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Improving care: what can leaders do?

The Fund’s annual conference focused on what needs to be done to implement the NHS five year forward view and deliver the productivity improvements required to fill the £30 billion funding gap facing the NHS between now and 2020/21. Many answers were proposed, including innovation and technology by Secretary of State for Health Jeremy Hunt, and harnessing the power of the people working in the NHS to deliver change by Ed Smith, Deputy Chair of NHS England.

A recurring theme throughout the conference was the central role of leaders in engaging and supporting staff in innovating and implementing new models of care. David Dalton told the story of Salford Royal’s journey of improvement in which freeing up staff to deliver higher quality and safer care was a critical ingredient.

Staff at Salford Royal are supported through investment in leadership development and training in quality improvement methods. David emphasised the trust’s high ratings in the annual NHS staff survey, which reflect positive staff engagement. The result is that the organisation is widely and rightly admired for the progress it has made in its ambition to become the safest hospital in the NHS.

Many of the same themes emerged in a presentation by Sarah Patterson from the Virginia Mason Medical Centre in Seattle. Sarah described how Virginia Mason had become a learning organisation by adapting the Toyota production system methodology (Lean) and training its staff in using quality improvement methods to reduce harm and deliver better outcomes. The medical centre’s leaders have shown a deep personal commitment to this way of working, leading by example and showing resilience in the face of setbacks.

Jeremy Hunt’s thinking on safety in the NHS has been shaped by his visits to Virginia Mason and its experience that improving safety and outcomes often releases resources. A key development along the way was agreement with medical staff of a ‘give and get’ compact setting out the deal between the medical centre and its doctors in working to improve care. Coincidentally, David Dalton also developed a compact with medical staff at Salford Royal to ensure greater alignment between the goals of the organisation and the objectives of the doctors working there.

We can learn a lot from the stories of Salford Royal and Virginia Mason about what successful leaders do. In both cases leaders worked alongside staff, understanding the profound truth that, in organisations like hospitals, many of the answers are found among staff rather than in the executive offices and boardrooms. A key role of organisational leaders is to support and enable staff to discover these answers by creating time and developing skills among those delivering care.

Organisational leaders also have a key role in setting direction, defining and measuring progress towards goals, and ensuring alignment behind these goals at every level. This means paying attention to objective-setting and appraisals, giving honest and direct feedback, and being clear about desired values and behaviours. Leaders of high-performing organisations act as coaches and mentors, devolving decision-making as well as holding colleagues to account.

At last week’s Foundation Trust Network annual conference, Jeremy Hunt said, ‘change that comes from the inside is always more powerful’, citing the Fund’s work showing the clear and direct relationship between leadership and culture. Our programme for 2015 draws on this work to support boards in understanding whether they are well-led, using analysis carried out for the CQC. We are also working on site with organisations throughout the NHS to help them develop the capabilities needed at a time of unprecedented challenge and change.