As we moved through our programme of inspecting all acute hospitals, it became increasingly clear that one of the strongest indicators of a high-performing organisation that delivered good quality care was the quality of its leadership.
Our 2016 State of Care report, which drew on the findings from inspections, noted that effective leadership and a positive, open culture are important drivers of change. In hospitals rated as good or outstanding, the trust boards had worked hard to create a culture where staff felt valued and empowered to suggest improvements and question poor practice.
That shouldn’t be a surprise: as the ‘Developing People – Improving Care’ framework indicated, research shows the most powerful factor influencing culture is leadership. Leaders who model compassion, inclusion and dedication to improvement in all their interactions are the key to creating cultures of continuous improvement in health and care.
Compassionate and inclusive leadership creates an environment where there is no bullying, and where learning and quality improvement become the norm.
So, if these are the factors of good and outstanding trusts, what behaviours would leaders need to demonstrate to move inadequate trusts to good or outstanding?
We selected eight trusts where we had found major improvements in quality upon re-inspection and asked them to tell us how they had achieved those improvements. We set out to explore the steps that leaders had taken to instigate change and the effect of those actions on staff and patients. Although the particular issues facing each trust were different and the approaches taken were individual, collective themes stood out. These included the importance of cultural change and staff engagement, strong governance and patient and public engagement. Each of these themes is, of course, an element of the CQC’s Well Led assessment.
Some trusts changed the leadership team to help drive improvement. For others, it was about empowering existing staff to take leading roles in effecting organisational change. Trusts that unleashed the potential of their staff are now seeing higher staff engagement and improvements in service quality.
What are the steps to improve
One of the first steps on an improvement journey starts with changing the culture of the organisation. Typically, trusts rated as inadequate are disjointed organisations. The priority for leaders is to bring all the elements of the trust together. This is best done by engaging and empowering staff – underpinned by shared values. Good leaders ensured that the vision and values were developed by staff, and therefore ‘owned’ by staff. They also ensured that leaders at all levels were empowered and supported.
What do our leaders need to do
Leaders need to lead and be seen to lead. Our improving trusts placed emphasis on the visibility of leaders: chief executives and senior staff spending time on the ‘shop floor’, meeting staff and setting up regular channels of communication. This helps to give staff the confidence that they will be listened to and removes the fear of reporting problems. A feature of an improved trust is one that has moved from a blame culture to an open culture where concerns can be raised and shared and staff are supported.
An outward looking approach is another aspect that’s enabled improvement. We heard how trusts reached out to their communities and encouraged staff to use social media to share stories and interact with patients and the public. They also involve patients and the public in the work of the trust, shaping services and providing feedback.
The eight trusts we featured all showed how compassionate leadership is the driving force behind improvement. Here you can find all the Driving improvement: Case studies from eight NHS trusts.