Exploring CQC’s well-led domain: How can boards ensure a positive organisational culture?

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Part of Leadership in action

Following the Francis Report into the failures of care at Mid Staffordshire NHS Foundation Trust, and the government’s response to the report, the Care Quality Commission (CQC) has introduced a more rigorous and wide-ranging approach to inspecting health care providers. The main purpose of inspections is to assess the quality of care delivered to patients. In making this assessment, CQC now also analyses the leadership and organisational culture of providers.

The CQC’s inspections focus on five key lines of enquiry as part of its ‘well-led’ domain. These lines of enquiry derive from research undertaken by staff at The King’s Fund and the Center for Creative Leadership into leadership and culture and draw on a strong evidence base.

Key findings

The five areas that boards should focus on to ensure their organisation is well-led are:

  • inspiring vision – developing a compelling vision and narrative
  • governance – ensuring clear accountabilities and effective processes to measure performance and address concerns 
  • leadership, culture and values – developing open and transparent cultures focused on improving quality
  • staff and patient engagement – focusing on engaging all staff and valuing patients’ views and experience
  • learning and innovation – focusing on continuous learning, innovation and improvement.

This paper sets out what boards can do in these five areas and draws on examples of good practice in leadership and culture in health care. It has been written as a practical guide for board members in strengthening leadership and culture and in preparing for CQC inspections.

How can we help?

Leaders need to achieve shared agreement about the direction of the organisation, align people around this vision, and get commitment from all staff to make its success a reality. Part of the answer can be found in the development of leadership strategies within NHS organisations that encompass not only the development of individual leaders but also the development of collective capability in the organisation as a whole.

To find out how we can help your organisation develop a leadership strategy, please contact Katy Steward, Assistant Director of Leadership, or see our resources on collective leadership.


Pearl Baker

Independent Mental Health Advocate and Advisor,
Comment date
30 September 2015
My current concerns are related to NHS 111 where it has been reported that many ill people have died due to lack of training and resources to deliver the service.

Liz Daly

Head of Service Engagement and Experience,
Comment date
02 December 2014
This is really inspiring to read. We are also doing a lot of work based around our values and behaviours and it is good to see the impact that this is having.

Misra Budhoo

Comment date
24 November 2014
There is no surprises on what makes an organisation well led.... and good to see that some organisation 'seem to get it right' many NHS organisation still are some way from really using the value of single focus on vision and values with engagement from staff. Too few really take up on this and 'make it real'. We often know what needs to be done but it is the doing... Perhaps focus from CQC would help on really being 'well led'

Umesh Prabhu

Medical Director,
Wrightington Wigan and Leigh FT
Comment date
17 November 2014
We are not perfect and still face many challenges. But over the last 6 years we have come a long way. 450 less patients die each year, 22 quality measurements have improved, got 200 patient safety champions, got 16 Awards and got amazing staff who made it possible

Following 10 things have made us successful

1. We defined our values by asking our staff (Listening in to action)
2. We appointed value based leaders
3. We promoted value based culture – Fair and Open culture, supportive and learning culture and culture of accountability for all
4. Robust staff engagement
5. Excellent patient engagement
6. Excellent governance
7. Wonderful relation with CCG, Local GPs and also social services
8. Our amazing staff
9. 200 patient safety champions
10. We create lot of positive energy in the organisation by thanking and praising our staff often. We have removed blame, punishment, humiliation but we have promoted accountability for all.

Of course we are not perfect and still face many challenges but overall we are on the right track one day we will be the best Trust in the country or one of the top best Trusts.

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