McCray, Janet

Palmer, Adam

Warwick, Robert

Investment in leadership development (LD) is essential for high quality patient care (Vaithianathan, 2010). This is urgent with greater public demand (Royal College of Physicians, 2012) complexity of care (NHS England, 2013) health inequalities (Marmot,2010) and financial challenges (Kings Fund, 2011).Ross Baker (2011) note that for building effective NHS leadership having learning strategies that test improvement and scaling up what works may be one response to this challenge.Evaluating an action learning (AL) focussed leadership programme for Senior Medical Consultants (SMCs), the overall study examined the impact of this learning strategy at individual and organisational level to establish what is effective to deliver cultural change and embed SMCs as NHS leaders. Here, this paper will focus on one measure, data gained from the analysis of semi-structured interviews carried out with course delegates after thelearning programme

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      BAM2015 This paper is from the BAM2015 Conference Proceedings                 About BAM The British Academy of Management (BAM) is the leading authority on the academic field of management in the UK, supporting and representing the community of scholars and engaging with international peers.  http://www.bam.ac.uk/  1  Page One  BAM Exploratory Paper Word Count 1490 - 2629 including References  The impact of an action learning programme on medical consultants in senior clinical leadership roles. 150 word summary    Investment in leadership development (LD) is essential for high quality patient care (Vaithianathan, 2010). This is urgent with greater public demand (Royal College of Physicians, 2012) complexity of care (NHS England, 2013) health inequalities (Marmot, 2010) and financial challenges (Kings Fund, 2011).Ross Baker (2011) note that for building effective NHS leadership having learning strategies that test improvement and scaling up what works may be one response to this challenge. Evaluating an action learning (AL)  focussed leadership programme for Senior Medical Consultants (SMCs), the overall study examined the  impact  of  this learning strategy at individual and organisational level  to establish what is effective to deliver cultural change and embed SMCs as NHS leaders.  Here, this paper will focus on one measure, data gained from the analysis of  semi-structured interviews carried out with course delegates after the learning programme.    Track 12.  Leadership and Leadership Development or Track 18 Organisational Transformation, Change and Development          2  Page Two Introduction   In the UK at national level a number of NHS Leadership programmes have been offered in response to NHS transformation. One NHS organisation a Foundation Trust with two district general hospitals, each with a distinct culture, resulting from a merger five years ago  wanted a more locally based  programme that would :  change the organisational culture, impact on performance, establish new networks for collaboration and  improve quality and resilience of care delivery .They commissioned an action learning module within a  bespoke leadership programme leading to a Post-Graduate Certificate in Strategic   Management and Leadership. Action learning  (Revans, 1982) is defined as : “a process underpinning a belief in individual potential: a way of learning from our actions, and from what happens to us, and around us, by taking the time to question, understand and reflect, to gain insights, and consider how to act in future.”(Weinstein, 1995, p.3) An external evaluation of one cohort (Arup Consulting, 2012) had been undertaken showing strengths in the approach but further measures of individual and cultural change, cost effectiveness and patient care pathway outcomes are required to provide more evidence of impact and benefits for the NHS. The response is a longitudinal (one year) mixed methods case study  The main aim of this exploratory paper will be to report findings from one measure. A set of data gained from the analysis of 9   semi-structured interviews carried out with course delegates before the learning programme.   Literature Review A backdrop of  diminishing fiscal resources, public concerns over patient safety and the quality of care (Francis, 2013) and the challenging demographic of an aging population with complex  needs (Oliver, Foot and Humphries, 2014) demand new ways of working in the NHS. One solution to changing the culture is that clinicians would be more engaged in leadership and management (Kings Fund, 2013, p 5). Medical Doctors and General Practitioners holding strategic clinical leadership roles are charged with making new models of care effective. Such leaders are in the gap between managerial and clinical communities (Marnoch. Mckee and Dinnie 2000), and face the differences between clinical priorities and financial controls, and individual versus systematised perceptions of clinical work (Degeling et al 2003, Kings Fund, 2013).The transformation in service models to person-centred care may affect how individuals fit with the organisational culture (Adkins & Cadwell, 2004). Equally the efficiency gains versus safety balance as set out in the Nicholson challenge remains unsolved (NHS England, 2013) as   events at the Mid Staffordshire NHS foundation trust (Francis, 2013) show, illustrating poor engagement of clinical leaders and the lack of voice of Doctors (Drs) (Kings Fund, 2013, p 12). These behaviours were seen as part of a culture driven by command and control leadership. One solution to changing this was that Drs would be more engaged in leadership and management (Kings Fund, 2013, p 5).  Ros Baker (2011) in a study of high performing health care organisations notes effective quality 3  patient care occurs when leadership is aligned and distributed across the organisation.  Roebuck (2011) notes the cost to organisations of poor leadership as the role of Drs and the onset of clinical leadership  from Cogwheel (1967) through to  the Griffiths Report (1983) the  Darzi Review (DOH, 2008) ( Ham & Dickinson 2008)  and Keogh (2014) has been seen as critical for effective leadership in the NHS. The commitment of Drs to this shift has been mixed. In the medical profession clinical leadership is not perceived as a specialism in its own right (Fitzgerald et al, 2006). Nor is there always clarity about what leadership roles involve (NHS Confederation, 2009) and what organisational supports are in place (Spehar et al, 2012).Storey et al (2013) report that the cross boundary context of care requires different leadership strategies and structures. Ros Baker (2011) note that for building effective NHS leadership having learning strategies that test improvement and scaling these up where they work may be one response to this challenge. Mcleraney et al (2006) in a large US study advocate a conceptual LD model based on organisational commitment to strategy, culture and structure.  The Study Research Question The overall research question is to consider how leadership activities will come to affect performance (Kirkpatrick & Kirkpatrick, 2007) at personal, team and organisational level over time. By leadership activities we mean a planned leadership programme which uses action learning to facilitate learning though experience, success, failure or other striking mo- ments; and the combination thereof (Avolio & Gardner 2005).  Paper Aims This exploratory paper will  report findings from one data set of the research study from  9   semi-structured interviews. The paper  aims are to  :  Address what happens during and after people have attended a leadership programme.  Focussing on the interaction between the enthusiasm they have gained and the insights and tools they have developed and how this plays out in the context of their day to day work.   Consider the nature of any dissonance between a clinician’s leadership and identity, shaped from medical school, and a changing contextual landscape requiring a different leadership style across the wider systems.  A leadership approach requiring an acceptance of uncertainly, a distributed form of leadership, a focus on values and relationships as well as an open and enquiring mind-set  (Welbourn et al. 2012).  In other words moving from close hand direct leadership to a more diffusive leadership of influence and seeing a wider connected picture. Paper Objectives 1.  A critical review of the self reported impact of an  action research  programme on the leadership and management practice of nine Doctors in clinical leadership roles. 2. Whether an action learning programme can contribute to the leadership capabilities of Doctors during a period of transformation of service delivery. 4  3. How an action learning leadership development  programme can assist organisations to develop clinical leadership.  Methodology A narrative inquiry methodology was used. Narrative can be defined as focusing on the meanings that people ascribe to their experiences, seeking to provide "insight that (befits) the complexity of human lives" (Josselson, 2006, p.4).  Its meaning and application differs across disciplines but as Reismann ( 2008, p 11) writes the “investigator focuses on particular actors, in particular social places at particular social times “ . Narrative inquiry  seeks to explore  the  intention and language (Reissman, 2008, p 11) the how and why of people’s incidents and the function set by them.  It is relevant for individuals or groups, and  because it is case centred  it offers the opportunity for refining theory and generalisation to  theoretical propositions (Radley and Chamberlain, 2001). A range of methods can support a narrative approach including interviewing which was used here.   The interview was chosen because it is   a well understood method (Bryman & Bell 2003) in leadership research (Bryman, A, 2011) and within health (Staniland 2009), (Bolton 2004), (The Health Foundation 2014). A middle line was taken, whereby structure was provided to ensure detailed accounts of participants biographical, educational and career experiences  ,with room for participants to take their own narrative path (Chase, 2005 ) and to pursue topics important to them (Mason 2006),  but maybe unknown to the interviewer.  Sample  A representative sample of nine senior medical consultants from the  leadership programme were interviewed. All were in full time Senior Medical Consultant roles. There were seven men and two women in the sample. The Interviews  An  interview schedule was designed  with four main areas for exploration. Initial questions were aimed at gaining a picture of the participants’ leader ship story – their leadership experience, role development learning style preferences and educational models experienced prior to the educational programme. Secondly questions aimed at getting an indication of use of action learning as a model of leadership development were planned. Thirdly participants were asked to explore their action learning set experience. Finally any accounts of  self or peer reported behaviour change in the workplace as a result of the ALS approach were sought to gain  insights into leadership activities and their perceived effect, both in terms of how they made sense of experience (Weick 2001) and the leadership decisions taken.  These four areas of exploration were planned with a set of probes if more detail was required. A Research assistant undertook the interviews. Often in discussions around the interviewer / interviewee the power relationship is explored – the researcher being viewed as the holder of power.  As the participants were all senior medical consultants we upheld the view of Trahar (2009) that the power in any interview shifts constantly -the difference in narrative inquiry 5  being that this is explored more explicitly in the form of participants intentions and messages presented. Data Analysis and Findings Data Analysis and findings of this cycle of the research will be reported and include: the identification of key learning activities for skill development for individual and organisational learning. Impacts will include evidence of change in leadership behaviour and style via self report. The influence of the programme on organisational culture will be critiqued. Next Steps These will be explored in the full paper. 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The impact of an action learning programme on senior medical professionals in clinical leadership roles within a United Kingdom NHS health trust.

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The impact of an action learning programme on senior medical professionals in clinical leadership roles within a United Kingdom NHS health trust.

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