Empowering clinical directors to lead at Barts Health NHS Trust

We worked with Barts Health NHS Trust to provide clinical leaders with individual leadership development and to build a collective leadership capability across the organisation. The programme gave people a much clearer ownership of the role of clinical director and a wider understanding of the challenges the trust was facing and their role in helping to overcome these challenges.

The flexibility and willingness of King’s Fund colleagues to work with what we wanted rather than impose a tried-and-tested formula on us was extremely welcome. Most importantly the facilitation was really excellent. A space was created where clinical directors could work in a trusting way with each other and be prepared to discuss vulnerabilities and uncertainties safely. The learning was deep and real as a result of this.

Dr Alistair Chesser, Chief Medical Officer at Barts Health NHS Trust

The Barts Health group of hospitals is the largest NHS trust in England, employing more than 16,000 staff and providing health care services for around 2.5 million people in east London and beyond.

When the trust was formed in 2012, a number of hospitals were brought together under one umbrella and this has resulted in significant challenges. The trust has had difficulties in retaining staff and has also faced significant financial pressures. In spring 2015 the Care Quality Commission (CQC) rated the trust as ‘inadequate’. Crucial to addressing the issues raised by the CQC was the appointment of a strong clinical leadership team throughout the organisation.

The implementation of a new leadership model strengthened the role of clinical directors to lead staff during this time of unprecedented change. However, attitudes and understanding about the expectations required of the role varied enormously and the trust recognised the importance of engaging this key leadership group to work collaboratively within and across its hospitals to raise the standards of patient care. We were asked to design and deliver a development programme for clinical directors and those interested in applying for the role in the future.

Our approach

We run a highly successful open programme for clinical development and were able to use the building blocks from this model as the basis for the programme at Barts Health. We then built in tailored content based on the local context and the specific needs of participants. This approach enabled us to keep design costs to a minimum, while also delivering a bespoke programme.

Our aim was to help the trust create and pilot a tailored development programme that it would then be able to run in-house itself in future years. We worked as part of a small project group – including an associate medical director, the assistant director of culture change and three clinical directors from the trust – to co-design all aspects of the programme and plan its co-delivery.

Together, we delivered a nine-day programme in three modules that started in September 2015. Around 25 participants took part, from a number of specialties across the trust.

The programme was designed to support individual leadership development, but also to build a collective leadership capability, acknowledging the powerful role clinical directors could play as an engaged and inspiring team to lead clinical services.

Our focus throughout was the role of the clinical director in relation to the wider system and the changing day-to-day context of the role at the trust. For this reason we kept the design process fairly flexible, reviewing our plans and incorporating feedback from the project group before the start of each module. This helped us to remain a step ahead of the changes across the trust over the lifetime of the programme, but also meant we could adapt quickly to the changing needs of the group.

Our impact

Feedback from the clinical directors who participated in the programme was overwhelmingly positive. Our evaluations showed that the programme gave people a much clearer ownership of the role of clinical director and a wider understanding of the challenges the trust was facing and their role in helping to overcome these challenges.

Participants were given the space and time to think and to connect with each other about the dilemmas of leading, and this proved very powerful. Trust built quickly within the group, enabling people to grow as leaders both personally and collectively.

As a result a new identity emerged for those in the role of clinical director at Barts Health. As well as developing new levels of self-awareness and advanced leadership behaviours, clinical directors now have a strong sense of the corporate responsibility they share in their roles and a real ownership of the learning culture that has been created.

This has helped to lay a powerful new foundation that is helping the organisation to move forward on its journey of cultural change and quality improvement.