In the 2007 NHS Chief Executives Annual Report Sir David Nicholson commented as follows:
‘’The NHS, like all healthcare systems, is the sum total of the people who work in it and the day to day interactions they have with patients and colleagues. A healthcare system is a powerful coalition of organisations and professions, not just a set of individual organisations operating in a market.’’ This would indicate that certain previous NHS systems and procedures were deemed to have been insufficient and quite un-corporate.
Here, then, was a clear call for an increase in cohesion and order, and for an improved working together of individuals and teams in a time of profound change. The implication was clear that further and on-going non-clinical training and development of staff at all levels within the NHS would play a crucial role.
The following year in his 2008 Final Report, ‘’High Quality of care for all, Next Stage Review’’ , Lord Darzi, the then Parliamentary Under Secretary of State at the Department of Health, was more explicit in the role of Leadership and Management and the need for greater focus on Leadership and Management training: ‘’making change actually happen takes leadership. It is central to our expectations of the healthcare professions of tomorrow.’’
What type of leadership did Lord Darzi have in mind? ‘’Placing a new emphasis on enabling NHS staff to lead and manage the organisations in which they work.’’and, further to this, ‘’A clear focus on improving the quality of NHS Education and Training, strengthening arrangements to ensure staff have consistent and equitable opportunities to update and develop their skills.’’
In point of fact, of course, the NHS had been fully aware of this need for the identification of training needs in both individuals and groups and for the implementation of training and education long before Lord Darzi’s 2008 comments. Perhaps, as a possible criticism of their efforts, this had on occasion tended to be on an ‘ad-hoc’’ and localised basis and not with a view of the greater picture called for by Sir David Nicholson.
Out of the awareness of the need for a common approach and cohesion to training throughout the NHS there evolved in 2002 the NHS Leadership Framework [LQF], further modified in 2006 and again in September of this year in order to ensure that the qualities and behaviours identified and required in 2002 were still appropriate. Since 2002, in fact, 180.000 NHS employees have taken the LQF and it ill behoves any external training organisation to be at the very least not mindful of the LQF and its purposes and intentions! The LQF was designed, after all, ‘’to work alongside processes that guide talent management and development and recruitment.’’ This clearly includes external training providers and experts in the field of working within the sphere of Leadership and Management.
Designed specifically for the NHS, the LQF defines those abilities and qualities required of both existing and potential leaders at any level of the service.
The LQF, designed by the Hay Group, is formed of three major areas – Personal Qualities, Setting Direction and Delivery of Service. Within these are a total of 15 leadership qualities further broken down into a number of levels representing varying degrees of Leadership and Management within the NHS. The purpose of this is to identify the presence [or possible lack of] requisite behaviours, characteristics and attitudes deemed necessary.
So, in the context of the NHS, what is a good Leader?
At a recent Conference [July 2011] Karen Lynas, Director of the NHS Top Leaders Programme asked a gathering of 800 senior leaders for words they associated with NHS Leadership over the past ten years. These included ‘’unsafe’’, ‘’top down’’, ‘’oppressive’ and ‘’risk adverse’’’. Striking a positive note, the words ‘’exciting’’ and ‘’progress’’ were used. It was widely acknowledged that the NHS approach to Leadership and Management and the addressing of revealed needs through use of the LQF had come a long way in the past decade, and not only in approaches to coherency, cohesion and professionalism.
At the same Conference Ms Lubna Haq, Associate Director of the Hay Group, discussed and shared the data she had gathered on the subject of major current styles of leadership within the NHS, identifying: Directive, Affiliative, Participatory, Visionary, Pace Setting and Coaching.
The predominant trait appeared to be that of ‘’pacesetting’’, indicative of determination, vision and focus. Leading from the front is a salutary gift and skill, provided that one is always aware of the occasional danger of a lack of partnership with those being led. It was widely acknowledged that new and different styles of leadership needed to evolve with the fast changing environment.
A number of other desirable traits were identified. These included ‘’humanity’’ and ‘’positivity’’. The consensus is that the good leader needs to possess the ability to both inspire and to take risks. Of equal importance is the need for realism and the setting of realistic goals.
There are seven main uses of the LQF; investigation into organisational development, leadership development, coaching, assessment, selection and recruitment, team development, career development and the 360 degree feedback tool.
Those external organisations providing training support to the NHS should take due note of an increasing clarity of vision and cohesion within the NHS and increasing sophistication and refinement of diagnostic tools. This is especially the case with Organisational and Leadership development, Team development and Coaching. In taking note of all the findings, evolving attitudes and requirements in a fast changing environment the NHS and the external provider need to find common ground and march in step to provide the diagnosis and training that is required.