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How leadership development can help improve patient services

1 November 2007

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Neil Offley

Coaching Consultant

Neil works with public and private organisations on leadership, coaching, strategic human resource management, change management and evaluation. His work is informed by 25 years’ experience in the NHS, the Department of Health and other sectors in executive and nonexecutive positions. Neil enjoys travel and photography, which fits with his work in various locations in the UK and abroad

Organisations and those who lead them are under constant pressure to deliver improvements, to do more with less more quickly, and to improve the quality of services delivered.

Commentators on the NHS not only cite its overwhelming size and scale in comparison with other organisations across the world, but also the fact that it is continually subjected to major reform.

Professionals working in the NHS are well aware of this. Over the last few years, each layer of the NHS has been restructured or reformed in some way.

Of course, practice managers and those who work in general practice have a growing role in delivering primary care through initiatives such as practice-based commissioning (PBC), alongside the day-to-day demands of running their own organisations. Continual change and the pursuit of improvements place greater demands on those individuals who are expected to deliver these improvements.

A positive sign is that those leading the changes are often encouraged – or even expected – to take charge of their own professional development. The view is that leadership development is often a requirement for “getting the job done”, and has been shown to provide significant help for those leading change.(1)

Leadership research – does good leadership make a difference?
Until fairly recently, there has been relatively little research evidence into leadership or leadership development and the effectiveness of leadership development. But now, a number of studies have helped to identify the impact of leadership on organisations and their performance in the NHS.(2–4)

Such studies show a link between good leadership and good organisational performance. This is due to leadership at top level and at immediate line manager level. Managers are also shown to be important in determining staff satisfaction.

Top-level leadership has also helped to set the climate for teamworking and innovation across the organisation – both are major requirements these days – continually to develop better ways of doing things.

Leadership development – results
A number of evaluation studies were carried out, which proved invaluable in identifying the beneficial impact of leadership development at the level of:(5–7)

  • Individual participants – through improved leadership abilities.
  • Organisations – developed through the actions of participants.
  • Service delivery – improved through participants leading changes to how services are delivered.

Leadership development can improve the leadership capabilities of individual leaders through developing their strategic thinking, drive for results and personal accountability. It can also engender change in the workplace, by giving individuals greater confidence and alignment with organisational strategy.

When this is delivered to a collection of individuals within and across an organisation, it helps to build leadership capability and capacity on a wider basis.

Effective leadership development
Leadership is about managing change. Leaders need support in developing effective ways of delivering this change, and leadership development has been found to help managers understand and manage change.

Among effective forms of leadership development are coaching and mentoring. These have been particularly valued by those who have experienced them, including chief executives, directors, aspiring directors, general managers, matrons, nurse leaders, and leaders from black and minority ethnic backgrounds.

A series of evaluation studies have shown the benefits that can result from coaching and mentoring programmes, which are set out in two publications.(8,9)

Coaching and mentoring have helped to improve confidence, leadership, relationships, alignment with strategy, and provide career development and support for coachees and mentees. Mentoring has also provided ground level insights for mentors.

Coaching may be delivered on its own – to provide development focused on meeting specific needs. It may also form part of a wider leadership development initiative, including formal workshops, small group discussions, action learning sets, and service improvement projects.

Each form of development plays its part, and the various elements combine to provide a more powerful development experience overall. The individual is enabled to develop their leadership abilities, and helped to apply them in a service setting, and to evaluate the impact of their actions.

Leadership development initiatives in primary care
GP and practice manager development
In 2006, practice managers and GPs participated in a range of leadership development courses organised by NHS Wales’ National Leadership and Innovation Agency for Healthcare (NLIAH) team, led by Christine Bamford, Director of Leadership and Organisation Development.

This included participating in the multiprofessional, multiagency “Care to Lead” programme, which is run in conjunction with Birkbeck College, London.

The programme, which concluded in early 2007, was designed for senior professional and clinical leaders, and included modules on key topics for strategic leadership and change management for healthcare, and access to the Harvard ManageMentor online learning system.

Participants integrated their learning with performance objectives, their personal development plan (PDP), and projects linked to delivering improvements in chronic condition management. A further element of the programme was the opportunity to learn alongside chairs, chief executives, other board members and senior leaders.

In support of the programme’s aims, some practice managers and GPs have held facilitated development workshops with colleagues back in their own practice to examine how they can best deliver primary care services.

“GP Leadership” programme
This programme – developed by the NLIAH team with Birkbeck College, London, and then shared with the British Medical Association’s (BMA) General Practitioner’s Committee (GPC) in Wales and the Royal College of General Practitioners (RCGP) – started running in March this year, and will be ongoing until February 2009.

It has been designed to align with GP appraisal, and to support developing roles in primary care. The programme has four main themes:

  • GPs adopting a leadership role.
  • GPs leading/influencing system
  • change in a care pathway.
  • GPs developing GPs.
  • GPs as business leaders.

The programme includes an individual diagnostic – to identify development needs for each individual – and looks at options on how best to meet these needs, which include: a taught programme; action learning; action-based projects;
and e-mentoring.

Designed for Life – the 10-year strategy in Wales for improving health and social care, which was issued by the Welsh Assembly Government in 2005, acknowledges that GP engagement is necessary to deliver required service changes, and the GP Leadership programme has been designed to support this.(10)

Learning needs analysis for GPs and practice managers
In 2006, a learning needs analysis was carried out for GPs and practice managers to encourage a better understanding of emerging development needs, and to inform the range of leadership development programmes that have since been developed by NLIAH and its partners.

Example of leadership development
“Transforming St Mary’s Programme”, St Mary’s Hospital, London
St Mary’s introduced a leadership and coaching programme to support the “Transforming St Mary’s Programme”, which was set up to engage senior clinical leaders in delivering significant service changes over the next few years.

Lane4 performance development consultancy firm were commissioned to design and deliver a programme that would equip senior clinical leaders (many are consultants) to lead and inspire change through others. As one of the coaches involved, I had firsthand experience of the development that was delivered, and the results that followed.

A programme of workshops, action learning sets and one-to-one coaching was developed and delivered over an eight-month period. The programme evaluation yielded considerably positive feedback. All parts of the programme were valued. Workshops provided inputs on relevant topics and group learning and discussion. Action learning sets provided group support for tackling challenges more effectively, and the one-to-one coaching seemed to receive strong positive feedback through providing personalised support, challenge and development in a way that met individual needs.

All elements of the programme were focused on helping senior clinical leaders deliver real benefits in the workplace. While this programme took place in an acute hospital and academic setting, many who took part highlighted the inter-relatedness between primary and secondary care, and that the scale of improvements needed were unlikely to be achieved without developing and utilising wider professional networks.

Feedback from participants was that as a result of the programme they were considerably more likely to:

  • Think about the wider NHS context when developing services.
  • Form relationships across the organisation’s leadership community.
  • Take a coaching approach with their own team.
  • Influence the development of future services and business plans.
  • Actively participate in trust developments.

Individual issues that were focused on included:

  • Increasing self-awareness of particular skills and ways of using these skills to maximum benefit in the future.
  • Influencing others.
  • Focusing on priority objectives.
  • Becoming more strategic, and considering the longer term.
  • Increasing self-confidence – a common issue among senior clinical leaders.
  • Working in a more integrated way with wider organisations and partner organisations.
  • Creating space for thinking and planning about major projects.
  • Delegating to others.
  • Building capability in others and creating capacity for self.
  • Being more assertive with others.
  • Taking managed risks.
  • Improving understanding of the role and the contribution that the manager can make.

Improvements and results reported by participants were:

  • “Fantastic increase in self-awareness – insight into personal strengths and ways of developing.”
  • “Improved delegation – in a responsible and supportive way.”
  • “Planned-for success in important objectives.”
  • “Thinking about, and taking into account, other people’s perspectives.”
  • “Learned more about how to plan and prepare for key meetings, with increased successful outcomes.”
  • “Started to think about what is important to me – looking ahead more – how I can make the best contribution.”
  • “Have been more assertive with others.”
  • “Increased self-confidence.”
  • “Increased awareness of transferable skills.”
  • “Now more involved in a project group to deliver service change.”
  • “Now more able to describe the risks to quality of patient services.”
  • “Learned the importance of engaging others early on to influence their thinking.”
  • “Can be more honest in discussions.”

Those faced with leading health service improvements could do much worse than taking stock of the challenges they face, and reviewing their PDP to assess honestly how well this is likely to support the changes they are required to deliver. Is the PDP “up to the job”, or does it need strengthening?

Also, how well does the practice support the development of its staff? Are there any areas that may benefit from additional support? As the pace for change continues to grow, why not put yourself and your team in a position to succeed?

After all, it is leadership and people that make the difference.

1. Offley N. Why is leadership development important? What role do leadership and leadership development play in enabling change? [article on the internet] July 2006. Available from:
2. Patterson M, West MA, et al. The impact of people management practices on business performance. London: Institute of Personnel and Development; 1997.
3. Hartley J, Hinkman B. Leadership development; a systematic review of the literature. London: NHS Leadership Centre; 2003.
4. West MA, Borrill C, Dawson J, Broadbeck F, Shapiro DA. Leadership clarity and team innovation in healthcare. London: NHS Leadership Centre; 2005.
5. Offley N, Brown H, Larsen L, Anderson B. Review of coaching and mentoring research and evaluation. London: NHS Leadership Centre; 2005.
6. Burgoyne J, Williams S. Systematic Review: Evaluation and Leadership Development. London: NHS Leadership Centre; 2004.
7. Fielden S. Coaching effectiveness. London: NHS Leadership Centre; 2005.
8. Offley N, Brown H, Larsen L. Review of coaching and mentoring research and evaluation. NHS Leadership Centre, Department of Health; 2005.
9. Williams S, Offley N. Research and reality – innovations in coaching. NHS Leadership Centre, Department of Health; 2005.
10. Welsh Assembly Government. Designed for Life: creating world-class health and social care for Wales in the 21st Century. Cardiff: Welsh Assembly Government; 2005.