Supporting leaders to deliver transformational change: Nicola Walsh on our work with communities

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In 44 areas in England, NHS organisations have come together with local authorities and other partners to develop sustainability and transformation plans (STPs) – ambitious, five-year plans for the future of health and care services in local areas. In this brave new world of delivering care across organisational boundaries, one challenge stands out among many: how can leaders collaborate to deliver the changes that are needed?

Nicola Walsh, Assistant Director of Leadership and Organisational Development at The King’s Fund, has been working with STP leaders from STPs including Frimley Health, and Bedford, Luton and Milton Keynes who are developing collective strategies to deliver greater impact for patients and service users in their areas. And it is not just STPs that are experimenting with new ways of working. Nicola and her colleagues have also supported local authority and CCG leadership teams developing new models of commissioning, as well as areas implementing new care models such as Salford, and North East Hampshire and Farnham.

Our approach

‘We design our leadership and organisational development activities based on intelligence we collect from holding conversations with local leaders – so each programme is tailored to specific needs,’ explains Nicola. ‘Our intention is to work in partnership with leaders “in place”, providing an appropriate level of support and challenge to provoke new ways of working.’

Often the focus is on how organisations can collaborate more effectively. ‘Involving leaders in a process of enquiry, we design interventions that aim to build relationships and develop leadership practices as part of a place-based approach,’ says Nicola. ‘We also spend time working with NHS and local authority leaders to explore the shared purpose for collaborating with one another.’

In the past, partnership-working between the NHS and local authorities often meant one organisation leading and driving the change. Nicola challenges this way of working. ‘STPs and the implementation of new care models requires a range of different leadership models that distribute decision-making and authority across collaborating organisations,’ she explains. ‘We explore these issues in our work with leaders, recognising that distributed decision-making will maximise staff and community engagement and contribution.’

Time is also spent exploring how leaders talk and listen to each other. Nicola says: ‘Leaders who have the skill to understand how they may intervene to keep the dialogue going to explore new and different solutions to longstanding problems are vital.’ She has found that focusing on this is key to success: ‘People are often in transmit mode and may not be listening sufficiently to the different perspectives nor perhaps creating the space in meetings to explore and generate new solutions to the challenges they are facing.'

Understanding the context

Nicola describes a further layer of expertise that permeates all her work with leaders: ‘Our work is firmly rooted in our knowledge of health policy and health services research. When we design a programme for system leaders, we use this knowledge to work through real issues and apply an appropriate level of challenge.’ For example, leaders working with the challenges of introducing new models of care may find experiences from health and care systems outside the UK a useful way of examining their local issues.

For Nicola, the challenge can often be one of focus. ‘Leaders are, understandably, often focused on the technical issues such as new ways of contracting for services. But inter-organisational relationships, collective responsibility and commitment are critical to secure the changes needed to transform services. Our role in the leadership and OD team at the Fund is to support leaders to focus on these, enabling them to implement new models of care that place a greater emphasis on prevention, integration of services and enabling people to take more control of their own health.’



Health centre
Comment date
01 March 2018

Teaching leadership is full of theory. Leaders grow in units where they become leads , showing the way and being accepted as wise . These people are thrust on units who are fed up of change with no real benefit . Everyone loses as change needs a good purpose.

Rebecca Hewitt

VCS Rep, local Accountable Care Provider Alliance,
Community Action Bradford and District
Comment date
20 April 2017
These are exactly the issues we've been thinking about locally except from a different perspective, the Voluntary and Community Sector. How do we bring together that broader range of cultures from not only statutory partners but including community groups and organisations? Thanks.

Dr Umesh Prabhu

Patient Safety Champion and Proud of NHS,
Comment date
20 April 2017
Dear Nicola,

Good to see your work with STP. I was in a meeting with 8 Medical Directors (I have now stepped down after being a MD for 15 years) in London about STP and all 8 said following comments

1. No one knows anything about STPs real work
2.Poor staff that too medical staff engagement and involvement and that too secondary care
3.No one knows how junior doctors training fits in and no one has involved and engaged junior doctors and their leaders.
4. Who holds the contract for all staff and where is the accountability?
5. How the service will be transformed like Diabetes, Dementia and other services
6. Where does mental health fit in all these?
7. There is no money for transformation so how can transformation take place?

All these suggests me that there is still poor engagement of staff and that too senior medical staff! This does concern me and I suggest that all STP look at improving communication and engage staff and that too medical and nursing staff without which transformation won't be successful

Please do not shoot the messenger. I am very fond of NHS and want STP to be successful and this is why I have written this feedback. Important is to have excellent staff and patient and public engagement for STP to be successful. I fully support the concept of STP

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