Intended for healthcare professionals


“Threadbare” approach to leadership needs radical change, says King’s Fund

BMJ 2016; 352 doi: (Published 18 February 2016) Cite this as: BMJ 2016;352:cfnews_threadbare1602
  1. Matthew Limb
  1. BMJ Careers
  1. limb{at}

The NHS is “scrabbling” to find medical leaders to fill vacancies because of a “threadbare” approach to leadership development, the King’s Fund has said.

Michael West, head of thought leadership at the King’s Fund, said that leadership was the key to improving organisational cultures that affect the way staff treat patients and each other. “We’ve been able to identify the key elements in cultures that deliver high quality, continually improving, compassionate care,” he said. “The resounding answer from research is that . . . leadership has the most significant influence on culture.”

West told BMJ Careers, “It’s not just about getting leaders in post but making sure that there are pipelines of leaders being developed so that when vacancies occur there are people ready to step into post with the skills and the motivation to sustain those cultures.”

The King’s Fund said that NHS organisations needed to sustain cultures that showed commitment to providing safe, high quality care. These should promote leadership values and behaviours that build trust and cooperation, empower staff, and encourage shared learning. They should also reflect values of “support, compassion, and inclusion” for all patients and staff.

A new programme of work being run by the King’s Fund and NHS Improvement will pilot ways of supporting trusts to consider cultural issues and develop collective leadership strategies. Three trusts are taking part in the pilot: Central Manchester University Hospital NHS Foundation Trust, Northumbria Healthcare NHS Foundation Trust, and East London NHS Foundation Trust. Over the next two years they will test online support tools to diagnose cultural problems, develop collective leadership strategies to tackle them, and implement any necessary changes.

Initially the pilot programme will help organisations identify the key aspects of their organisational culture and leadership—including leadership capacity and behaviours. Staff and board members will be asked for their views on culture.

In the second stage, the programme will support trusts to design a strategy for leadership “that will get them the numbers of leaders they need with the profiles they need . . . to produce the cultures that are required.” This will include making sure that there are good practices for recruitment, selection, and development of clinical leaders and black and minority ethnic staff.

West said, “Involving clinicians is very much a part of what we’re doing because a key part of the leadership development will be skills for leading quality improvement.”

The emphasis would be on creating “collective leadership,” he said. The scheme would be assessed to see how it had affected organisations’ care quality, financial performance, staff engagement, staff wellbeing, patient satisfaction, leadership, and culture.

West emphasised that the programme was not in any way linked to the NHS inspections or aimed at failing trusts. “We’ll be working with change teams in each organisation, synthesising this material, and producing a report on the current state of leadership and culture and what they need to do in the future,” he said. “I think that it is a major issue within NHS organisations at the moment—they are scrabbling to find leaders to fill the positions that they need, and it’s a threadbare approach to leadership.”