2010).

4.4.5. The manager who was leading the change followed these principles
because she planned how the change would take place, what her
organization wanted from the change and how it would be achieved. She also
implemented the changes by putting in place policies and procedures the staff
she had taken over had to follow. She also sought information from both
service users and support workers which illustrates her competence.

4. 5. Challenges
4.5.1. Though leadership is taken to be a vital activity on its own and right ,
more writers and those that make policies want to know the aims and purpose
for leadership. The difference between technical and adaptive issues is
influencing leadership literature (Heifetz, 1994). Heifetz characterisation of
leadership is based on what a leader or leadership is attempting to
accomplish. Technical issues are the ones that people have gone through
before, whose causes are well known, which already have a way of being

sorted, which can be sorted by a certain agency or there is a service for it

already in place. Although technical problems can be complex but they can
be solved by services in place (Hartley and Benington, 2011). For example, A
technical problem at the organisation D after the takeover was that of not
putting on aprons and gloves. The new employees knew about putting on
personal protective equipment (PPE) after reading policies and policies of the
new company and the training in health and safety regulations but the
challenge was to implement it and put the regime in practice.
4.5.2. However adaptive issues are characterised by not having knowledge or
disagreement cause of the issue or solution to it. It is necessary to try to solve
the issue by changing their values, attitudes or the way they behave.
Sometimes the people trying to solve a problem and other people may also
contribute to the issue knowingly or unknowingly. It is essential for leaders
that operate with or within networks of service provision to encourage better
person centred, coordinated, tailored to needs of a person, carer and family
(Hartley and Benington, 2010 and Hartley and Benington, 2011).

4.5.3. One of the challenges faced by the manager observed in the situation,
was that organisation R did not want to handover the paper work they were
using. This would make it very difficult for the organisation taking over. The
staff from organisation R did not want comply with the new policies and
procedures when they felt it was not suitable for them. The manager in the
situation observed felt stressed as she was not receiving enough support from
her seniors yet she was expected to make it work.

Stress refers to the

unfavourable reaction individuals get when they are under much pressure or
have too many demands (Health and Safety Executive, 2012).

4.5.4. All the above can be classified as adaptive issues that the manger had
to deal with. She dealt with first one by negotiating more with the former
organisation and involving her seniors. She had deal with the staff not wanting
to comply to the organisation Ds policies by informing them how important it

is to follow the policies and procedures. According to the Code Practice for
Social Care, employers have to put in place written policies and procedures
for their employees (Care Council Wales (2016). The manager was also
supervising staff in order for her to manage the change effectively, she deal
with their values, beliefs and the way they were working. As most of the
employees she had taken over had worked for that organisation for long they
had picked up some bad practice which they now believed was right but had
to be changed. An employer has to effectively manage and supervise
employees to work effectively, have good conduct and they have to be
supported to address areas where they are not working well (Care Council
Wales, 2016). In order to deal with the stress, she was going through, she
sought for supervision from her seniors in order to keep going.

4.6. Capabilities
4.6.1. The skills that make leadership to be effective or not include: mindsets
and behaviors (general competencies, emotional intelligence, leadership,
having knowledge politically) (Hartley and Benington, 2011). Emotional
intelligence refers to being able to establish, incorporate, understand and for
one to reflectively manage their own and others feelings.
4.6.2. Leadership and management skills are very important qualifications for
care professionals to have in whatever role they play. These skills are very
vital whilst providing care in addition to managing change (Gopee and
Galloway (2013). These are usually referred to as competencies though here
they are called capabilities. However, there is an argument that emotional
intelligence is narrow but it would be better to think about it as emotional labor
that leadership goes through (Askenasy and Humphrey, 2011). In the King
Fund report, the authors came up with other concepts of leadership
capabilities and competence that is learnt but not taught, qualities of practical
wisdom and making decision in a complicated situation (Hartley and
Benington, 2011).

4.6.3. Qualities of a good leader are: thinking ahead and thinking of ways in
which things would have been done in another way and how they could be
made better next time. By being a role model whom other people can follow.
one who focuses on client or patient which means that he or she involves
clients and respects their views. Takes responsibility unto themselves to
initiate change when there is an issue or challenge. Takes step to challenge
poor standards. Has to be able to solve problems and be resourceful. Has to
be good at communicating with patients and health and social care
professionals in order for care to go on and empower other people. Has to
take note and reward care that is good and give feedback that is positive
(Gopee and Galloway (2013). The manager observed, was able to lead by
example as she followed the policies of work place while at work place. She
involved clients views and respected their views at all times by
communicating to them or speaking to people who know them better. She
also worked with other professionals and support workers in order to meet the
needs of the clients.

4.6.4. The skills approach focuses on abilities and skills that a leader needs to
achieve as time goes on instead of personal traits that one is born with.
Robert Katz (1955) proposed that effective leadership requires personal skills,
technical skills and being able to work with individuals which is human skills
(Grout and Fisher, 2007; O'Brien and Hauser, 2015).

4.6.5. The skills approach was modified to capability model of leadership

which pinpointed elements of leadership which are: performance; ability to do
something effectively; quality or characteristics of a person, leadership
outcomes; social skills and awareness. The model is of the view that the way
the leader performs depends on how competent they are, which is affected by
the leaders experiences, attributes and situation in which they work (Grout
and Fisher, 2007). The performance of the manager who is being evaluated.

depended on her experience, knowledge, competence as a manager to

manage the change.

4.7. Consequences.
4.7. 1. Consequences of leadership illustrate its effect on individuals and
systems (Hartley and Benington, 2011). The manager leading the change
wanted the two individuals who are mobile to be more independent. Risk
assessment will be done to enable them to do more activities on their own.
She wants the lady who was hoisted by one person to be hoisted by two
people. All the above have been made come to reality and risk assessments
are in place to all that happen. So although the transition is still going on but
there are outcomes that have been achieved. She also contacted the
community occupational therapist and physiotherapist to go to the individuals
home and assess her for a new hoist that could take her to the bath room
without passing the corridor as she shares a house with men. They came and
assessed the situation of the individual and went to apply for funding in order
to make adaptations to the service users home. Scott and Spouse, (2013)
state that it is essential for an assessment to take place immediately in health
and social care environment to avoid putting clients to risk. Under the Social
Services and Well-being (Wales) Act 2014, the needs of an adult have to
assessed for the care and support (Welsh Assembly Government, 2014).

4.7.2. For leadership to be effective it is essential for individuals to work as a

team in order to offer better services (National Health Services (NHS)
Leadership Academy 2011). Change that is done collaboratively or in a group
is perceived to be more efficient than a change done by a sole person. When
a leadership style fosters a two-way interaction and other peoples views this
encourages engagement and partnership working which are vital aspects for
effective change management. Even if collaborative working is accepted as
good practice but it is argued about and have to be presented at the agreed
time. Social Services and Well-being (Wales) Act 2014, promotes coproduction and integration which will enable practitioners assess care and

carer support needs of people in the community which enable them to find the
services required (Welsh Government, 2015).

4.7.3. The views and how effectiveness is measured are determined by what
people consider to be the cause, the consequence although at times it may
not be true. Goals are not easily achieved because various stakeholders may
also have various perceptions about the value and how effective the actions
have been (Hartley and Benington, 2011).

4.7.4. The leader of change has to monitor activities and outcomes achieved,
ensuring that the care provided is of quality standard or make changes if
necessary (Gopee and Galloway (2013). So this was in line with what the
manager did, so it can be concluded that she was effective she succeeded in
achieving the outcomes her organisation was interested in although one is still
in the process.

4.8. Leadership style.

The style the manager that was observed in the situation used was
democratic, she always consulted support workers while making decisions
where it was appropriate. She held several meetings with staff to discuss on
changes that were necessary to make. A democratic leader gets information
from employees and involves them in making decisions Each staff in the team
are treated individually and respected, there is openness and trust among the
group (DeWit and O'Neill, 2013). The student observed that although each
member was respected as an individual by the manager who was being
observed but the employees from the old company had not gained her trust
and were not very open to the new manager. A democratic leader has to be
part of the group he or she is leading not more important than the people he is
leading and has to be responsible for their actions (DeWit and O'Neill, 2013).

5.0. Conclusion
In this report, Warwick 6 Cs leadership framework has been used to evaluate
how a manager in a third sector organization managed a change in a home
that she took over . The observation was done while the author was on
placement. Management includes planning, directing or guiding and
supervising or monitoring work done or being done to achieve goals and
objectives (Gopee and Galloway, 2013). The manager that was observed in
the situation planned, directed, monitored and supervised what was done in
order the get the goals and objectives that were aimed for. She also evaluated
the work done. In health and social care, a manager has to use expert skill to
get clients outcomes such as managing and putting into practice person
centered packages of care or making sure high quality care is provided
(Gopee and Galloway, 2013). The manager also used expert skills to put in
place packages of care that centred around clients and made sure that the
care provided is line with policies and procedures of the organisation. The
author included that the skills, knowledge the manager used to handle the
situation. She also mentioned the challenges faced by the manager while
managing the change. As there are always challenges while managing
change, the student came to conclusion that the manager she observed used
a democratic leadership style as she got information from stuff, involved them
and made decisions with them at team meetings. She also treated support
workers individually and treated herself not more important than people she
delegated.

6.0. Recommendation

The professionals working with people with learning disabilities need to get
more training on how to meet the needs in this group of clients and service
users.
6.1 Although there are policies and legislation about people with learning
disabilities they are still being discriminated or not accessing services as other
people do. So policy makers need to include them more and even enforce
their inclusiveness so that the gaps are closed.
6.2. More work needs to be done on how to communicate to people with
learning disabilities more effectively as professionals rely on what the
individuals families or support worker tell them in cases where the individual
cannot talk. Some times what they say may not be what or how the individual
feels which may lead to wrong diagnosis.

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Appendix

D -stands for Dimensions.