Which qualities are needed in those who lead their organisation's services transformation? Triona Buckley sets out one trust's formula

One of the most complex, challenging and rewarding roles anyone can undertake is to lead improvement in the NHS. The obvious benefits are how improvements can make a difference to the lives of patients and their families.

The sometimes less tangible, yet equally rewarding, benefits can be the team working that has achieved this improvement, the identification of latent skills and abilities in others and the increased sense of common purpose and shared goals.

In June 2007 our approach to leadership development at Alder Hey hospital was in its second year of implementation and evaluations of each programme were extremely positive. However, participants sometimes struggled to implement their ideas and a new approach in their own areas. This was a concern as the Royal Liverpool Children's trust was about to launch a trust-wide service transformation programme, using lean thinking principles, tools and techniques, which we called the rapid improvement programme.

This has produced some early success in delivering improvements for patients and their families. Its scale across the trust has meant leadership in the design, delivery and ongoing sustainability of the solutions would be critical. We needed some fresh thinking about how best to support and develop leaders to meet this challenge.

The Health Foundation had seen a number of leaders from the trust successfully apply for their Leadership Fellows Scheme. It wanted to explore more about what made Alder Hey tick when it came to leadership and improvement. It made a special award to the trust to support us in our thinking about leadership. We used this funding to continue our partnership working with The Talent Foundation chair Bill Lucas.

With his support, we set out to identify and develop:

  • the Alder Hey model of change;

  • characteristics of improvement leaders.

To develop a model of change for the Royal Liverpool Children's trust, we had to consider the exact whys and whats of the things we were doing. Our emerging model of change brings together the "why" and the "what" we, as senior leaders, are doing within the organisation to deliver world-class services.

These assumptions, analyses and actions will be specific to each organisation and therefore it is the process of articulating and understanding them that helped us to develop a shared vision and common understanding of the pulls and pressures on the time of middle to senior-level leaders and managers.

Becoming more explicit about what we are doing and why has been a really valuable piece of organisational and leadership development work. It has provided a focus for leaders at all levels to debate, share opinions and deepen their understanding.

The challenge for us as an organisation is to encourage and support staff at all levels to actively aspire to lead, whatever their job title, and be clear about what the trust expects in the behaviour and approach of improvement leaders, by explicitly defining improvement leader characteristics.

From the scoping work undertaken, it is clear a transformational leadership model at all levels is essential to embedding service transformation. This model was explored by identifying and examining in depth a core set of four main leadership styles, which would be flexed to meet the situational requirements of the role and task for the individual improvement leader.

These four main leadership styles which made up the transformational leadership model are:

  • formal;

  • empowering;

  • influencing;

  • collaborative.

Developmental workshops explored each of these styles in more depth and the characteristics of improvement leaders (what do they do, what should they do) were developed and tested through the workshops to gain commitment and ownership of the outcomes.

Walk the walk

So what is it that over 300 staff within Alder Hey identified would demonstrate an improvement leader was "walking the walk"?

  • Focused. Always focusing on improvement and creating space for improvement activities; talking about improvement as if it really matters.

  • Questioning. What am I improving?; why am I doing it?; how am I doing it?; how do I know if it is improving?

  • Engaging, facilitating and motivating. Always showing that "we" is stronger than "I".

  • Demonstrating and sharing. Role modelling; championing other improvers; being expert in improvement techniques.

Other qualities demonstrated would be:

  • Resilience - in the face of difficulties while making improvements, the leader stays positive and fixed on the overall goal.

  • Humour - during those difficult times, being able to laugh and generate energy in others.

  • Emotional intelligence and empathy - understanding when to push and when to support others to make improvements.

  • Risk taking - ability to take risks in changing the way things are done and manage any consequences.

  • Political adeptness - ability to know how and who to influence at what point in order to support improvements in service.

The work done to date has been extremely beneficial to us as an organisation and the more we have developed the model, the more we have identified that there is further work to do and learning to be gained.

Our next step is to test these improvement leader characteristics with children and young people from our foundation trust membership, explore with our council of governors and non-executive directors their ideas around collaborative leadership and see how we can put collaborative leadership into practice with our staff-side colleagues.

The core lessons learned from this process have been the fundamental importance of working with leadership cohorts to explicitly define why they do what they do and test how this has an impact on patient care.

Through actively exploring individual and group leadership styles, people identified that much of what they did already had a significant impact on children and young people and that many of the obstacles they identified as holding them back were actually within their sphere of influence to change or remove.

So how do we know when our leaders at all levels are truly walking the walk? It could not be put better than a quote from one of the staff we interviewed as part of this work: "One of the newest nurses I have demonstrates all the improvement leader characteristics every day by making every patient he looks after feel special."

That is what we want to see now and in the future, as others follow his example.

For more information on the Health Foundation's leadership programmes, visit www.health.org.uk