Towards a New Model of Leadership for the NHS

This paper was commissioned by the NHS Leadership Academy as a contribution to thinking about the future development of leadership in and around the NHS. It was prepared in collaboration with the Hay Group. The backdrop and one of the triggers was the launch of a new suite of professional development programmes sponsored and organised by the NHS Leadership Academy. From the research reported in this paper a new framework for leadership in the healthcare is built. This is being used to guide the construction of a new Leadership Model. To quote the NLA this 'will be a well-researched, evidence-based model that reflects the values of the NHS, what we know about effective leadership, what we have learned from the Leadership Framework and what our patients and communities are now asking from us as leaders'

Clinical leadership in action

The nature, scope and potential for clinical leadership are explored by focusing on four cases. These were cross-boundary service redesign attempts for dementia and sexual health in London and Greater Manchester. Each case contained multiple organisations, including GPs and primary care trusts, acute hospital trusts, mental health trusts, local authorities and independent sector provider

Possibilities and pitfalls for clinical leadership in improving service quality, innovation and productivity

The idea that something called ‘clinical leadership’ is the favoured ‘answer’ to many of the huge challenges facing the NHS has been advanced with increasing intensity. Inter alia, Lord Darzi in the Next Stage Review emphasised the importance of clinical leadership; the Health and Social Care Act (2012) puts clinicians to the fore; and the Royal Colleges have accepted the need for Medical Leadership Competences to be defined and developed. Despite such emphasis and expectation, the reality of clinical leadership attempts to redesign services across the extant boundaries of the NHS and which reveal how the many barriers can be overcome, has not so far been studied. The overall research question was: What can be learned from the experience of enacting the Darzi model of clinical leadership in practice? What are the main enabling and constraining conditions for its effective realization and performance? Subsidiary research questions that feed-in to this main research question were: 1) What general lessons about its nature and its practice can be educed from a series of examples of effective clinical leadership in introducing more integrated models of care? What variations are required when enacting the model in very different service areas? 2) What are the enablers and the blockers of effective clinical leadership? 3) How do effective clinical leaders both initiate and lead service improvements while also engaging constructively with top-down service redesign and improvements initiatives? 4) How do service-level clinical leaders in acute and primary care develop and implement service quality improvements through achieving greater integration between primary and acute care? How do they go about mobilising other clinicians while also engaging with commissioners and managers? The main findings of the study were: 1. The obstacles to the exercise of the clinical leadership of cross-boundary service redesign within the context of the NHS are many. 2. Despite the extent and severity of the obstacles, we found some significant examples of clinical leadership of service redesign which were all the more impressive because of the challenges that had to be surmounted. 3. In general, clinical leadership was found to occur at multiple interlocking levels and the role of clinicians in shaping national policy should not be underestimated. Many of the important changes required national endorsement – and often funding – in order to put traction behind good ideas. 4. Successful clinical leadership requires the enactment of skilful practice across a number of constellations including collaborative working with a host of actors including managers, IT staff, project managers, estates and many others. 5. Clinical leaders were capable of being open to new ideas and new knowledge while also having the political wisdom to seek new reworked boundaries around which professional identity could be redefined and reformed. 6. Implementation leadership was important; it is the essential minimum for change. 7. Informal, lateral, leadership can mobilise and bring along clinical colleagues and conversely formal project planning on its own can be relatively ineffective but the most effective service redesigns were achieved when both of these processes worked in tandem

The contribution of clinical leadership to service redesign: a naturalistic inquiry

Numerous policy papers and academic contributions across a range of countries emphasise the importance of clinical leadership in health services. This is seen as especially vital at a time of simultaneous resource constraints and rising demand. Most of the literature in this topic area concerns itself with conceptual clarification of types of leadership and with delineation of requisite competences. But other work on leadership has emphasized the importance of attending to practice in concrete situations in order to identify the dynamics at play and the nature of the challenges. The purpose of this article is to contribute to this latter task by drawing upon a set of data which reveals crucial aspects of the problems facing potential clinical leaders of service redesign. The paper reports on the nature and extent of the challenges as identified by clinicians of different types as well as managers and commissioners

Innovating Healthcare

Why is there a need to ‘innovate healthcare’? The basic reason stems from the sheer scale of the challenges now facing healthcare provision in the UK and across many other countries. The aim of this book is to interrogate past and current attempts to innovate in this arena and to draw-out the key lessons. Innovating Healthcare: The Role of Political, Managerial and Clinical Leadership presents the latest state of knowledge based on original data from a series of NIHR-funded research projects set in the context of a review of extensive secondary research. The book draws upon first-person verbatim accounts of change attempts made by doctors and other clinicians as well as upon research findings about the roles played by policy-makers and managers. The analysis draws upon theory and practice in leadership, innovation and institution-building. The mutually-reinforcing contributions of political, managerial and clinical leadership are at the core of the investigative narrative. This book will be of interest to students and researchers, clinicians and managers in the health and care sectors as well as policy-makers. While the focus in on healthcare, the book has wider relevance for students of management, leadership, innovation and organizational studies

The Overlap Between Geriatric Medicine and Palliative Care: A Scoping Literature Review

With an increasing aging population worldwide, there is a growing need for both palliative care and geriatric medicine. It is presumed in medical literature that both specialties share similar goals about patient care and could collaborate. To inform future service development, the objective of this review was to identify what is currently empirically known about overlapping working practices. This article provides a scoping literature review on the relationship between geriatric medicine and palliative care within the United Kingdom. The review encompassed literature written between 1997 and 2019 accessed via Scopus, Web of Science, PubMed, and Google Scholar. Three themes were identified: (a) unclear boundaries between specialties, (b) communication within and between specialisms, and (c) ambiguity of how older people fit in the current health care system. We suggest that more empirical research is conducted about the overlap between palliative care and geriatric medicine to understand how interprofessional working and patient care can be improved

Client and consultant engagement in public sector IS projects

Engagement between clients and consultants has been identified as important in public sector IT projects. However, current literature is not clear what constitutes engagement, and how this is related to other concepts such as cooperation and collaboration. This study proposes a model of engagement based on a range of related extant literature. Five case studies of IT projects in the public sector in the UK are analysed in order to empirically validate and extend the proposed model. The validated model suggests that engagement can be understood as three conditions (environment, participants, expertise) and three behaviours (sharing, sense-making and adapting) that dynamically interact in self-reinforcing cycles. The model represents a starting point for academics interested in the future development of a theory of engagement and is of value to practising managers and consultants in either a diagnostic or prescriptive mode to increase the effectiveness of their joint IT endeavours

Devolving healthcare services redesign to local clinical leaders: Does it work in practice?

The purpose of this article is to present the findings arising from a three year research project which investigated a major system-wide change in the design of the NHS in England. This radical policy change was enshrined in statute in 2012 and it dismantled existing health authorities in favour of new local commissioning groups built around GP Practices. The idea was that local clinical leaders would ‘step-up’ to the challenge and opportunity to transform health services through exercising local leadership. This was the most radical change in the NHS since its inception in 1948. The research methods included two national postal surveys to all members of the boards of the local groups supplemented with 15 scoping case studies followed by six in-depth case studies. These case studies focused on close examination of instances where significant changes to service design had been attempted. We found that many local groups struggled to bring about any significant changes in the design of care systems. But, we also found interesting examples of situations where pioneering clinical leaders were able to collaborate in order to design and deliver new models of care bridging both primary and secondary settings. The potential to use competition and market forces by fully utilising the new commissioning powers was more rarely pursued. The findings carry practical implications stemming from positive lessons about securing change even under difficult circumstances. The article offers novel insights into the processes required to introduce new systems of care in contexts where existing institutions tend to revert to the status quo. The national survey allows accurate assessment of the generalisability of the findings about the nature and scale of change

An Open Research University

This is the final report of the Open University’s RCUK-funded Public Engagement with Research Catalyst, ‘An open research university’, a project designed to create the conditions in which engaged research can flourish. The report describes an evidence-based strategy designed to embed engaged research within the University’s strategic planning for research and the operational practices of researchers. This programme of organisational change was informed by action research, working collaboratively with researchers at all levels across the institution to identify and implement strategies that work for them and the stakeholders, user communities and members of the public that engage with their research. Through a combination of surveys, interviews and interventions, we identified a number of challenges and proposed solutions to address them. For example, we found that researchers have a relatively narrow view of engaged research and the communities with which they interact and very few researchers strategically evaluate their engaged research activities. The report documents some of the interventions we have introduced with the aim of broadening and deepening future researcher engagement, including a definition of engaged research and revised promotion criteria that include knowledge exchange profiles. In conclusion, we argue that there is still a battle to be won for open and engaged research. For a culture of engaged research to be sustainable in the medium to long-term requires ongoing recognition and acceptance of its progressive value(s) by researchers, universities, funders and ultimately, policy-makers

Practices, issues and possibilities at the interface between geriatrics and palliative care (InGaP): An exploratory study and knotworking

Introduction With the recognition of the need for palliative care for people with non-malignant conditions, there is an increasing emphasis on interdisciplinary working between geriatric and palliative care teams. This interdisciplinary work has evolved organically; more needs to be known about current working practices. This is of policy and clinical interest as the older patient population continues to grow. Methods An exploratory qualitative interview study was undertaken of end-of-life care for older in-patients in a large London NHS Trust. 30 semi-structured qualitative interviews were conducted with staff from palliative care and geriatric medical and nursing teams, two with patients and five with carers. Questions covered: examples and perceptions of collaboration and patient/carer perceptions of clarity as to who was providing care. Interviews were transcribed and thematically analysed focusing on: examples of successful collaboration; areas of tension, duplication or confusion about responsibilities; and suggestions for future practice. Results Participants were positive about collaboration. Examples of what works well include: the referral process to the palliative care team; inter-team communication and use of face-to-face handovers; unity between the teams when communicating with patients and families. Areas for potential development include: embedding palliative care within ward multidisciplinary team meetings; continual on-ward education given rotation of staff; and improving collaboration between palliative care, physiotherapy and occupational therapy. It is unclear whether patients’ and carers’ lack of awareness of the different teams has a detrimental effect on their care or needs. Conclusions There is evidence of strong collaborative working between the teams; however, this study highlights potential areas for improvement. An exploration of these relationships in other settings is required to determine if the same themes arise with a view to inform national guidelines and policy to improve care towards the end of life