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

Enterprise profiles in deprived areas: Are they distinctive?

This paper examines the extent to which segmenting business activity on the basis of the relative deprivation of a given area provides additional understanding (in terms of analysis and policy) that is not obtained by alternative divisions, e.g., by sector, size, etc. The paper is primarily motivated by the explicit inclusion of a deprived area dimension to many UK small business/enterprise policies introduced since 1997. We use two datasets drawn from the customer records of Barclays Bank PLC to obtain an initial analysis of the business stocks and dynamics in deprived and non-deprived areas of England. The data indicate that the deprived areas of England vary systematically from the wider economy in terms of several business stock characteristics and associated dynamics. These differences include a lower proportion of business service firms, lower female involvement in the owner-manager base and a poorer risk profile. The analysis supports the view that there are likely to be benefits from the tailoring of small business/ enterprise policies to sub-national levels

Computational Science: A Field of Inquiry for Design Science Research

The digitalization of science has resulted in the development of essential, specialized, devices and software. Computational science, as a branch of science, is specifically identified as an important, potential area for which it would be helpful to apply design science research. This paper examines computational science, identifies its past and ongoing challenges, and suggests that progressing computational science with design science research can serve as an important area of inquiry for continuing design science research

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

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

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

Identifying Authorship from Linguistic Text Patterns

Research that deals with linguistic text patterns is challenging because of the unstructured nature of text. This research presents a methodology to compare texts to identify whether two texts are written by the same or different authors. The methodology includes an algorithm to analyze the proximity of text, which is based upon Zipf’s Law [47][48]. The results have implications for text mining with applications to areas such as forensics, natural language processing, and information retrieval

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