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11 January 2013
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Servant Leaders in the NHS – Stand up and be counted

Airline operational performance results for major carries in USA have come out and it shows that in general flying experience parameters are all getting better. The WSJ has a nice tabular column which explains it really well.Southwest Airlines had the largest number of system wide emplanements (I take this to mean the highest number of passengers took Southwest flights) and they have the lowest rate of complaints per 100000 emplanements. Southwest had about 40% less complaints than the next best complained airline and the highest complained about airline had 14 times (1400%) more complaints than Southwest.United had the highest complaints. The stats show that United had the highest rate of bumping (passengers denied boarding due to overbooking by airlines) and highest rate of lost baggages and understandably they had the highest complaints.Then an interesting fact leaps out:Out of 7 major USA airlines, Southwest had the second highest rate of bumping, third highest rate of late flights and was in the middle of the field for lost baggage but had the lowest rate of complaints. As I explained earlier it was not just lowest it was (at least for the month November 2011) had 14 times lower complaints than United.

There is nothing more that annoys passengers than bumping or flight delays or lost luggage. Why did Southwest have such a low rate of complaints? Why did Southwest customers not complain more? Looking at the data, one would expect many more complaints. How can we explain this?

Southwest Airlines practices Servant Leadership, which is pretty unusual at a whole organisation level. Servant Leadership seems to have led to employee empowerment which then leads to building ground level relationships with customers. All those lovely videos on youtube about Southwest are examples. Customers begin to see Southwest employees as 'friends' who are coping with difficulties that are common and typical of airlines; they do not want to add to the burden of their 'friends' by complaining.

Relationships trumps poor stats and bad stories. This is true of healthcare as well. Patients relationship with their doctors and their local hospitals are the ones that keep our NHS hospitals going; if that was not the case we would see a significant movement of patients away from high mortality hospitals every time the mortality results hit the press or a bad news story hit the press. That is not happening at a perceptible level.

However, some hospitals are finding an increase in complaints every time the mortality results are published and on the occasion when bad news stories are published. Complaints are a useful tool for feedback, problem detection and improvement but when an organisation is already on a well recognised path of validated development complaints on routine operational matters can also be a source of distraction, expense and negative publicity. Problems which were not or could not be prevented, as might happen in healthcare often, if identified, as soon as they happened and customer service methods were used to deal with them, could avoid complaints and its ill effects.

In an organisation that is clinically performing well, to ensure that the doctor-patient relationship and the hospital-patient relationship which clearly exists is translated into a low number of complaints would need empowered employees enabled by an organisation wide servant leadership approach.

Where are the servant leaders in healthcare? Which organisations follow servant leadership approach? I can recognise very few leaders but no organisation practising servant leadership.

The thoughts on servant leadership are quite old, ''Mark 9:35 Sitting down, Jesus called the Twelve and said, "If anyone wants to be first, he must be the very last, and the servant of all''; there are other religious and philosophical variations which are older and younger to that quote. However the management description of it was by Robert Greenleaf who wrote:

"The servant leader is servant first. It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead."

"The difference manifests itself in the care taken by the servant-first to make sure that other people’s highest priorities are being served. The best test, and difficult to administer is: Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servant? And what is the effect on the least privileged in society; will they benefit, or at least not be further deprived?"

Robert Greenleaf: The Servant as Leader 1970. (

One would have thought that the medical profession with its high altruistic calling of serving the ill would abound with servant leaders; it seems that may not be the case. The time has come for any true servant leaders in the NHS to stand up and be counted as this seems a good model for leadership development for our caring and noble profession.



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About the author

Makani Hemadri's picture

Makani Hemadri

M Hemadri is an Associate Specialist in General Surgery and Clinical Innovation and Improvement Lead at the Northern Lincolnshire and Goole Hospital NHS FT. He spends half his time on matters such as system and clinical quality improvement. He was a Fellow of the NHS Institute for Innovation and Improvement and a Leaders for Change award holder from the Health Foundation.

He is one of the 1.4 million employees who have strong views and are all passionate about the NHS. Of course all of them including him are always right. Hemadri only wishes we genuinely agreed with each other more often.

[Biography supplied by the author].



11 years 2 months ago

hear yeah hear yeah lend me your ears

the saying goes that listening is the beginning of understanding yet many don't want to stand and speak of what's on their mind since they don't want to be outcasts or be finger-pointed of nasty things that people will say against them. it's just don't seem fair.

11 years 4 months ago

Servant leadership

Hi, I have long admired and tried to practise this sort of style of leadership. In my experience however, it does not sit well with the hierarchical nature of many NHS organisations. Perhaps it is because NHS leadership positions currently tend to attract certain personality types whose preferred styles sit more with directive and hierarchical leadership than this approach? Bit of a catch 22 that is difficult to change when it is so pervasive an attitude. I don't of course believe that servant leadership is completely accepted in the business world either but perhaps that world is diverse enough to accommodate it. The NHS talks much but changes very slowly when it gets down to it and it is hard to break through what is in effect a glass ceiling of preferred leadership styles. Perhaps we can start it here?! lol

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