Conversations with healthcare leaders from a range of contexts to explore how public engagement is understood, unlocking a deeply human part of leadership.
The research journey
My research – Relational leadership in the NHS: How healthcare leaders identify with public engagement (Hawley, 2021) – identified what motivates leaders to be collaborative with the public, how leaders identify with public engagement, and the conditions needed to support leaders in collaborative practice.
The initial aim of my research was to better understand how healthcare leaders understand public engagement. What became clear in the literature review was that the leadership associated with public engagement necessitated a level of collaboration and genuine relationship that has hitherto been under-reported from a relational perspective. The aim of my study was therefore refined to better understand how healthcare leaders identify with public engagement. An approach was needed that would elicit how leaders engage with others, self, and their context for public engagement.
As my research was focused on relationships, I became drawn to a relational world view. Data was gathered over the period of one year. Narrative interviews were combined with artefacts to elicit leaders understanding of relationships with themselves, with others and with their leadership context. I engaged 12 participants from 3 NHS Trusts and 3 national organisations to gather range of leadership perspectives: national policy, board level, co-ordinators of public engagement-experience, and organisational champions of public engagement. At the end of the first interview participants were invited to bring an artefact as a conduit for representing their sense of professional identity in relation to their leadership and as part of triggering the research conversations.
Combining narrative interviews with participant selected artefacts formed a conduit for representing leaders’ sense of self in relation to their public engagement practice. This approach opened space to engage in a relational exploration around how leaders identify with public engagement, and how holistic views as a relational issue become involved in professional and personal conceptions of self.
“A maker of patchwork, a weaver of stories; one who assembles a theoretical montage through which meaning is constructed and conveyed according to a narrative ethic”
The data was analysed using a variation of Voice-Centred Relation Analysis (Mauthner and Doucet, 2003), which involved multiple readings for story, voice, artefacts, relationships, and context. Leadership portraits were then scaffolded to recognise both the linguistic and non-linguistic ways that healthcare leaders identify with public engagement and to provide new insights on relational leadership in the NHS. I began with 12 participants, 24 interviews and almost 220,000 words of data. This led to 6 core themes: curiosity, courage, creativity, kindness, role modelling, and reflexivity.
Relational leadership in the NHS came into focus somewhat unexpectedly at a late stage of the study. This shift brought into focus a connection between the work I had undertaken with participants stories using Voice-Centred Relational Analysis (Mauthner and Doucet, 2003) and the Ganz (2010) model. Its relational orientation provided a valuable frame to add a further layer of analysis, to test the analysis, and to enrich perspectives of the findings. The process provided a reflexive perspective to enrich the data analysis themes by re-framing the research findings. The relational orientation of the Ganz model (2010) was particularly helpful for a practice-based professional doctorate because of its focus on how it can inform practice. It reminds us that how we identify with public engagement in healthcare is an active dynamic process between ourselves, our relationships, and our leadership context.
“Relational leadership brings leaders’ reflexive relationship with themselves, with others and with their context into focus. My definition differs from others in the literature by bringing leaders’ reflexive relationship with themselves to the fore.”
“I found it particularly helpful to reflect on the questions you (the researcher) asked because of how you ’showed up’ during our call. You created a safe container for me. Your thoughtful questions enabled me to reflect and make sense of my own thoughts. I was very conscious that the dialogue we engaged in felt very generative in nature. This was facilitated by your presence and holding of the space. I believe that as the researcher the attention you paid to what I was saying (and not saying) enabled me to move into a more self-reflexive space. In our conversation I believe that the quality of my sense making was a direct consequence of how at ease I felt, and this sense of ease was facilitated by the attention you paid to our work together… the kind of dialogue that supports collaborative generative conversations.”
Reflections and implications for practice
My research speaks to the search for reasoning behind why, despite the policy imperative of public engagement in healthcare, it remains a leadership challenge almost a decade after Francis (2013). This is the reason why my motivation for the research, which can be traced back to my own experience almost three decades ago remains so resonant. Exploring ideas on reflexivity resonated with the relational nature of the research methodology and methods; narrative and visual. This led me to re-imagine reflexivity as a bricolage.
The picture that participants painted in this research was of a very human leadership where their desire to make a difference to public engagement has been able to flourish and take them through extraordinary professional and personal challenges. Leaders identified with public engagement over time, suggesting multiple, contradictory, and changing identities; professional and personal. Several leaders in my research reflected that there is rarely time to reflect on their experiences. The importance of a safe space for reflection was viewed by them as important to make sense of their experiences and support their resilience. The concept of self-identity is offered in my research as an example of reflexive bricolage. It is important to attend to what it is that enables people to shine brightly, creating the leadership conditions that enables us - and others - to do that - ‘creating space’.
As I look back on the relational journey, I realise the deep truth. There really was no single path. Because my research participants had the courage to share their stories, experiences, and knowledge so generously I forged path that defined me. My experimentation with the concept of reflexivity led me to consider my own practice - and participants practice - as an example of reflexive bricolage. This signifies a profound shift in my thinking and learning on my doctoral. journey.
“Reflexive bricolage is a process of re-visiting experiences through a variety of lenses to form holistic understanding and as a way for discovering profound moments of self in leadership and public engagement practice.”