Nicola Hartley: Patient-centred leadership: Rediscovering our purpose


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Nicola Hartley, Director, Leadership Development, The King's Fund, summarises The King's Fund third annual review of leadership in the NHS.

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Nicola Hartley: Patient-centred leadership: Rediscovering our purpose

  1. 1. Patient-centred leadershipRediscovering our purposeNicola Hartley, Director,Leadership Development, The King’s Fundtwitter: #kfleadSponsored by:
  2. 2. Public Inquiry led by Robert Francis QCRaises major questions about the leadership andorganisational culture at Mid Staffordshire NHSFTAn unhealthy and dangerous cultureClear that organisational culture is informed bythe nature of its leadershipTop-down, command and control leadership style– “shame and blame”
  3. 3. The Francis ReportThe King’s Fund endorses and supports emphasison leadership and cultureUsed thoughtfully the recommendations couldtransform the experience of patients and staff byintroducing changes that will:– Strengthen leadership– Enable organisations to create a more caring cultureWe believe a transformation of systems,leadership and organisational culture is neededthroughout the NHS if lessons are to be learnedand acted on
  4. 4. Let’s not forget...Unprecedented improvements made in patientcare across the NHS during the period of theInquiryNHS Staff are intrinsically motivated to helppatients when they are vulnerableFailures primarily occur when the systems inwhich staff work let them down:– emanate from senior NHS leadership at national level– Systems and leadership in place in each and every localNHS organisation
  5. 5. Building the evidence base2011– Massive, complexorganisation like NHSrequires top class leadershipand management– Recognise value ofdistributed leadership2012– Evidence base supportingbetter engagement3 lines of defence:– Frontline– Boards– National organisations
  6. 6. Patient-centred leadershipContributions from expertsand researchers and TheKing’s Fund’s own expertiseSummarise findings fromFrancis relating to culture andleadership2013 Leadership Survey – 900NHS professionalsRole of leadersChallenges in changing cultureActions likely to promote care-centred culture
  7. 7. Leading the NHSLeadership of the NHS at a national level needs to:– create the conditions– Set clear goals and standards– Reorient the organisational culture of the NHSA key challenge – fragmentation of seniorleadership following reforms– Need to demonstrate commitment and ability towork togetherLeadership in NHS organisations:– Quality of care is first and foremost a corporateresponsibility under leadership of boards
  8. 8. 2013 Leadership SurveySurveyed 900 professionals across the NHS73% felt not enough priority was given to qualityof care in the NHSOnly 14% thought quality of leadership in NHS‘good’ or ‘very good’Time/resources and organisational culture biggestobstacles to improving patient care
  9. 9. Leading the NHS on the frontlineNowhere is leadership more critical to improving carequality than in wards, clinics and general practicesOften best performed by clinicians together with generalmanagersClinical teams perform best when their leaders:– Value and support staff– Enable them to work as a team– Ensure main focus is on patient care– Create time to careTeam leaders more effective when:– They work in a group that emphasises shared andcollective leadership– They establish well structured teams
  10. 10. CultureBasic values, shared beliefs, deep-seatedassumptions and working practices that underpinhow staff behave – the way things are donearound here– Usually more than one culture– A web of sub-cultures each associated withdifferent levels of power and influenceLeadership = key to changing nature of anyorganisationChallenge = how to develop and sustain adifferent culture that always puts patients first
  11. 11. The way things will be done aroundhere...Quality is the organising principle in the NHSFocus staff efforts on learning and improvementSupport risk takingAccept failure when innovations don’t succeedClinicians:– Understand the implications of choosing not to raiseconcerns about quality and safety– Fully engage in management, leadership and serviceimprovementClinicians and managers – build effective relationshipsBoards and CEOs create positive quality-oriented culture –what they say and pay attention to matters
  12. 12. Patients as leadersEnabling patients to help frontline teams toredesign services according to patients needsTrue co-production to improve services andpatient experienceKey skills and approachesRecruited from a variety of backgroundsClear about their role and expectationsAccess to support and development
  13. 13. What does this mean for LeadershipDevelopment?A chequered historyResources must be directed where they will havegreatest impactMove away from traditional individualistic modelsof leadership towards leadership that is shared,distributed and adaptiveFocus on:– developing individual performance in order toimprove performance of team, organisation orsystem– Supporting networks of people practisingleadership throughout an organisation
  14. 14. Leadership DevelopmentShould be about how skills and behaviours can behoned and applied in the situations in whichleaders find themselves, whatever their level inthe organisationShould tackle relations, connectedness andchanging organisational practice and processesHow much organisational change will be achievedby the development of unconnected individuals?Development with others in context is the wayto ensure organisational values, goals and cultureare aligned
  15. 15. In summaryJourney to achieving consistently highperformance is lengthy and complexLeadership in the NHS needs to be seen asshared, distributed and adaptiveDifficulties of changing organisational culturemust be fully acknowledgedSize and complexity of NHS means actions mustbe aligned at different levelsResponsibility for leadership and organisationaldevelopment rests with every NHS organisationWithout a coherent approach, leadershipdevelopment will have limited impact
  16. 16. In summaryLeaders must work on several frontssimultaneously to deliver success. They need tobe:– Seeing quality as an organising principle– Building capabilities and skills for improvement– Engaging patients in their care– Promoting professional cultures that supportteam work– Provide consistent leadership themselvesMost importantly, must create systems in whichstaff are supported to do the right thing
  17. 17. Finally...No quick fix – sustained effort at all levels tolearn lessons and bring about difficult butessential changes in leadership and culture toprevent future failuresThe journey of improvement and of rediscoveringour purpose starts here............