Develop a compelling, shared strategic direction

Research from health care and other sectors shows that leaders who help their organisations to develop a clear vision and a compelling narrative about mission and priorities achieve higher levels of staff engagement. Staff are more enthusiastic about their work and collaborate more effectively, and this is reflected in better performance (MacLeod and Clarke 2009).

In health care, there is evidence that developing a clear mission focused on high quality, compassionate care helps to bridge the fault lines between managers, clinicians and other groups (Bezrukova et al 2012).

Achieving this is no easy feat and requires more than a wellcrafted mission statement. In health care, leaders face a bewildering range of external expectations, which can lead to overlapping or disjointed goals (Dixon-Woods et al 2014).

Successful providers have articulated simple but persuasive visions for higher-quality, safer and more compassionate care and have maintained them consistently over time. Salford Royal NHS Foundation Trust announced its ambition to become the safest NHS hospital in 2008 and it has retained that vision, with minor changes, for the past seven years.

Just as importantly, the vision needs to be seen as authentic and meaningful. Leaders need to demonstrate their commitment to the vision through the way they spend their time, how they allocate resources, what they measure and what they reward, as well as by ensuring that the vision is reflected in staff objectives across the organisation. The most successful organisations set explicit and challenging goals for achieving the vision and they measure progress in meeting them. Salford Royal set an initial target of saving 1,000 lives in three years and reported on progress in meeting it. Northumbria Healthcare NHS Foundation Trust has published targets for quality improvement, such as a new zero-tolerance strategy towards hospital- and community-acquired pressure ulcers and falls in hospital. It has set the target of a 20 per cent reduction in harm from pressure ulcers and falls in 2014/15 and is publishing levels of performance in its annual report.

The ultimate test of a vision has to be whether it transcends the mission statement and enters the organisation’s bloodstream – the rites, rituals, cultural norms and stories about ‘how we do things around here’. In November 2014, staff at Wrightington, Wigan and Leigh NHS Foundation Trust wheeled a 77-year-old cancer patient into the hospital car park to say goodbye to the horse she had cared for for more than 25 years. For staff, the message from the story is clear: this is an organisation that really is trying, as it claims in its mission statement, to put patients ‘at the heart of everything we do’, and is giving staff the freedom and support to translate the vision into practice.

Board members should ask the following questions

  • Do senior leaders and staff agree that they are all working towards a clearly defined common direction?
  • Do staff across the organisation understand the vision and how their roles contribute to it?
  • Has the organisation set demanding goals for achieving the vision and is it monitoring progress in meeting them?

Next: build collective and distributed leadership