NHS Leadership Academy

Why are we doing this?

The case for change

We’re working in a context of an increasingly older population and an increasingly unhealthy population. There is limited money available to the NHS and social care to tackle this and this will not change in the foreseeable future. We have concerns over the quality of some of our NHS services – the Francis Report will bring this to the forefront later this year. And we have a population which expects the NHS to be there for them, providing top quality, modern and convenient advice and services, when they’re needed, in ways people want to access them.

We also have an NHS which looks very different. We now have Clinical Commissioning Groups (CCGs), Health and Wellbeing Boards and foundation trusts. Decision making is devolved and much more clinically led.

There has been investment in leadership development for some time now, and NHS leaders have done a remarkable job over the last ten years. But the last ten years was a different place to the one we’re in now. It was a place which suited a certain style of leadership; one which ensured targets were met and where the approach was one of telling people what needed to be done. And, while this worked at the time and served the NHS well, it won’t in the future.

So the NHS and the wider economic and health environments, mean the approach our leaders put in to good effect in the past now needs to be flexed with different styles coming to the fore.

We need to coach and be more facilitative, supporting the new NHS leaders. We have to help these new and young organisations and their leaders build relationships with all parts of the health and social care system, while at the same time taking risks, innovating on an industrial scale and completely transforming many services if the NHS is to meet the challenges of the coming years.

Tweaking around the edges won’t deliver what’s needed. We need to transform the whole system, supporting each other to take risks and innovate and engaging our staff and the public in difficult conversations. The fundamental difference between success and failure will be the calibre of our leadership.

The NHS Leadership Academy brings together in to one body, for the first time, all of the national activity supporting leadership development in health and NHS funded services. This gives us a unique opportunity to make the significant impact which is needed.

The evidence for change

Karen Lynas on The Academy’s Core Programmes
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Good leadership and good performance

There is unequivocal evidence in every sector that there is a strong relationship between leadership capability and performance. Good leadership leads to a good organisational climate and good organisational climates lead, via improved staff satisfaction and loyalty, to sustainable, high performing organisations. This is as true in health care as it is in any other business.

The impact of good leadership on organisational performance as measured by the business and commercial success is extremely well evidenced:

A study in the Harvard Business Review (Bassi and McMurrer 2007) provides a strong link between leadership skills and the bottom line
The Institute for Strategic Change reports that the stock price of companies perceived to be well-led grew 900 per cent over 10 years versus 74 per cent for companies perceived to lack good leadership (2008)
The Corporate Leadership Council estimates that employees working for good leaders put in 57 per cent more effort and are 87 per cent less likely to leave than those with poor leaders
The Hay Group study of 2012 demonstrated that the top 20 companies for leadership had a 36 times better shareholder return over a 5 year period than the companies with the poorest leadership.
Murray Dalziel, Director of Liverpool Business School summarises: “There is incontrovertible evidence from the academic literature that leadership makes a difference. Across a wide range of industries about 15 per cent of the variance in performance can be directly attributed to CEO performance. This figure has been constant for over 25 years.”
Good leadership and good performance in the health sector

There is an increasing body of evidence on the impact of good leadership on performance in health organisations, though much of this is still built on the US model which also equates good performance to financial return and investor satisfaction. There is data on the impact on quality of care and patient outcome. A study by Vance and Larson published in 2002 showed; “a dramatic increase in hospital discharge rates for patients…as a result of introducing special physician leadership” and Wong and Cummings (2007) found “evidence of significant associations between positive leadership behaviours…and increased patient satisfaction and reduced adverse events”

The National Institute for Health Research Service Delivery and Organisation research programme prior to its review and closure in 2012 had commissioned significant research into the connections between leadership and aspects of organisational and clinical performance and patient care. The summary report published in 2011 concluded that there was sufficient evidence to connect good leadership to improvements in performance.

Leadership linked with safety or patient outcomes or experience is increasingly the focus of research in the UK. The evidence is particularly strong in relation to leadership and quality improvement. Ovretveit (2004) refers to the very positive contribution that leadership can make to healthcare delivery which is expanded on by a Health Foundation Study in 2011 that found; “responsive and nimble leadership which anticipates change, is ready to adapt to altering, unpredictable circumstances is particularly associated with sustainable improvement and tangible impact.”

Good leadership and good performance in the NHS

In the NHS we make the connection that good leadership is more likely to lead to a good organisational climate and that good organisational climates are more likely to produce sustainable, high performing organisations, particularly in relation to quality and safety improvement and patient care and experience.

There is a growing body of evidence on performance in the NHS, particularly as it relates to quality improvement and patient care and experience.

West et al (2001) found that good leadership which led to good team working and human resource practice was correlated with significant improvements in mortality and morbidity following emergency surgery. A subsequent study by the same authors found a “significant reduction in patients standardised mortality rates in organisations with high staff engagement” associated with high levels of effective and engaging leadership.

There has been a particular emphasis on exploring the connection between good medical leadership and performance. The Tooke report (2007) stated: ‘The doctor’s frequent role as head of the healthcare team and commander of considerable clinical resource requires that greater attention is paid to management and leadership skills regardless of specialism. An acknowledgement of the leadership role of medicine is increasingly evident.’ Furthermore, the work of the NHS Institute to develop the Medical Engagement Scale, demonstrates a clear correlation between medical engagement and hospital trust performance.

Beyond frontline changes to behaviour there is broader evidence on executive leadership behaviours and the Board. Shipton, Armstrong, West & Dawson (2008) found “Significant reduction in patient complaints in organisations where there were positive leadership climates created by the top teams.”

The evidence is neatly summarised by Prosser (2009) where he states that “the evidence, while not voluminous, is sufficient to assert that effective leadership (and leadership development) does make a positive difference to the patient experience.”

Poor leadership and poor performance

The corollary is true also. Recent enquiries into failures in organisational performance particularly where it impacts on patient experience and care, have all pointed to a failure in leadership. The consistent message is that a failure of leadership is likely to result in organisational failure as measured by the clinical performance of a hospital service.

As far back as the Bristol enquiry (1995) there was a strong connection made between leadership and performance: “It is an account of people who cared greatly about human suffering, and were dedicated and well-motivated. Sadly, some lacked insight and their behaviour was flawed. Many failed to communicate with each other, and to work together effectively for the interests of their patients. There was a lack of leadership, and of teamwork.”

The Francis enquiry into the failures at Mid Staffordshire points to failures in clinical and medical leadership as well as failures at the board and in the organisational culture created by the leadership of that hospital.

Leaders fail for many reasons and whilst the context and environment in which they operate is significant, much is also attributed to individual behaviours Summarising in his 2006 study Burke concludes that the key indicators are a leader’s; “Inability to develop effective interpersonal relationships (arrogant, stubborn, egocentric), inability to take risks and make errors (cautious, avoids responsibility) excitable individuals with difficult relationships (impatient, moody, negative, volatile, emotional instability) and finally Lubit (2002) scepticism and distrust will reduce leaders effectiveness in motivating others.”

The consistent message is that a failure of leadership results in organisational failure and a failure in the quality of care and care outcomes experienced by patients.

How will we deliver outstanding leadership in health?

Our activities will fall into one (or more) of four areas (see our circular diagram for a graphical image of how these four areas fit together)

Developing and embedding a common vision for health leadership

Researching, creating, developing, refining, sharing and embedding tools, evidence and examples setting out what good leadership and good leadership development looks like, in a health care context.

For example: the Leadership Framework, the NHS Leadership Recognition Awards, NHS Talent Management framework and best practice guides, an executive search function, a resource pack for inclusive leadership, a set of board inclusion guides, Board Development Framework, Top Leaders diagnostic suite, leadership academic research and resources.

Leading the way in leadership development for a new health system

Equipping leaders to meet the current and future challenges of the changing system

For example: support for the new structures such as the Commissioning Board, Care Quality Commission, Department of Health, CCGs, Health and Wellbeing Boards, Directors of Public Health, Adults and Children’s Social Services and Foundation Trusts.’

Work includes: Foundation Trust Governor Framework delivered through the Foundation Trust Network, shared leadership programmes with health and social care, a QIPP development programme and a suite of development for CCGs.

Supporting local leadership development

Working with local delivery partners to embed a nationally consistent, professional approach to leadership development while meeting local needs.

For example: the Academy will develop a field force of organisational development experts who will support local delivery partners in embedding Academy programmes and frameworks and develop a suite of programmes to support local clients, for example for ambulance service operations directors and healthcare scientists.

Developing and delivering the largest and most comprehensive set of leadership development and training programme ever run in any sector

Professionalising clinical and managerial leadership, raising the profile, performance and impact of leaders in health and creating an environment where they are required, and supported to, demonstrate their fit and proper readiness to fulfil the role they occupy.

The Academy’s three core programmes for leadership will for the first time create a cadre of leader at every level and from every professional background who are universally and comprehensively equipped to lead following the principles of good practice and expertise in leadership found in high performing organisations. They will also become essential criteria for those applying for the relevant positions in the NHS.

The three programmes:

A foundation leadership programme: leading to a post-graduate diploma in Leading compassionate health care
A mid-level leadership programme: leading to a Masters in Leading compassionate health care
An executive/senior leadership programme: which will be peer assessed
All of these programmes will include elements of patient and service user involvement and assessment. All will include an emphasis on the skills, knowledge and behaviours needed to lead responsive service redesign with a focus on patient experience and health outcomes and more integrated systems of care. Particular emphasis will be placed on return on investment and measurable outcomes.

The Graduate Management Training scheme and Top Leaders, for the most senior Board level leaders, will continue, as will our successful Clinical Fellows programme.

What are the benefits of doing this?

The industrial scale of professionalisation of NHS leadership proposed will have some significant benefits and make it stand out from what has been done before.

Our work will:

Establish the pivotal role of leadership to a world class health service
Enable the grass roots culture shift to recognise the value of good leadership in the service
Create a consistent set of standards for leadership
Give greater focus on the inclusion agenda, NHS values and the NHS Constitution in the development of leaders
Enable more rapid dissemination and implementation of best practice leadership evidence and development of behaviour through inclusion in the core curricula of the programmes – ‘best practice as basic practice’
Enable greater efficiency of resources spent on training due to reduced fragmentation and duplication
Develop a common language and experience for leaders through the shared learning processes
Stimulate the educational provider market to align products closer to the real needs of the service
Promote cross organisation and boundary networking to enable communities of practice to be established and supported to flourish