Developing leaders to build a supportive environment for improvement

At a time when the NHS needs to deliver unprecedented savings, effective leadership at every level will be vital to enable and support staff to make improvements.

This partly explains why the government is so keen to invest in NHS leadership development. The new NHS Leadership Academy will build on the work of the National Leadership Council and bring together all the government’s leadership activity for the first time.

There’s also a wealth of great work going on, led by organisations like The King’s Fund, developing new thinking for leadership in health.

At the Health Foundation we are focusing our energies on how senior leaders can cultivate organisations that particularly encourage and nurture improvement. Through our life-changing Quality Improvement, GenerationQ and Improvement Science Fellowships, we are also developing a small number of leaders who are having a disproportionate impact on quality improvement.

What is effective leadership for improvement?

We all know that effective leadership is central to improving healthcare, but our work is helping to define exactly what ‘effective’ means. This translates into some important leadership skills and behaviours. Leading healthcare improvement is not about telling people what to do, it’s about being able to transform the behaviour of staff and organisations.

The Health Foundation is focusing on creating leaders with that vital combination of improvement expertise and influential leadership behaviours.

Our leadership fellowships provide much needed time and space to develop leadership capacity and the specific interpersonal and engagement skills needed to involve and encourage others. The feature on our Quality Improvement Fellows illustrates how this approach is starting to have far-reaching effects.

A supportive environment for quality

Overcoming Challenges to improving quality, a report by Mary Dixon-Woods which reviewed the learning from 14 Health Foundation leadership and service improvement programmes, identified what a profound effect organisational context can have on whether improvement projects succeed. This includes factors such as having sufficient organisational capacity and easy access to the data needed to guide change, through to whether the culture and incentives at all levels in the system are aligned to improvement goals. Leadership is a key enabler interwoven with all these ‘environmental’ or ‘contextual’ factors. 

As well as getting the right resources and systems in place, how leaders approach change is critical. The report argues that getting leadership right requires, for example, ‘a delicate combination of setting out a vision and sensitivity to the views of others. “Quieter” leadership, oriented towards inclusion, explanation and gentle persuasion, may be more effective.’

Our GenerationQ fellows agree. When interviewed they described how the fellowship is helping them think to differently about relationships and develop a leadership style that supports quality improvement.

One said: ‘It has heightened my awareness of what I do to help or hinder a change process... What I do models what my juniors do. I have seen some significant impact just by changing what I do in small ways. It’s been phenomenal.’

Engagement for improved outcomes

This month we also interview one of our GenerationQ fellows, Annie Laverty, about her work to improve the quality of care in Northumbria. She describes how impactful it can be to put patient and staff engagement at the heart of all improvement activity.

Annie believes it’s not just the quality of leadership that counts, but also the style and approach taken. Being a fellow is helping her to realise she is most effective as a leader when she focuses ‘less on being in control, and more on being in charge of creating the right environment and conditions for different ideas, leaders and approaches to emerge.’

Making connections at all levels

We know that future healthcare challenges won’t be met purely through efficiencies but by changing how different parts of the system work together. This requires leaders who can think across health and social care organisations and systems, with a focus on improvements that are driven by the patient’s perspective.

We also need leaders who can connect up teams at a local level. Our new Shared Purpose programme is designed to encourage these new relationships, providing funding for projects which see corporate support services and clinical teams working together to improve care. 

At the root of all our work to support leadership is the belief that senior leaders can and must establish a culture which allows innovation and improvement to flourish. Leaders must be improvement ‘enablers’ who can build trust, spark enthusiasm and maintain momentum.