The NHS culture and leadership toolkit

Academic Michael West has turned research about high-quality care environments into a toolkit

“It’s not enough to know what leadership and cultures we need. We must support organisations to develop their leadership, to deliver the cultures that are needed.” So says professor of organisational psychology at Lancaster University Management School Michael West, regarding his research in conjunction with The Kings Fund, NHS Improvement and the Center for Creative Leadership, on creating high-performing NHS Trusts.

Nowhere is pragmatic action more critical perhaps, given the well-documented scale of the challenges the NHS faces. So West has translated the significant body of research about what characterises high-quality care environments into a culture and leadership toolkit.

This toolkit has been subjected to rigorous testing by three NHS Trusts. The programme is currently in a second ‘design’ phase, with Northumbria Trust, East London Foundation Trust (ELFT) and Central Manchester University Hospitals Trust feeding back their suggestions. The toolkit is already available to all Trusts for free, with more organisations getting on board all the time.

HR magazine sat down with West, along with associate director of organisation development at Central Manchester University Hospitals NHS Foundation Trust Helen Farrington, and director of HR and OD at ELFT Sandi Drewett, to find out more.

Michael West: The high performance characteristics we’ve identified are: lived vision; effective performance management, which is about clear agreed objectives; enlightened people management and employee engagement; cultures of learning, innovation and quality improvement; team- and crossboundary working; and collective leadership.

Sandi Drewett: There’s no silver bullet; it’s the interaction between them. Getting the conditions right will deliver collective leadership but collective leadership is also an enabler.

Helen Farrington: We’ve traditionally used the staff survey as an indicator of whether NHS organisations have got those conditions in place. What we’ve done with this programme is say ‘that’s not the most effective mechanism’. Also we’d benchmark ourselves against one another, but that doesn’t necessarily mean you’re benchmarking against excellence.

SD: So it’s important the research behind this programme has come from across a variety of industries.

HF: With evidence from Toyota, for example, we were able to improve the quality of the product as well as reduce costs and increase efficiency.

SD: We need to be data-driven and evidence-based. One thing the NHS does have is huge amounts of data. There’s also rapid cycling; you’ve got high throughput so you can test change ideas rapidly. This works because medicine is evidence-based, so you’re talking the same language as some of the most powerful people in the organisation.

HF: Organisational development like this is a new concept in the NHS. Despite the fact we work with everything evidence-based, I’m not sure we’ve applied that to the way we develop staff. I tried to use Michael’s research 12 years ago to support a team development programme, but because there wasn’t as much evidence I didn’t get the traction.

SD: Collective leadership is crucial because we don’t deliver care in isolation… One of the tools is a leadership survey and we’ve gotten about 900 staff to fill that in, from board-level directors to frontline staff. And every single one of these people were able to rate themselves on leadership behaviours.

MW: When you look across the NHS landscape there is a deficit of leadership; there’s lots of vacant spaces from chief exec down to frontline, and chief executives who are only in post for two years. So part of what we’ve been doing is leadership workforce planning.

HF: When I looked at self-directive teams years ago there was this article ‘The Conductor-less Orchestra’. It’s the idea that if you create a high-performing team you can take the leader out and for quite some time they’ll be able to sustain that.

SD: We have to recognise that rightly or wrongly the way that successful NHS organisations have been recognised in the past is when they’ve successfully delivered against a series of top-down initiatives and targets. So when we talk about exec teams we have to also consider NHS England and the wider system. I think if the regulatory body starts to monitor our performance based on this philosophy that will be hugely influential in changing mindsets and behaviours.

MW: We’re talking with all of the national bodies because they can’t encourage this without modelling it. Whether we can get the politicians to change their behaviour – that’s the final frontier!

HF: Because there’s a lot of change happening in Manchester this has come at a great time for us. People in the local authority, in social care services, in local community groups, they understand we’re all going through a difficult time so are positive about also embracing these practices. The challenge will be adapting it to the language and approaches they use. That’s where we start to think beyond organisation and about systems.

SD: I think the communities of practice ethos is hugely important because often people doing service improvement work or organisational development are lone voices.

MW: One of the problems in the NHS has traditionally been spreading learning between organisations; the levels of quality are hugely variable. So you’ve got places doing really great things but just down the road you’ve got somewhere facing a problem the first organisation could help solve.

HF: I think as three Trusts we’ve been quite challenging. But to give everyone their due the three organisations [The Kings Fund, NHS Improvement and Centre for Creative Leadership] have been really open to that. You can imagine: you’ve got a concept, it’s your baby, and then all of a sudden we pick it up and scrutinise it.

MW: That feels brilliant though. The word I’d use actually is privileged. We must always understand that the purpose of this is to ensure the delivery of high-quality, continually improving and compassionate care. And implicit in that is we want to ensure the health and wellbeing of staff. So it’s about creating cultures where staff flourish rather than being damaged by the process of delivering care.