The NHS is made up of more than 8,000 organisations, with many more across the wider health and care sector.
What can we do to ensure people in positions of influence role model inclusive leadership, with dignity and compassion? Stephen Hart, national director for leadership development at Health Education England and managing director of the NHS Leadership Academy, explores the importance of leadership training in the NHS
Leadership in the NHS has been reviewed, revised, studied and addressed throughout the past 70 years. Leadership approaches and styles have evolved and changed in the NHS as they have across society and business. Heroic, transactional, and competitive leadership approaches have each come, and gone. Each change has taken our service forward, but like other parts of the public and private sector, the NHS is still searching for leadership nirvana; a leadership strategy that unlocks the vast resource of individual and collective potential held within the staff of the NHS. Pursuit of such an aim is more than wistful; it is in keeping with the high ambition and societal status of the NHS. However, despite investment of huge global resource and creation of a ‘leadership development industry’ to meet demand, there remains scant evidence of which leadership approaches work, and even less for how to develop ‘successful leadership’ in individuals or groups.
In recent research only 20 per cent of globally surveyed CEOs believed that leadership development had any clear business impact, and only 11 per cent of surveyed executives strongly agreed with the statement that ‘leadership development interventions achieve and sustain the desired results’. Despite this lack of confidence in the impact of leadership development, the global industry is worth over $50 billion and is still growing.
The evidence that establishing cultures of outstanding leadership is at the heart of delivering long-term organisational success is clear. This link has also been explicitly made for NHS organisations. Cultures of outstanding leadership lead to improved staff engagement, and improved staff engagement results in improved outcomes. For the NHS there’s a strong argument for the link between outstanding leadership and patient safety. This is something that came into stark focus in the Francis report following the shocking events in Mid-Staffordshire. In fact, these events - and the subsequent recommendation for improved leadership to help avoid future incidents - led in 2012 to the creation of the NHS Leadership Academy.
The Academy is charged with supporting the NHS to develop cultures of outstanding leadership across NHS-funded services that improve health, enable efficiencies, and lead to better lives in communities. My view is that developing outstanding leadership across a system requires progress in four areas.
Developing leadership behaviours
The NHS has made great progress, but there is more to be done. Firstly, progress is needed in identifying and developing leadership behaviours linked to the NHS’s strategic priorities. These have been identified through evidence and published by the Academy and 12 other Arm’s Length Bodies - including the Care Quality Commission, Department of Health, NHS England and Public Health England - in the Developing People: Improving Care Framework.
This framework describes the inclusive and compassionate leadership behaviours needed to ensure that staff and patients are listened to, understood and supported, and that leaders at every level of the health system truly reflect the talents and diversity of people working in the system and the communities they serve. The framework also identifies: the need for leaders who are able to collaborate across traditional boundaries and create new partnerships and alliances; and the need for leaders at every level to have knowledge of improvement techniques and how these can be applied.
Of the behaviours described in the framework, it’s worth dwelling on those required to create cultures of inclusion. Despite sustained attention, the pace of change around equality, diversity and inclusion across health and care has also been too slow. For example, it’s estimated that the NHS would need to recruit a further 500 women for NHS boards to become representative by 2020. NHS WRES survey data also paints a deeply concerning picture of the NHS’s approach to ethnicity and race. It’s clear that there’s a need for new knowledge in the fields of leadership practice, and leadership development practice to support progress on inclusion.
To develop this knowledge, the Academy is embarking on a major project: ‘Building Leadership for Inclusion’. Based in five pilot sites in health and care systems across the country, the research will share evidence and knowledge on how leaders can create cultures of inclusion. This work is exciting, challenging, and necessary. The 2017 Cabinet Office Race Disparity Audit challenged us all to show leadership, take accountability and identify where we need to do things differently’ – Building Leadership for Inclusion is the Academy doing just that.
Following on from identifying and developing leadership behaviours linked to the NHS’s strategic priorities, it is also important to develop those behaviours in a way that is designed to transfer learning. The Academy has created a suite of development programmes for leaders at all levels. These internationally award-winning programmes focus on the implementation of improved leadership. Our measurement of their impact isn’t assessed through the satisfaction of participants with the programme - important though that is - it’s on assessment of the impact of these interventions on organisation performance.
Recent findings show that over 80 per cent of the NHS leaders who responded judged that the Academy had had a positive impact on leadership in the NHS. But there’s scope for better in this dimension of leadership development performance. Training that transfers learning must be linked to the roles that colleagues do while they’re on - and especially once they’ve completed - development programmes. The local and national system talent management approaches required to enable such a link aren’t currently in place. The Academy is developing such approaches and has piloted a Regional Talent Board in the Midlands and East Executive Team scheme. Early results are encouraging.
Sufficient scale and reach
The NHS has some distance yet to travel in this area. There are currently 276,000 NHS colleagues working at Band 6. These front-line leaders are at the ‘bleeding edge’ of leadership in the NHS and too many are taking on leadership roles having had insufficient - or even no - development support. While seminars, masterclasses, and leadership toolkits all have their place; they’re no replacement for focused and deliberate personal development that supports leaders to develop the behaviours that really matter and to transfer this learning into practice. The Academy is currently scaling up development programme offers so that capacity matches service. This also means the Academy letting go of responsibility and providing leadership development programme content to frontline organisations and systems. This enables team leader development, and from later in 2018 mid-level leader development, to be done in-place.
Furthermore, it is worth highlighting the significance of implementing processes and structures that support the demonstration of great leadership. Effective leadership development needs the right systems and processes to lock in change. Here too the NHS is on a journey to even better. The NHS is not a single organisation; it’s a complex and interconnected system of systems, organisations, supporters, and enablers. Creating and embedding process across this network of networks is no easy task and cannot, as in other industries, be done by dictate or declaration. The Academy, in partnership with stakeholders and influencers across regions, is convening and enabling Regional Talent Boards to bring together those whose collaboration is necessary to embed change. Progress is furthest advanced in the Midlands and East region, but these are planned for every region in England.
Effective leadership development is about enriching, explorative and impactful development opportunities. But there’s so much more. Given the known impact of outstanding leadership on the performance and outcomes in health and care, the effort and resource required to create outstanding leadership development offers a rich return on investment.
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