The reputation of top leaders is not achieved by delivering national bottom-line outcomes. Yes, if they don’t deliver then their reputation obviously suffers but the fact is that delivering national performance requirements does not differentiate one leader from another. What does differentiate is the ability to deliver local change, innovation and transformation seen as important to local people.  

My own research over the years, recently updated, confirms that local contextual challenges are often more challenging than meeting national requirements. Of course there’s a link between the two but local relationship development features strongly in the challenges identified by chief executives interviewed for my research. Relationships with leaders of other organisations, politicians, patient groups and boards rightly preoccupy chief executives as they endeavour to establish leadership by creating sustainable implementation networks.

 Paying attention to local relationship building is important because research indicates that the leadership style of chief executives is the most critical determinant of organisational style, culture and the quality of relationships. Nothing new I hear you say but show me a leader who is struggling and I’ll show you a set of poor quality relationships.

 Although the chief executives interviewed for the research identified other challenges, for example reputation management, maintaining turnaround, team development and performance management, much of these are also local in nature. When asked to identify what national challenges would have the biggest influence on their role the results were variable. The future impact of regulation, QIPP, GP commissioning, the transfer of community services and national demographic changes all featured but also reflected local strategic preoccupations.

 If leadership development is about anything then it is how to ensure that the provision of enhanced skills, greater self-belief and confidence will ultimately flow through to better organisational performance. This points to a much stronger emphasis on the importance of managing local contextual issues in leadership development. The problem however is this has been historically underplayed in NHS leadership despite the literature clearly indicating that development rooted in the reality of local leaders has the greatest chance of sustained success.

 Although a national framework of values and principles for NHS leadership and management is necessary for workforce development it should be kept as simple as possible and aimed at ensuring that developing leadership talent is aligned much more closely to local organisational and health system vision, values, aims and challenges. An approach more important than ever before as the government’s reforms move the NHS away from a hierarchical structure to a market-based and regulated system.