Relatively simple changes in leadership practice can make a big difference to staff engagement and patient experience, writes Chris Ham.
NHS managers have seemed like an endangered species in recent years. Politicians of all parties have called for cuts in management costs and have outbid each other in the headlong rush to release resources to invest in patient care. The counter view – that a massive and complex organisation like the NHS requires top class leadership and management – has not been well articulated.
It was for this reason that the King’s Fund set up a commission to investigate the future of leadership and management in the NHS. Its report, subtitled No More Heroes, published in May 2011, brought together evidence from many sources to make the case for excellent leadership and management in the NHS.
The report set out why managers are not only essential to the effective running of the NHS, but also have a critical part to play in supporting doctors, nurses and other clinicians to improve patient care.
Our new report, Leadership and Engagement for Improvement in the NHS, builds on the arguments put forward by the commission and explores in more detail the role of leaders in engaging a range of significant others in improving health and healthcare.
The debate over the Health Act and the government’s reforms to the NHS have reinforced the central importance of effective leadership and management at all levels, from the ward to the board and across traditional organisational boundaries. The purpose of effective leadership, put simply, is to improve population health and patient care, and this must be recognised now more than ever.
As our report shows, there is strong evidence that leaders who engage staff deliver better patient experience, stronger financial management, higher staff morale and less absenteeism and stress. There is also evidence that links medical engagement and organisational performance, both from the NHS and other healthcare systems. As Angela Coulter put it in a paper we commissioned: “Happy staff make happy patients.” An eternal truth that we ignore at our peril.
Nowhere is an engaging style of leadership more important than in the frontline teams delivering care to patients in hospitals and the community. Research summarised in our report shows that team leaders have a critical role in creating a climate that emphasises patient care and enables staff to perform to the best of their abilities. This research has clear implications for the Francis inquiry into Mid Staffordshire Foundation Trust, not least in ensuring that priority is given to the role of team leaders and their development across health and social care.
At the King’s Fund, we attach particular importance to leaders who engage with partner organisations to achieve improvements in care. Integrated care will only become a reality when leaders work across organisational boundaries to ensure that services are joined up around the needs of patients and users. Place-based leadership, as it is known in local government, must be the priority to make best use of increasingly scarce public resources.
One of the recommendations in our report is that the pace setting styles of leadership prevalent among top NHS leaders must be complemented by other approaches in the future. This requires the NHS Commissioning Board to lead by example and move away from the “targets and terror” regime that has recently characterised the NHS. It also requires the new Leadership Academy to support top leaders and others in promoting a diversity of leadership approaches and emphasising the value of an engaging style of leadership.
NHS boards have a key part to play in promoting engagement and in setting the tone for staff. The results of the staff survey should be studied closely by boards, especially those relating to whether staff would recommend their organisation as a place to work and to be treated. Warning signals from the survey should alert board members to likely problems that demand attention to avoid a repetition of the kinds of problems that emerged at Mid Staffordshire Foundation Trust.
The good news is that relatively simple changes in management practice can make a big difference to staff engagement, and therefore the experience of patients. The things that matter are clear objectives, control over the work to be done and well structured appraisals. All of these are under the direct control of NHS organisations and can be strengthened regardless of the approach adopted by the NHS Commissioning Board and politicians.
The bottom line is that the business case for leadership for engagement is compelling at a time when the NHS needs to deliver unprecedented efficiency savings over many years. Leadership for engagement is not something that would be “nice to have” in the NHS. It is essential in the next stage of reform.