Stephen Ramsden on being a good chief executive

Too much emphasis is placed on operational performance, constantly reinforced by the wider NHS performance management culture. The interpretation of personal accountability often seems to translate into the chief executive signing letters of complaint, and hospital infection data returns, and tracking out-of-network intensive unit transfers.

The symbolism has fostered the wrong emphasis on the chief executive role. Many of us have neglected the really important objective of transforming our organisations, setting ambitious improvement goals (way beyond national targets), being visible to our staff and developing talent in our organisations.

Emboldened by foundation trust status and influenced by some inspiring work with management consultancy McKinsey (both through a chief executive officer network and as a Monitor service-line management pilot site), I have begun to change my role dramatically. On the premise that to achieve transformational change you must first change yourself, I have transferred the reporting line for clinical directors from myself to the medical director, and stopped attending weekly executive team meetings.

The intent is to devolve autonomy throughout the organisation. Every decision can and should be taken by at least a tier below. It has been a daunting process for me, letting go but remaining accountable. It has also required trust from my executive directors, who are becoming more interdependent and less reliant on me.

The changes allow me to spend 30 minutes a day on walkabout. It is the first time in my 16-year chief executive career that I have found a visibility formula that works for me. It has put me back in touch. I feel better, staff feel better and, hopefully, we will change some of the cultural barriers that are so frustrating for all.

It has also freed me up to develop a transformational story for the hospital that above all else seeks to 'lead the NHS in patient safety'. I wrote recently in HSJ about the power of storytelling in moving people to improve. I can now spend more time on reducing our hospital standardised mortality rate and patient safety. Nothing should be more important to chief executives than saving lives and showing their staff they care about this.

I also now have time to join clinical pathway improvement teams, and challenge clinicians on long-standing service deficiencies - such as giving patients with a fractured neck of femur higher priority access to theatre.

I am set on developing new skills as a coach to my team and on improving my presentation skills. Many chief executives are probably already doing all this. But some may still be stuck in an operational role that they feel is warranted by their financial problems.

The role of the chief needs to be re-examined. We can be so much more effective than we have been allowed to be. If the chief executive is not leading transformational change there is a good chance no one is.