Leadership in healthcare: fad, fashion or in for the long haul?

Leadership and the lure of the panacea of cultural change that it promises, is undoubtedly currently in vogue. It is widely espoused to be the key to successfully helping us address the many complex challenges that we face in health care today; continuing financial pressures, changing demography, increased expectations from patients and the public, remarkable advances in patient treatment and leaps in scientific knowledge.

Therefore, as the NHS Leadership Academy is currently embarked upon researching and developing a new model for leadership in our health care service – a leadership model that we believe will meet the demands, expectations and pressures that our NHS faces, not just now but into the future – it seems timely to consider this question.

Not least perhaps because, as Hartley and Benington posit in Leadership for Healthcare (2011), it could be considered that the language of “leadership” has simply replaced that of “management” as the “fashionable” language of business, suggesting perhaps that there is little substance behind the rhetoric.

And, as we look around the NHS and listen to the many interested commentators, it is immediately apparent that the language of “leadership” certainly is flourishing and, as is so often the case, “buzz word” fatigue and cynicism are biting at its heels.

Patient safety
Perhaps more importantly, the time is right because the need to focus on patient safety and to understand the needs of users in shaping the development of health services, a central theme in Liberating the NHS (2011), was brought sharply back into focus following the publication of the Francis Report (2013).

This clearly emphasised the role that effective leadership has to play in our future: a role in listening to and learning from patients and in ensuring that patient safety is prioritised. The significance of which is supported by a growing body of more recent research on “effectiveness” in many kinds of service sectors – healthcare included.

So, is the NHS a victim of this latest trend? Is the notion of “leadership” as a “cure-all” for the challenges we face in our health care system today simply a fad, the latest fashionable language of our particular kind of business? Or does effective leadership really matter for us, for health care, for our patients? We believe the answer to be a resounding yes.

Leadership practice, at its most effective, actively promotes positive behaviours in individuals and creates healthy and enabling climates in which to work. These, in turn, lead to the delivery of truly effective, even outstanding, organisational performance.

Respect, care and compassion
But what drives our belief? That would depend upon how we might choose to frame our understanding or concept of leadership; where we might choose to shine a light.

However, Professor Michael West (Lancaster University Management School) in a blog for NHS Employers (May 2013) usefully helps us to frame this quite simply. He said: “If we want staff to treat patients with respect, care and compassion, we must treat staff with respect, care and compassion. If we don’t want staff to treat patients rudely, brusquely, aggressively or as onerous tasks rather than as vulnerable and often anxious human beings, we should not manage them [staff] rudely and aggressively.”

This is easy to say, and the sentiment may reek of platitude: the 
stuff of headlines and Twitter conversation, but this is far from being the case.

Customer satisfaction
Indeed, there is a growing body of evidence that demonstrates this link.

Drawn, in large part, from evidence in retail and other competitive settings, where leadership has been demonstrated to be an effective means to driving customer satisfaction and loyalty, there is now a growing body of evidence in health care settings, specifically.

West, et al (2012) root their work firmly in NHS healthcare. They evidence links between staff experience and patient outcomes, and staff experience and their leadership climate.

Analysing data from the NHS staff survey and related sources, between 2004 and the present day, they demonstrate that high levels of staff engagement directly correlate with lower standardised mortality rates, reduced absenteeism and a positive association with both quality and financial performance of the organisation.

Quality of care
And they go on to demonstrate that patient satisfaction is highest in organisations where staff report clear goals at every level, staff views of leaders are strongly related to patients’ perceptions of the quality of care, and the more positive staff are about their work generally, the more positive patients are about their care.

But, leadership is not such a new kid on the NHS block, The NHS Plan (2000) first signalled the shift when it made the case for greater focus to be paid to leadership and the development of leaders, stating that: “A new Leadership Centre will be set up to develop a new generation of managerial and clinical leaders.”

From this time, the NHS has given clear focus to leadership. The NHS Leadership Framework (2011), building from its origins in the Leadership Qualities Framework (2002), originally developed for senior leaders, has actively engaged many of us with the importance of leadership as a central tenet that underpins the delivery of great NHS health care.

Indeed, it has been used as the foundation underpinning the development of the Medical Leadership Competency Framework (2008) and the Clinical Leadership Competency Framework (2010).

Good leadership behaviour
So why are we still discussing leadership?

The Framework has served us well; it is a great descriptor of our current model of leadership. It has done a great deal to help shape our thinking about what good leadership behaviour should look like.

And the Framework has challenged us to focus on the benefits of more collaborative, distributed leadership approaches. But the service has been challenged by significant change. Unprecedented change, driven by both our successes and our failures. Change that we will continue to see, and change that has manifested an increasingly command and control culture; a culture that has refocused our attention on the disconnect that can so easily exist between the manner in which we each practice our leadership, day to day, and that which we espouse.

Primary research
However, such change does not simply provide us with significant challenges, it also presents us with huge opportunities, and the NHS Leadership Academy is seizing one such opportunity.

Against the backdrop of a desired shift in emphasis towards greater autonomy, responsibility and accountability, and with a strong orientation towards patient care, compassion and safety, the Academy is working to develop a new model for leadership in our health service.

Working closely with its partners, and the wider NHS, the Academy is reviewing the current evidence on leadership, drawn from health care in the UK and beyond, as well as across wider public and commercial sectors. It is undertaking primary research in order to better understand “what is the difference that really makes the difference?” in the leadership practice of some of our highest performing leaders.

The aim of the Academy is simple: a new Leadership Model. One that will meet the demands, expectations and pressures that our “new” NHS faces, and will be as effective at helping create a new vision for leadership that reflects the best in care and compassion as equally as it does for excellence in strategy, vision, direction and engagement.

This will not be easy or straightforward as effective leadership is learned, nurtured and developed in organisations.

Actively engage
Therefore, if we are to ensure that our desired culture of care and compassion reaches all corners of the organisation, we must provide an unquestionable example to our staff. We must engage in using the new leadership model in our efforts to guide and develop the behaviours we seek of our leaders.

It will require each of us to actively engage in understanding ourselves as leaders through this new lens.

And for our leaders to provide the time, support and access to world‑class leadership development that is necessary if we are to grow the capacity we need to achieve “better leaders, better care, brighter future”.

Further information
www.leadershipacademy.nhs.uk