Reinvigorating management and leadership training is going to be vital to sustaining a cost-effective health service, say Caroline Cake and Eleanor Murray.

The NHS needs highly capable managers to negotiate the current healthcare environment.  However, there is little evidence that the present training approaches to building these skills are working. We propose six practices that would create more effective training programmes, at no added cost.

The NHS appears to be spending less on management development compared with private sector organisations. Analysis of annual spending on management and leadership training for NHS provider employees equates to approximately £260 per employee. In comparison, the private sector spends on average £320 per employee.

There is huge variation in spending between NHS providers. Even taking into account outliers and allowing for data accuracy issues in trust allocation of training and education spending, provider annual spending varies from less than £100 to more than £1,000 per employee.

In addition, many trusts do not track how much they spend on development. Interviews conducted by public service management consultancy 2020 Delivery with NHS senior leaders found that there was little aggregation of development investment within trusts, inadequate evaluation of programmes, and no comparison of development spending between trusts.

The same leaders highlighted key management capability gaps, for example analysing and presenting financial positions. They suggested that existing investments in leadership skills are not translating into large-scale improvements.

The regulator Monitor’s report Lessons Learned from Recent NHS Foundation Trust Applications highlighted similar problems. It said: “Where applicants often fall short is in demonstrating a sufficiently thorough understanding of the underlying drivers of their cost base, and the evidence to underpin the achievement of significant efficiency improvements.”

These findings underline the importance of giving management development a higher priority, and monitoring the return on investment from such programmes.

International best practice for development and effective approaches from our own experience are used to identify six practices that can improve the effectiveness of management and leadership development programmes for no additional cost:

Outcome focused training – focus on solving clearly defined and urgent business problems 

There are few results-driven development examples within the NHS. Often programmes are activity centred, for example, where success is measured by the number of people trained or number of projects delivered.

The hope is that these activities will lead to better business performance. However, rarely is it made explicit how this will happen.

Training focused on delivering tangible business outcomes, for example quality or financial improvements, is more likely to be effective.

Pull rather than push training – respond to pull from business units (such as clinical divisions) rather than push from the centre 

Central programmes will be most successful if they are connected to the needs of the business units. As an example, a trust divisional director wants to make service level changes within the hospital and has asked the trust learning and development team to design a programme to give his team the analysis and project delivery skills to facilitate this. He is working closely with the learning and development team to identify who needs the skills, select training providers, evaluate training delivery and ensure that new skills are applied to business critical areas.

Making it real – ensure that skills developed can be applied in everyday work and that the working environment is conducive to developing them

A number of public sector organisations have developed structured work based programmes that provide opportunities and incentives for participants to apply the skills and develop them. Royal Surrey County Hospital Foundation Trust, as part of its creating a culture for continuous improvement (C3i) programme, asks participants to bring a work-based project agreed with their line manager to the training. The participant is supported through this project by a mentor and has the opportunity to present the project outcomes to a viva panel consisting of senior managers.

High expectations – set high expectations for the results and behavioural changes required from the training investment, evaluate against these and performance manage service providers against them

Very few public sector organisations have structured evaluation approaches for development programmes. The Royal Marsden Foundation Trust in London is using an impact assessment with one of its training providers to evaluate the skills developed by participants and the quantified performance impact achieved (based on financial and quality measures) following the training. The training provider’s fees are linked to successful impact evaluation.

Talent management connection – integrate business development priorities with existing talent management and succession planning programmes

One trust selects training participants based on business needs and a structured performance and potential talent assessment, thus supporting succession planning, career aspirations and immediate business delivery.

Collaboration and competition

Encourage collaboration between trusts for training on core shared management capabilities, for example project management and financial skills. Through the C3i programme, Royal Surrey has trained people from external organisations and subsequently worked with them on joint projects. These projects have helped to reduce inappropriate patient referrals and admissions, reduce the length of stay and improve communication between multidisciplinary teams.

Promote competition by making management development a key differential at the heart of trust strategy.

Trusts will achieve a competitive advantage where development programmes deliver demonstrable service improvements, improved retention and an attractive environment for new recruits.

Given the cash constrained economic environment, strategies for moving from 
the generic to genuinely impactful development programmes are critical to ensure valuable learning and development resources are directed towards business imperatives and contribute to an improvement in productivity and quality.