BU Research Blog

The Care Quality Commission’s State of Care report for the Adult Social Care Sector offers both reassuring and worrying elements: reassuring in that 60% of adult services were providing good or outstanding care, but disturbing in that 7% of services were rated inadequate.

A key element related to good or outstanding ratings concerns leadership. Unsurprisingly inadequate leadership is linked to inadequate care, whilst good leadership supports an environment of high quality and continually improving care. According to the CQC report outstanding leaders are characterised by their ‘passion, excellence and integrity and collaboration with their staff.’

How can leadership be improved across the adult care sector? This is a challenging question as the health and social care sectors are increasingly beset with ‘wicked problems’. Wicked problems are defined by complexity, may have long standing origins and for which there are no easy solutions. Wicked problems may be seen differently by different stakeholders, and this can be particularly challenging as services come together through integrated care.

This approach is informed by the work of Rittel and Webber (1973) who defined tame, crisis or wicked problems. Tame problems are often easily understood with clear causes and resolutions identified. Crisis problems require urgent responses but often respond to strong leadership and control during the crisis period. Wicked problems are much more complex, often with multiple contributory elements, are intractable and difficult to solve. Many of the issues within the adult social care sector are ‘wicked problems. These include a complex and challenging range of issues: an ageing population with increasingly complex needs; the impact of austerity measures on funding for the health and social care sectors; systems which are in a state of perpetual flux and change; the impact of concerns about quality of care; the need for an increasingly skilled workforce; and the problems of recruiting and retaining a suitably qualified social care workforce. So what leadership approach would be better to deal with the challenges posed by ‘wicked problems’?

To cope with the ‘wicked’ nature of problems within adult social care it is important that leaders are able to think beyond usual leadership and management approaches. ‘Wicked problems’ require ‘wicked solutions’, a break with the constraints of the past and an approach which embraces creativity. It requires individuals who can facilitate a collaborative approach to harness creativity across different stakeholders both internal and external to their organisation. It requires a style of leadership which is focused on participation rather than top down direction – that is inclusive, and supports engagement with collective ideas. Such leaders need to work with the resources within their own workforce by adopting ‘the moral resourcefulness’ to engage in challenging conversations (Hutchinson et al. 2015:3022). Only collective engagement within and across organisations can hope to address the ‘wicked problems’.