Health Service Focus

The professionalisation of leadership in healthcare

The NHS Leadership Academy’s new core programmes are now accepting applications and registers of interest for courses beginning this year. NHE talked to Chris Lake, head of professional development at the Academy, who says it is possible that 30,000 people will come through the programmes in the next three years.

The driving aim of the team heading up the NHS Leadership Academy is to professionalise and formalise health service leadership development, to prepare people for senior roles and management responsibilities rather than expecting on-the-job learning.

Chris Lake, head of professional development at the NHS Leadership Academy, said one model they were seeking to emulate was the National College for School Leadership (since April 1, the National College for Teaching and Leadership), set up 13 years ago. He said: “Its core programme is the National Professional Qualification for Headship (NPQH); before anyone becomes a headteacher, they do that programme. There’s a lot of development and learning and an assessment, they qualify, get the award and then they start applying for headship jobs.

“It’s that type of shape we want, but at various different levels of leadership, from first line leader all the way up to executive director – to do the learning and then apply for the job, rather than the other way round.

“Our aim is to have programmes that help people get ready for the job before they apply, as opposed to programmes that help people get better whilst doing the job.

“It’s a significant change for the NHS. We call it the professionalisation of leadership within health.”

‘Good leadership saves live’

Alongside the existing NHS Top Leaders and NHS Graduate Training schemes, the different levels of new core programmes mean there is something suitable for everyone. The lowest level course is suitable for those with no formal leadership role but who want to understand more about leadership in general, while for those at the top end, there is a programme suitable for executive directors who want to develop further skills.

Lake told us: “It’s frankly really proven that good leadership saves lives. There’s lots of research that shows that good leaders promote a really effective climate, engagement, teamwork – and that will come out in the form of better patient care.

“If that’s true, surely we should be developing our leaders before they take up leadership positions, rather than trying to do some remedial action.

“I often stand on stage talking to groups of people and I’ll ask them what sort of learning, development or award of qualification they got before they did the role. Clearly doctors, for example, do seven to 12 years of development, with lots and lots of examinations.

“The Francis report said it. The Bristol heart inquiry said it. In every big investigation into failures of care, a big slug of the recommendations point to a failure of leadership.”

Health service talent-spotting

Running alongside the core programmes is the leadership compact (TLC), a talent management initiative.

Lake said: “That is to provide a range of tools and processes for line managers, supervisors and mentors across the NHS and NHS-funded care to really engage in talent management conversations. In the NHS, we don’t have a great track record in basic appraisal, let alone good quality talent and CPD conversations.

“The workflow for that would be: somebody has a conversation with their line manager, supervisor, training supervisor, whoever it may be, and identifies that they are thinking of and working towards the next level of leadership. Then they’ll think about the core programmes, one of them, apply on the website and then, if a place is available, get taken on to the next available cohort – or if not stay on the waiting list.

“The vast majority of core programme places are centrally funded. Essentially, to the individuals and their organisations, they’re free of charge – at least for this year and next year – because they’re centrally funded from the Department of Health.

“That may change over time; organisations may decide to buy extra places and systems of care may decide that this is the route to increase leadership effectiveness across their system but essentially the thousands and thousands of people coming through the programme through the next two to three years will already be funded.”

Each of the Leadership Academy’s 10 local delivery partners will have a process to help it decide who will come straight onto the programme and who will have to stay on a waiting list, as part of their responsibilities for talent mapping in their local area. That’s especially true for middle and senior managers, Lake said, on the Elizabeth Garrett Anderson (Leading Care 2) programme and the Nye Bevan (Leading Care 3) programme (see panel below for more details on the programmes).

For the Mary Seacole programme (Leading Care 1), it’s more down to local trusts to promote and to identify the right people to apply for the programme, via line managers, supervisors and through mentor relationships.

Thousands of participants

Lake couldn’t give precise numbers on the amount of applicants they are expecting, but said a “rough guess” would be about 3-4,000 participants on the Mary Seacole programme in the first year, about 1,000 on the Elizabeth Garrett Anderson in the first year, and 200 to 400 participants on the Nye Bevan programme in the first year. It is “perfectly possible”, he said, that 30,000 people could come through those three programmes (“the core of the core programmes”, as he put it) in the first three years.

Two of the programmes carry academic qualifications: Mary Seacole leads to a postgraduate certificate healthcare leadership, and Elizabeth Garrett Anderson to a MSC in healthcare leadership.

“The academic elements are going through university exam boards and accreditation right now,” Lake told us.

Sitting underneath those three is the Edward Jenner Programme, an online course of 21 sessions that’s free to access for anyone with an NHS number – there’s no application process.

It’s been developed with newly-qualified clinicians in mind, but is accessible to anyone working in healthcare who wants to think about formal leadership behaviours and capabilities.

Lake said: “A newly-qualified nurse or a newly-qualified paramedic, classically, probably have people who look to them for leadership and responsibility, but they don’t have a formalised leadership role.”

Values, behaviours and skills

Lake explained more about the difference between values, behaviours and skills in leadership development.

He said: “Behaviours and skills are quite close; they certainly can be taught. For example, the skills of how to have a difficult conversation, the skills of running an appraisal, the skills of motivating a team – they can all be developed.

“The methodology of development is around experience and teaching, which is very different to ‘content’ or ‘knowledge’.

“That is why our programmes, although two of them have academic routes as part of the programmes, are primarily leadership development programmes delivered through experiential learning rather than lectures and boring talks.

“They are much more about participation, engagement, discussion and dialogue between the participants themselves and whoever is leading the session, rather than somebody standing at the front doing ‘chalk and talk’. That’s about behaviours and skills.

“Values – that’s about engaging people in reflective processes, and many people don’t understand what their values are until they’re elicited; until something happens and makes them understand that ‘these are the values I have and now I can decide whether to have them and carry on or not’. They tend to be more deep-seated.”

He noted that a recent two-day design event started with a “very powerful story” from a patient who had had 29 orthopaedic operations and experienced “the best and worst of care the NHS has to offer”.

“This patient told us that sometimes he was humiliated and sometimes he lost his dignity; it was not really about any clinical errors, but about the errors in care and leadership of care. It was such a hard-hitting experience: there were tears in the room and people find it uncomfortable, and it’s those sort of experiences that will wrap into the delivery of the programmes.

“It’s about getting people to experience how they would feel as a patient or as a service user – that is how we will shift peoples values and how those values are manifested.”

The new core programmes

The Edward Jenner programme

Leadership Foundations

Edward Jenner was an English physician from Gloucester, who spent part of his career developing the smallpox vaccine.

Leaders in the NHS have a key role to play in improving the health of their communities and contributing to maintaining health as well as preventing sickness.

This breadth is well represented by Edward Jenner’s work.

The Edward Jenner programme is our introduction to leadership, and is a free online learning and development package.

The programme was designed by clinicians and patients primarily for newly qualified clinical staff but is open and fully accessible to everyone working in health. The programme is a very interactive, patient-focused, introduction to leadership practice.

Once completed, the Edward Jenner Programme leads to an NHS Leadership Academy award in Leadership Foundations.

The Mary Seacole programme

Leading Care I

Mary Seacole was a Jamaican-born woman who provided assistance to sick and military personnel in Jamaica and Central America, before and during the Crimean War.

She embodied the care and compassion we look for in all our leaders and is a lasting example of the crucial role nurses continue to play in healthcare.

The Mary Seacole programme leads to an NHS Leadership Academy Award in Leading on the Frontline and a Post Graduate Certificate in Healthcare Leadership. For those who want to take on their first (formal) leadership role, this one-year programme combines experiential and online learning, personal development delivered locally, leadership diagnostics, group learning and stretch assignments.

It develops key leadership skills, like holding appraisals and giving feedback, staff engagement, communications, leading patient-centred services, patient safety and decision-making.

The programme will be open to all those working in health (nominated by an individual’s place of work) regardless of professional or academic background.

The Elizabeth Garrett Anderson programme

Leading Care II

Elizabeth Garrett Anderson was an English physician born in London, who became the first Englishwoman to qualify as a Physician and Surgeon in Britain, as well as the first female Dean of a medical school. She represents the courage of all great leaders and demonstrates the enduring importance of inclusion in our health leader communities.

The Elizabeth Garrett Anderson programme leads to an NHS Leadership Academy Award in Senior Healthcare Leadership and an MSc in Healthcare Leadership. When leaders are approaching readiness to take on more senior leadership roles – leading multiple teams or services – they can apply for this programme. The Elizabeth Garrett Anderson programme provides personal development, online and classroom-based academic sessions, group working, assignments and mentoring/ coaching. The programme is 18 months long, and available to all those working in the NHS or in NHS funded care, regardless of professional background.

The Nye Bevan programme

Leading Care III

Aneurin ‘Nye’ Bevan was Minister for Health in Clement Attlee’s post-WWII government. A champion of social justice, Bevan spearheaded the establishment of the National Health Service, seeking to create a health service free at the point of care for all Britons. Great leaders have bold visions that serve the needs of their populations selflessly. Bevan is an inspiration to those who seek a senior role in health with the potential to lead radical and lasting improvements to the NHS.

The Nye Bevan programme leads to an NHS Leadership Academy Award in Executive Healthcare Leadership. Working at an executive level in the NHS offers some very particular challenges, and this stretching programme is for those who are ready to apply for executive level roles.

The Nye Bevan is centred on the needs of patients, and led by internationallyrenowned academic and business leaders. It combines a significant element of personal and behavioural leadership development with the knowledge and skills needed to operate successfully at the most senior levels in NHS organisations.

(Source: NHS Leadership Academy)