Great leadership goes beyond the individual - and the ultimate top team combines strengths for the common good, says Phil Kenmore

Who would want to be in an executive team in the NHS at the moment? Unprecedented change, immense ambiguity, severe financial pressures and, to cap it all, many face uncertainty about their own future. Now is definitely the time for truly exceptional top teams to step up to the mark.

But are enough top teams in the NHS up to the job? There has been a residing myth that great individual leaders can make organisations successful. This is just not true. Great leadership is crucial, but the challenges are simply too big for one person. In times of change a great chief executive is one who can weld together a highly effective team (rather than simply a team of star reports) who establish and deliver a clear and compelling future remit and direction.

Here are some top tips for how to effectively lead executive teams during times of change to achieve the greatest positive impact on your organisation. This is drawn from research with over 100 high-performing teams worldwide and insights gathered from our experience working across the NHS, and the public and private sectors.

A useful first step is to consider what type of team you need to be given the challenges you face. There are four basic types of leadership teams (see box). In our experience, most top teams think they are a decision-making team. But often, when observed and questioned in detail, teams can be acting as one of the other three. 

Whatever type of team your organisation needs, there are four tips that, if implemented, will ensure your top team is the best.

Establish a direction

What’s interesting about the current environment is that there is a clear financial reason for change.

However, the challenge is to give that rationale a meaning and direction beyond itself, using the opportunity to remodel services while focusing on quality and outcomes. In outstanding teams, the leader gives far clearer direction that the team then builds on, working back from the aiming point and forming a clear plan for getting there.

Lay down the boundaries

Real teams have clear boundaries. Everyone knows who is a member and who is not. They have stability and the time to work together. They are highly interdependent, drawing on each others’ skills and experiences.

The chief executive must set team size and boundaries, establish procedures and spell out the code of conduct. A sound structure means having shared expectations about behaviours that are, and are not, tolerated and what may and may not occur during and outside meetings.

It also means that the team members are focused on tasks directly linked to the organisation’s strategy and change agenda.

Select the right people

People in outstanding teams are not necessarily brighter, more driven or more committed than members of less accomplished teams, but those in the best teams work well with others. They bring emotional intelligence to the table.

It is also vital to appoint people with integrity, who will abide by team decisions, avoid political manoeuvring and who, when under stress, will not forsake shared accountability.

Give reward and development

Great teams don’t just happen, they need to be built and welded together. The best teams are the ones where this is intimately understood.

The chief executive must ensure that the people in the top team get appropriate development and that their efforts are adequately rewarded.

They also recognise that, as much as anyone else, team members need honest feedback on their performance.

With the best top team, the payoff for an organisation can be significant: faster execution of the strategic agenda, performance transformation, improved efficiency and quality.

But creating and sustaining effective top teams is difficult. They are organic units and effective chief executives take care to nourish and renew

them, never taking for granted their performance or capability as the environment continually shifts.

As you face the mountain of current challenges and resulting changes, ask yourself: is your top team still up to the job?

The four types of leadership teams


  • Gather to exchange important information and maintain alignment
  • Meet with the CEO to hear about the organisation’s direction and its strategies


  • Typically small groups brought together periodically to advise the CEO on key organisation-wide decisions
  • Provide information and insight, debate issues and act as sounding boards. They don’t actually make decisions


  • Meet to co-ordinate various unit’s activities as they execute strategic initiatives
  • Team members are interdependent, they have shared responsibilities and must work together frequently to accomplish their shared goals

Decision making

  • Assemble to make important organisation-wide decisions
  • The most complex and dynamic type of team; often in need of a compelling direction, a sound structure, contextual support, and coaching


  • In the next few weeks we will be publishing articles on measuring patient experience, and the future of non-foundation trusts. If you would like to highlight your organisation’s ideas and examples of best practice both in HSJ and at the online Resource Centre, email