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Report

Patient-centred leadership

Rediscovering our purpose

This report summarises the main findings of the Francis Inquiry into the failings of care at Mid Staffordshire in relation to NHS leadership and culture. It sets out what needs to be done to avoid similar failures in future, focusing on the role of three key 'lines of defence' against poor-quality care: frontline clinical teams, the boards leading NHS organisations, and national organisations responsible for overseeing the commissioning, regulation and provision of care.

The report presents findings from The King's Fund's 2013 leadership survey. It also highlights the lessons that can be learnt from the experiences of high-performing health care organisations in other countries that have succeeded in developing effective leadership and a culture that puts patients' needs first.

Key findings

  • The leadership of the NHS at a national level needs to create conditions in which local organisations have the freedom to deliver consistently high standards of care and where the needs of patients come first.

  • The quality of care provided by NHS organisations should, first and foremost, be a corporate responsibility under the leadership of boards, who must lead by example by focusing on the quality and safety of care.

  • Leaders need to value and support frontline staff and ensure the main focus is on patients and their care.

  • Leadership development should give priority to supporting leaders at all levels to be patient-centred and to ensure that staff have the time and resources required to deliver high-quality care.

  • Patient leaders should work alongside NHS leaders to support the transformation called for in the Francis Inquiry report.

Policy implications

The NHS at national level must shift the predominant organisational culture from one focused on meeting externally imposed standards and targets to one in which NHS leaders and frontline clinical teams are committed to improving care and putting patients' needs first, working together to access the support they need to do so.

NHS organisations must abandon the traditional individualistic model of leadership and embrace a leadership style that is shared, distributed and adaptive. Board members in particular are responsible for setting the tone for their organisational culture, and should do more to actively seek and listen to the views of patients, governors, commissioners and staff.

The King's Fund's 2013 leadership survey

In the spring of 2013, we surveyed a range of NHS professionals to understand their views on the factors affecting the quality of patient care and the role of leadership in delivering improvements.

Overview of the findings

Overall, respondents thought that appropriate resources (including adequate staffing levels), leadership, and a clear focus on patients have the biggest impact on providing high-quality care, while limited resources and organisational cultures were seen as the most significant barriers to improvement.

Generally, respondents were more positive about the quality of leadership and priority given to the quality of care in their service/team than within their wider organisation or the NHS as a whole. However, there were significant differences of opinion between professional groups.

See the full results

Survey methodology

The survey was conducted via an electronic questionnaire with a series of closed questions and was targeted specifically at leaders and managers in provider organisations. The survey was promoted in partnership with the Faculty of Medical Leadership and Management, Managers in Partnership, the NHS Confederation, NHS Professionals, the Royal College of General Practitioners, the Royal College of Midwives, the Royal College of Nursing and the Royal College of Physicians.

Respondents were asked to indicate the type of organisation they worked for, their primary role, whether their work was primarily clinical or non-clinical, and whether they had responsibility for managing staff. Where respondents were asked to rank their responses, we reverse weighted these ranks in order to give a higher value to their preferred response while removing a possible skew from small numbers.