Is leading and managing in inter-agency settings really that different?
International Journal of Integrated Care, 16 September 2009 - ISSN 1568-4156
Editorial
Is leading and managing in inter-agency settings really that different?

Over the past decade, two of the prominent themes of public service reform in the UK have been leadership and partnership. This extensive process of reform is orientated around the assumption that in order to deliver high quality welfare services to the population, government bodies must work effectively with each other and a range of commercial and third sector agencies. Furthermore, these arrangements need to be led by ‘strong’ and ‘effective’ leaders and managers.

Yet, it is not just in the UK where these interests have manifested themselves. As this journal demonstrates; there is international interest in the types of methods and strategies that may be used for linking and coordinating various aspects of care which are delivered within national and local systems. Moreover, leadership in its various guises is a truly international preoccupation. When an organisation—or groups in society more broadly—encounters difficulty, it almost invariably looks towards some form of individual leadership to guide it through that time of turbulence, or to take the blame for failing to do so.

Against this background, recent years have seen a growing literature pertaining to leadership and management in inter-agency settings. This literature presents particular perspectives on leadership and management and argues that these are quite different to the typical or dominant perspectives of leadership. This editorial briefly interrogates some of the main themes from this literature and asks; is leading and managing in inter-agency settings really that different?

Popular leadership and management literature is typically heavily influenced by the principles of classical management theory. As such the “organisation in our heads” tends to assume hierarchical relationships between members of a single organisation [1, p. 171]. Typically leaders are differentiated from managers on the basis that they are transformational, whilst managers are transactional. The former do the right thing whilst the latter merely do the thing right: whilst leaders ask questions, managers organise processes. Yet this is a rather simplistic distinction and one which is not always helpful in practice. As such, the literature pertaining to leading in managing in inter-agency settings presents what it suggests is a different model and one which is more akin to the challenges of these settings.

Discussions of inter-agency working frequently suggest that the challenges faced in these settings are of a greater magnitude than those faced within ‘traditional settings’. Kanter [2] argues that leading and managing inter-agency partnerships is a more difficult task than operating in traditional hierarchical organisations where, she argues, the former may: lack a common framework between partners; exhibit asymmetrical power relations (i.e. one partner holds more power than other(s)); possess incompatible values; have unclear authority and communication channels; and deploy different professional discourses.

Given these complexities, one of the most frequently given reasons for perceived failure of inter-agency working is a lack of effective leadership and management. However, this is often somewhat of a post hoc rationalisation of a particular context and one which frequently lacks either a clear notion of what successful inter-agency working is, or what effective leadership and management would consist of in practice. Although leadership is a seductive notion, we must take care not to associate ‘strong’ or ‘effective’ leadership with every instance of organisational success. Undoubtedly, leadership and management are important contributors to facilitating inter-agency relationships, but they are not the only factors. There is a risk that in focusing on these aspects, others are overlooked.

Because of the types of difficulties associated with working in inter-agency settings, lessons from other literatures have been sought which might offer useful insights into the more horizontal, relational based linkages which it is argued are more applicable to these types of settings. As such, leading and managing in inter-agency settings is often contrasted to leading in a ‘traditional’ or ‘classical’ setting as being a network form of leadership. Classical management is typically suggested to take place through a single authority structure, with clear goals and well-defined problems, where the manager acts as a system controller who plans and guides organisational processes. In contrast, the network perspective takes places through a divided authority structure, where there are various and challenging definitions of problems and goals and the role of the manager is in guiding interactions and providing opportunities.

This contrast between ‘classical’ leadership and ‘network’ leadership is undoubtedly an appealing one, but it is also flawed. Whilst not unhelpful, it does seem a little naïve in its presentation of the ‘classical’ perspective. Many of the types of challenges encountered within single organisations require the leadership responses of the ‘network’ perspective. In some ways, the distinction between traditional and network leadership seems akin to that made between leadership and management albeit presented under a new guise. Transaction-based processes, such as those associated with management begin to look a lot like the types of behaviours associated with classical leadership; whilst transformational leadership is more akin to the network-based perspective of leadership.

Furthermore, it is possible to argue that the types of difficulties which Kanter identifies might also be encountered within apparently ‘traditional’ settings (e.g. NHS mental health trusts). Organisations which are charged with delivering integrated care are likely to incorporate multiple professional discourses, values and cultures at the very least–which would seem to lend themselves more to network, than traditional, approach to leadership and management. Interestingly, experience from the UK also suggests that when inter-agency working becomes critically important in the delivery of a particular welfare service that there is an inevitable tendency to turn what might have looked like organic, network arrangements into a hierarchical structure. That is, even where horizontal and relational interactions have developed that when these become politically important that these are turned into the types of classical management structures with their associated recognisable forms of accountability.

Whilst inter-agency settings inevitably bring with them a large set of challenges to managers and leaders there is a danger in overstating the novelty of these activities. Much management and leadership activities of the last thirty years (and longer) have arguably taken place in contexts which may be better characterised by a ‘network’ approach. Moreover, the influence of classical management theory and its associated notions of accountability are still pervasive within the delivery of welfare services. We should not, therefore, unquestioningly assume that leading and managing in inter-agency settings is really that different and more critically analyse the extensive literatures which already exist and which can further inform these activities. This message is in one sense problematic as it makes this complex field potentially even more complicated. Yet, what this also indicates is that there are significant literatures available to draw on in the search for advice pertaining to what inter-agency leaders and managers should do and how they might go about doing this.

About the Author

Helen Dickinson is a lecturer in health care policy and management at the Health Services Management Centre, University of Birmingham where she heads the Health and Social Care Partnerships programme. Helen is the author/editor, respectively of two recent books on Managing and leading in inter-agency settings (Policy Press) and International perspectives on health and social care (Blackwell). Helen is also an associate editor of the International Journal of Integrated Care.

References
1.
Anderson-Wallace M. Working with structure. In: Peck E, editor. Organisational development in healthcare: approaches, innovations, achievements. Oxford: Radcliffe Publishing; 2005. p. 167-86.
2.
Kanter RM. When giants learn to dance. New York: Simon & Schuster; 1989.