Strong leadership for a better health service

The Francis report (2013) on the Mid Staffordshire NHS Foundation Trust clearly showed a need for a different type of leader in healthcare. It is widely acknowledged that what happened was not due to the failing of one person, nor was it one single group of nurses, doctors or managers.

Instead, it was a whole range of things – from a heavy focus on targets, to not listening to patients, dismissing data and allowing a culture of fear and poor leadership to take hold – all of which meant that the focus on patient safety and quality was lost.

It is recognised that we need leaders in the NHS for whom the values of the NHS are central to how they lead. This means leaders at all levels who create a culture of openness, candour and compassion with the patient or service user at the centre.

There is no ‘quick fix’ to the many leadership challenges that we face, though we do know that there is a lot of evidence that leadership development is crucial to improving the safety, outcomes, experience and quality of patient care.
Previously, investment in this much needed leadership development – both nationally and regionally – has fluctuated. Many leaders, particularly those working at senior levels, have been spoilt for choice in selecting development options or have had little at all. The system was lacking a co-ordinated, strategic approach and following Francis, we couldn’t afford for it to continue in this way.

The creation of the NHS Leadership Academy two years ago was intended to address this situation. Our role is in helping to transform both culture and services by professionalising healthcare leadership and by creating a more strategic approach to the development of talent across the NHS.

Thinking globally
I cannot stress the importance of leadership development enough – it forms a central part of the transformation and cultural shift towards improving the quality of care in the light of a growing elderly population, a need to streamline and integrate services and in handling a very tough financial environment. It is also not just something for senior leaders. There are some fantastic people working and leading in the NHS and we need to embrace their passion, commitment and expertise – supporting current and future leaders to ensure the NHS and wider healthcare system is better able to respond effectively to the many challenges we face.
It is also important to recognise that the issue of leadership development is not completely isolated to the NHS. We are currently experiencing a global search for talent – healthcare systems in both the developed and developing world are all struggling to recruit leaders with the right level of skills and capabilities. The fight for talent at senior levels is acute, across all sectors.
Recent research from the internationally respected, Development Dimensions International (DDI) on global leadership showed a real problem with the perceived quality of leaders globally. It said there was no evidence that the high quality leaders we need in the NHS can be recruited from elsewhere.

The fact is, we are much more likely to be successful by deploying tactics to ensure we ‘grow our own’ more effectively and that the routine development of talented individuals, linked to career progression, becomes a core part of our business.

Changing the culture
Although ambitious and innovative, the philosophy behind the leadership development principles of the Academy is relatively simple and well proven. For leaders to be at their most effective they need confidence in their role – and to secure this confidence they need the competence, skills, expertise, experience and support that comes from expert development and training.

We need leaders to have a breadth of behaviours to draw on so they can exercise their role in the multi-agency, complex system that typifies health and social care. The success and culture of the NHS over the next decade or so will rely heavily on the behaviours adopted by leaders at all levels being able to work with their counterparts in other parts of the public and private sector – they will need the right behaviours, capabilities and skills to build relationships and alliances with a wide range of professionals across organisational boundaries, to serve the needs of increasingly diverse communities with enduringly complex needs.
And whilst there are many positives already throughout the NHS, we need to work towards eliminating the culture of fear that has previously allowed failings to happen and to do this, we need leaders who are able to engage and empower those working with them. The return gained from strong engagement is key; staff who feel fully engaged will have in return a psychological investment  in the mission  of their organisation – and in our case at a national level, the NHS Constitution – meaning they are more likely to go the extra mile, have greater loyalty and commitment to their purpose: patient care.  In order to create this engaged and positive culture where poor leadership is challenged and improved, leaders need to first be empowered themselves – and this is exactly what we aim to do.

Future challenges
At the Academy, our mission is to work towards developing and embedding a common vision for health leadership by searching for examples, setting out what good leadership and development looks like, highlighting its importance and equipping our leaders to meet both current and future challenges.
Our focus is to be more strategic than the NHS has seen before – ensuring that leadership skills are abundant where and when they are needed whilst being flexible enough to respond to changes in demand and organisational structure. Our radical approach; drawing increasing interest internationally, is a system wide scheme providing exceptional, rigorous and cutting edge leadership skills, knowledge, attitudes and behavioural development from entry point right to the most senior roles in healthcare.
We are now in a position where the complexity of leadership roles is more understood and, amongst others, we work with two internationally respected consortia that help us to deliver high quality leadership development,  training and skills. This is all part of ‘growing our own’ – having the right number and quality of leaders at every level is key and as the third largest organisation in the world, the NHS needs to be at least as rigorous in development as any other industry.
Our professional leadership programmes are part of the largest investment into leadership development that the NHS has ever seen. They ensure people are properly developed to fulfil the roles they aspire to and because of this, there is more likelihood of a consistent level of success overall. We are creating a more robust pipeline of talent of those who have properly gained skills, the experience and competence in their roles and provide structured and assessed development programmes to their career progression.
These programmes are designed to develop outstanding leaders for every tier across the healthcare system. Each programme has been specifically designed and all have a practical focus, insisting participants apply their learning and review the impact of their leadership practice on staff, colleagues and especially patient care. Importantly, whilst every effort is made to support participants through the programmes, not everyone passes. In short, we are setting standards for leadership capability across levels in the NHS, supporting people to attain these standards, and qualifying only those that reach them.

Engaging the health service
The appetite for our interventions from across the health and social care system has both confirmed and supported our approach. Having recently celebrated our two year anniversary, we are proud to say that 26,000 healthcare professionals – from all levels and backgrounds – have joined us on their own leadership development journeys. The system, and its staff, was clearly ready for change. These 26,000 engaged and empowered staff members will now take their learning back to their own roles and organisations. The potential impact of this is huge – and we hope that this is just the beginning.

To truly change culture, we need everyone to be involved and supportive of the difference that good leadership can make. Good patient care should be central to the ethos of everyone who works within the health and social care system. As well as our professional development programmes, we have a range of support systems, toolkits and programmes available for all levels of healthcare staff, including the Healthcare Leadership model, board development tools, an executive search function and a range of transformational programmes and materials – all for the benefit of our patients and local populations.
Transforming the whole system will take time and the journey to making the difference we all want to see is not just ours, it’s everyone’s.

Further information