Supporting clinical leaders to shape the future: the story of Barts Health

Background

Now, more than ever, the NHS is looking to clinicians to lead change. This can involve simultaneously managing backlogs, protecting the quality of care and increasing productivity, often without the resources or experience to enable this.

The ambition to develop professional levels of leadership among clinicians goes back many years. Experiences during the Covid-19 pandemic – when, by necessity, clinical engagement in day-to-day leadership increased – reinforced research findings about the positive impact of clinical leadership on staff morale and patient outcomes.

But studies also describe the complexity clinicians face when wanting both to retain clinical practice and to embrace leadership responsibilities. In the past, progression to senior leadership was rarely promoted as a legitimate career pathway, as evidenced by the lack of time or financial reward afforded to clinicians for their leadership roles.

Against this backdrop, since 2019, Barts Health NHS Trust (Barts Health) determinedly supported the development of its clinical leaders, aiming to increase the impact and collective capability of clinicians who are at the forefront of new approaches to acute care. They worked in partnership with The King’s Fund to offer a suite of leadership programmes for clinicians at distinct stages of their careers, from consultants in first leadership roles to divisional directors fronting sizeable clinical units within the Trust structure. Here we outline the approach we took, how this work differed from other development projects, and details how leaders benefitted, based on an in-depth evaluation of one of the programmes, the senior clinical leaders programme.

What was different

Maintaining a consistent offer across the suite of programmes over a five-year period was of itself noteworthy; typically programmes, development providers and funding are in place for the duration of one annual planning cycle. Unusually the client lead and the delivery team also remained largely unchanged throughout the period, enabling a strong partnership to develop. Together they held a joint understanding of overarching aims and the lead facilitator was able to act as the ‘golden thread’ across the programmes. This consistency enabled participants, at their respective levels, to experience a common approach to the exploration of leadership in context and develop an understanding of what is possible when individual and collective clinical leadership is at its best.

Each programme was co-facilitated by The King’s Fund in conjunction with the lead for clinical leadership at Barts Health, an orthopaedic surgeon, who played a key role in enabling robust conversations about the realities of life on the ground. Participants spoke of the adult approach, working with real-time issues, less didactic than other learning experiences, which they found stretching and engaging. They said the style of facilitation created a sense of trust and safety, plus confidence that those leading the programme understood something of their world that built over time.

The senior clinical leaders programme

Within the suite of programmes, the offer for senior clinical leaders, launched in 2019, comprised six days of development over three modules. Some 220 delegates have since attended the programme, which ran across ten cohorts. This included clinical leads from Homerton Healthcare Foundation Trust and East London Foundation Trust, as two of the other key trusts working across north-east London at that time. Participants were medical leaders, with a small number from nursing or allied health professional backgrounds.

How did leaders benefit from the programme?

The programme was evaluated in 2024, and respondents described a range of positive outcomes. These included:

• A restorative space was the most cited programme benefit: people valued a learning environment that modelled a culture of trust and inclusion and gave space to think together. This showed up as commitment to the programme during the aftermath of Covid-19, across periods of industrial action and many other pressures, when it provided a place to connect and a container for anxiety and uncertainty.

• Cross-speciality working enabled a forum that went beyond sharing frustrations. People said they valued learning from each other’s challenges and experience and the three very different trusts coming together shed light on contrastive realities. One stakeholder said it ‘diluted tribalism’, many that it opened their eyes to the range of challenges.

• New perspectives on the nature of clinical leadership and followership were formed, including the development of a deeper understanding of role authority and greater confidence in the capacity to influence. Those who have since taken on more senior roles noted that the programme served to create a pipeline of clinical leaders, which in turn professionalises clinical leadership.

• Working with operational managers was much debated across all programmes, with no neat recipe for doing this well. Participants recognised that building relationships and working in partnership was crucial to enable the delivery of the full range of management and leadership skills across clinical units of significant size and complexity.

In summary

The suite of programmes created their own reputation – and waiting lists. There was no shortage of clinical leaders wanting to learn, to do their very best to lead their teams through the most challenging of times. That in and of itself is very good news indeed.

Clinical leaders will continue to be at the forefront of leading change, and much will be expected of them. Thus the question about how best to enable them to do so should be one which preoccupies us all. This case study example may cast some light on how this could be achieved.