Royal United Hospital Bath trust, renowned for its leadership development work and headed until recently by Barbara Harris, director of the NHS Leadership Centre, has been strongly criticised in a Commission for Health Improvement report for its management style.
As well as expressing concerns about the trust's accident and emergency services and risk management, CHI described a culture with 'a serious disconnection between the executive team and the rest of the organisation'.
A new chief executive, Richard Gleave, formerly director of service development at United Bristol Healthcare trust, took up post formally this week, and the trust is also interviewing for new directors of finance and human resources.
The report said: 'A picture was presented to CHI of an inner circle with a limited focus on the needs of the wider staff group.
There has been insufficient executive team energy directed at assuring basic good care for patients. . .'
And it drew attention to the trust's practice of making significant changes to managers' roles and responsibilities without proper process, 'usually without advertisements or interviews' - changes which 'do not demonstrate good employment practice'.
CHI highlighted the trust's history of leadership development 'based on dynamism, creativity and innovation' and managers' involvement in new initiatives and pilot schemes. But the reviewers believed this was at the expense of developments within the trust and 'contributed to a slowness by the trust to address major issues in the hospital and local health economy, such as the current problems with A&E'.
At the time of the CHI visits, patients were waiting up to 27 hours in A&E before admission, and the need for ambulance personnel to stay with patients also put the 999 emergency service at risk, the reviewers complained.
A spokesperson for the Department of Health said all CHI reports were taken seriously and it would be 'considering all the implications including those - if any - for the Leadership Centre'.
Mr Gleave has already been working with staff on the development of its action plan and has set up a special e-mail account for CHI report feedback. A rebuild of the A&E department is underway and 84 elderly care beds will be added next April.
'Although we feel that a number of achievements have been understated, we take seriously the comments about needing to develop some of the systems and processes, 'Mr Gleave said.He told HSJ he had been 'struck by the friendly welcome he had received and the close relationship between management and staff '.
The trust was praised for innovations such as integrated care pathways, employment of consultant nurses and admission of patients with neurological conditions to a specialist ward - initiatives Mr Gleave pledged to build on.
Ms Harris said: 'The CHI report makes a number of useful comments and recommendations for action, many of which were already being implemented before I left.
'I feel strongly that good leadership is about learning lessons. The Leadership Centre is working with CHI and others to ensure everyone in the NHS learns from their current work, so they can improve their future service.'
lCHI's report into Sandwell Healthcare trust has praised its 'democratic management style' and 'loyal culture', leading to a stable workforce that felt valued. CHI also described the trust's clinical incident system and relationship with external agencies as 'excellent', but said more resources should go into creating an environment that ensured privacy and dignity.