Week 8: It’s downhill from the top #107days

Today we’ve a post from Rich Watts, inspired by this advert!

What is expertise, and where should it be located within an organisation?

Traditional views suggest expertise – and with it leadership – sits at the top of an organisation. People at the top know their stuff, know what needs to be done, how it should be done, what it will cost, and who should do it. This then cascades its way all the down an organisation until it lands in the lap of a nurse, social worker, doctor, OT or whoever, themselves tasked with working with actual, y’know, people.


In NHS Trusts, the top of the pyramid isn’t the chief executive: it’s the Chair of the Board of the Trust. And if taking the traditional view, the role of the Chair of a Board seems to miss entirely the point what the people at the bottom of a pyramid do, and indeed what the purpose of the pyramid is.


At least, this seems to be the case when taking a look over any advertisement for the role of Chair of an NHS Trust.


Being a sarcastic type, I’ve adapted a recent advertisement for such a post so that it reflects what this traditional view of expertise and leadership might really feel like to people who use services, their families, and staff.



This is clearly an exaggeration; as Amanda Reynolds has said elsewhere, it’s cleary what Boards should be doing. But the exaggeration hints at a mindset regarding expertise and leadership that isn’t working for the people NHS Trusts are actually there for.


If this is the traditional view, what is a non-traditional view of expertise and where it should be located? This is easy: it has to be recognised that expertise is in all of us, wherever we are in a system. This is most obviously in people who use services and their families themselves, as well as in every individual who makes up an organisation

This also tells us that the location of expertise isn’t concentrated at the top: it’s distributed throughout entire organisations and systems. Taking this view, the role of those ostensibly at the ‘top’ of an organisation is to create the conditions in which everyone’s expertise can be recognised, irrespective of who they are or what their role is.

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