Leading Edge

NHS staff are being urged to display leadership characteristics and play their part in improving outcomes for patients. Sally Priestley investigates


From prime ministers and monarchs to managers and sports coaches, ‘leaders’ come in many guises. So, too, the term ‘leadership’ – which brings with it a raft of interpretations, theories and definitions, with both positive and negative connotations.

Leadership is commonly defined in terms such as ‘organising a group of people to achieve a common goal’. If it’s agreed that the common goal among healthcare professionals is improving patient care and services, then this actually comes close to describing the concept that clinicians, including physiotherapy staff, are being encouraged to embrace.

‘Clinical leadership’ is a big drive for the NHS at the moment, and it’s about exactly what it says on the tin: clinicians – not just managers and not just doctors – playing their part in pushing health care services, and staff, forward.

And the ‘common goal’, according to the NHS Leadership Academy website, is ‘developing outstanding leadership to improve the quality of services and outcomes for patients’. Physios are among those taking part.

April saw the launch of the NHS Leadership Academy, the new national hub for leadership development and managing talent for all NHS staff.

In addition to promoting the values of NHS leadership, the academy will set new national standards and deliver leadership programmes and training at a national level and staff from all clinical backgrounds.

It will also provide support for local organisations in promoting leadership in their areas and aims to act as a beacon of best practice, nationally and internationally.

More details can be found at: www.leadershipacademy.nhs.uk

The reforms and cuts to budgets that are sweeping through the NHS in England make the drive to recruit clinical leaders even more imperative, according to the academy website.

It states: ‘With the economic challenges facing the service it is imperative that frontline clinicians have the leadership capability to drive radical service redesign. Their ability to influence and manage change is critical to our success.’

Launching the academy, Sir David Nicholson, chief executive for the NHS in England, said it would be critical to delivering the strategic shift in leadership the NHS needs in the coming years.

He said: ‘The ethos is simple. NHS success is dependent on great leadership right across the service, across clinicians and managers.

Great leaders create working climates where people working with them feel engaged, empowered and satisfied.

Those people in turn have a direct positive impact on patients’ experiences and their health outcomes. Everyone working for, with, or on behalf of the NHS has a crucial role to play in this, as we focus on our purpose of improving health outcomes for our patients.’

CSP’s contribution

Richard Dale, the academy’s interim communications manager, says the aim is to ‘develop people wherever they sit within the NHS to take it on themselves to become leaders’.

The academy is also charged with getting clinical leadership more firmly on the NHS agenda. ‘We know we will need different types of leaders in the future with clinical-led services,’ he says.

As a starting point, Mr Dale is keen to promote the tools and resources available on the website. He says there is information on a number of programmes and initiatives specifically aimed at those in clinical settings who are interested in taking on leadership skills (go to the ‘Supporting Local Capability’ section and click on ‘Clinical Leaders’).

The foundations for the academy’s work will include the NHS Leadership Framework. Launched in June 2011, the framework aims to develop the leadership skills of staff with the strategic purpose of improving patient care.

It applies to all staff –- clinical and non-clinical –- and recognises that leadership isn’t just for those in designated leadership roles.

The framework is accompanied by a practical set of development resources and downloadable documents, all of which can be accessed from the academy website home page.

These include a self-assessment tool to help individuals identify where their leadership strengths and development needs lie, a leadership development module signposting practical steps clinicians can take, and e-learning resources to help clinicians understand how their role contributes to managing and leading the health service.

The CSP contributed to the development of the Clinical Leadership Competency Framework.

The society has embedded this within its own framework, which defines and illustrates the knowledge, skills, behaviour and values required for contemporary physiotherapy practice.

This tool is available to members in the CSP’s CPD webfolio. See: www.csp.org.uk/webfolio for information to help you access this resource through CSP ePortfolios.

CSP assistant director of practice and development Sally Gosling said the society was keen to promote use of the framework in physiotherapy education, continuing professional development (CPD)and workforce development.

And she said the society supports initiatives that help members develop clinical leadership skills and encourage members to engage in these opportunities.

‘In the context of unprecedented change in health care, it’s vital that members develop and demonstrate their clinical leadership skills in their day-to-day practice.

This is all part of showing the value they contribute to achieving improvements and innovations in patient care, as well as being an important part of personal and professional development,’ she says.  

Dr Gosling adds that the society backed the notion of ‘shared leadership’, recognising that all members at all career stages can demonstrate leadership and achieve real change.

At the same time, she says there is a real need for services to be led by those with specialist, evidence-based expertise. ‘This is essential not only for delivering high-quality outcomes for patients, but to create professional development opportunities and ensure sustainable models of service delivery.’

Focus on women

The clinical leadership drive has, in fact, been quietly in motion for some time now, as many physios can testify.

Catherine Pope is just one of many who have embraced the call to take on a news skill set, and contribute to an improved NHS.

She trained as a physio and now works as associate director of allied health professionals (AHPs) at Nottinghamshire Healthcare NHS Trust.

Ms Pope undertook a leadership programme with the King’s Fund, designed for senior women in the health service, three years ago. The six-month programme encompassed a wide range of healthcare professionals who were placed in learning sets to provide peer support.

‘My group consists of a consultant psychiatrist, a Scottish public health consultant, and a local authority officer, among others,’ said Ms Pope. ‘We still meet two or three times a year and it has been so helpful to have the support and perspective of a group of successful women leaders outside of my normal working environment.’

Participants had to attend intensive, three or four day residential training events over the six months. They had one-to-one coaching and took part in activities that explored the need for leadership in healthcare and how leadership skills can be used in various situations.

‘It was about taking your existing values and strengths and learning how to make more of them,’ say Ms Pope. ‘And we looked not just at how other people lead, but how you would do it, and how you personally can get the most out of other people.’

A natural leader

Ms Pope is now committed to promoting leadership within the physiotherapy profession and among AHPs. ‘I think as AHPS we already possess many key leadership skills, and as a leader you can potentially make a positive difference for more patients.’

‘I was not aware of leadership theory before, but I now realise I have a lot of natural leadership skills. Many women in particular doubt their abilities as leaders, but I now have so much more confidence in the way I approach things.’

Ms Pope has since taken the opportunity to be seconded two days a week as clinical director of specialist services at her trust – the only AHP in such a position there.

And she adds: ‘In the East Midlands we have worked with the Leadership Academy to promote a new mentorship scheme for AHPs and other aspiring clinical leaders. I offer mentoring myself, both for this scheme and within my organisation for AHPs and for a black and minority ethnic mentoring scheme.’

As someone whose responsibilities have included being president of the Chartered Physiotherapists in Mental Health Care network, CSP council member and director of therapies on the board of the mental health network of the NHS Confederation, Ms Pope is obviously well motivated to stretch her skills when the opportunity arises.

But, as the new NHS Academy is so keen to promote, individuals do not have to be senior staff members to get involved in leadership.

The annual National Clinical Leadership fellowship programme is open to clinicians from all healthcare settings in England who put forward an innovative solution to a clinical leadership challenge. The 2011 intake of 60 fellows included a cohort of seven physiotherapists.

The programme began last November and runs for nine months. The fellows receive clinical leadership and management training with the emphasis on sharing best practice.

They also get the opportunity to work towards a post-graduate certificate in leadership and service improvement and are charged with designing and implementing a service transformation project in their own workplace.

Collaborative working

Sarah Withers, a consultant physiotherapist at Sheffield Teaching Hospitals NHS Foundation Trust, is one of the physios selected to join the 2011 fellowship intake.

She says before applying for the scheme she had been fortunate to be involved in service improvement projects, but was well aware there was more scope for crossing boundaries of practice in terms of what musculoskeletal services can offer.

‘At Sheffield we were lucky as we have primary, interface and secondary care services working together and cross-organisational group working on various care pathway projects.

‘I think collaborative working needs to be carried out on an organisational level rather than merely led by individuals, and we need to spread the word on collaborative working so we don’t work against the possibility for innovation.’

She says joining the fellowship programme has been a way of increasing the focus on this area of work and dedicating time to a working project to continue the progress already made in her service.

‘The project I’m doing was identified  before I got the fellowship and was part of the application and assessment process for being offered a place, so anyone who is identifying projects and getting started with them is potentially a candidate.’

Ms Withers explains that her project aims to improve patient outcomes and experience for those with soft tissue knee problems by improving skills and increasing consistency of care across primary, interface and secondary care services.

‘The first step has been to really analyse what’s going on now across the pathway in order to understand how to target smaller joint working changes.

‘Fully understanding the issues that the project will address has proved to be a key learning point for me, and the fellowship has helped me to address some of the assumptions that have been made in developing the project.’

She says other benefits to the scheme have been looking more closely at an evidence-based approach to service improvement, and getting practical guidance on how to run a project and on leadership and change management skills.

Ms Withers adds that working with others on the project is another plus. ‘It’s been a great opportunity to build professional and personal relationships with others on the programme and form supportive professional networks.’

Would she recommend the leadership learning experience to others? ‘Absolutely. It’s been a lot of fun, really challenging and demanding, but very enjoyable and rewarding.

‘If you want the opportunity to raise the profile of physiotherapy, draw attention to clinical-driven ideas and get the opportunity to influence decisions and policy, then this is it’. fl

The NHS leadership Recognition Awards are open for entries until 29 June 2012. 

See http://www.nhsleadershipawards.nhs.uk/

Sally Priestley

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