The NHS needs strong, stable leaders who are able to strategically plan and look ahead while taking the immediate needs of their staff and patients into account. We can spend years nurturing and supporting leaders to develop and progress into a chief executive role, yet the average tenure is just 18 months. What’s making people think about moving on so soon? And how can we get better at keeping them?
In the second of a series of blogs, Deborah Lee, chief executive of Gloucestershire Hospitals NHS Foundation Trust and a graduate of the Aspiring Chief Executive programme, discusses her experience and the impact the programme has had on her, her colleagues and the system. The programme is a collaboration between NHS Providers, the NHS Leadership Academy and NHS Improvement.
My early career was characterised by competitive ambition. I was keen to progress and became an executive director in my early thirties. I then met my lovely husband and children followed – my career remained important but being a chief executive was no longer a major ambition and for the next 15 years I held a number of board positions in commissioning organisations working part-time and – for some of these years – close to home. In my mid-40s I had something akin to a mid-life crisis, when I began to struggle to see the point of commissioning. I began to think about alternative careers (including that all too familiar dream of the rural idyll tea shop and/or B&B – you need to know me well to know just how bad a move that would have been).
In 2011, the option of a secondment to an acute trust came along; in fact, rather like buses, two opportunities came along in the same week: chief operating officer and director of strategy and performance, both in Bristol but at different trusts. I went with the latter, believing it would be an easier transition from my director of commissioning role.
From week one, acute hospital services felt like ‘home base’. The frustrations that had characterised my career as a commissioning director evaporated and were replaced by huge challenges, but challenges that I found myself able to address. A month in, I was clear that I wanted to be a chief executive of a similar organisation. For five years I had the best job I’ve ever had. I won the chairman’s lifetime achievement award for the person who had made the most difference to the trust in his tenure and was voted as one of the top 50 inspirational leaders in healthcare by the Health Service Journal.
In 2015, I competed with 75 applicants to secure one of 14 places on the Aspiring chief executive programme, developed and delivered by the NHS Leadership Academy, NHS Improvement and NHS Providers, and a month later I applied, and secured, the chief executive role at Gloucestershire Hospitals. It was all looking good…
A few people asked me if I intended to carry on with the programme now that I’d landed a chief executive job. I can say now that if it hadn’t been for the programme, I doubt I would have survived my first chief executive job, let alone thrived.
Four months into the programme, I started my chief executive career. Within weeks it was apparent that many of my hopes and aspirations would need to be put aside while I wrestled with the unexpected issues that surfaced almost daily, almost all of which were apparently previously unknown: money (from £18m planned surplus to £30m forecast deficit and a foray into Special Measures), performance (from achieving three to failing all four constitutional standards followed by regulatory enforcement action), and a prevailing culture far from conducive to turnaround.
Without doubt the programme couldn’t have been better timed. It challenged me in ways I have never experienced and prompted me to really think about my leadership: what was it for? How would it manifest? What was it like to be on the receiving end of me? Obvious questions perhaps, but not ones I had embraced as honestly as I did through the programme. The Praxis Group was one of the most enriching experiences of my professional life. It reduced most of us to tears (or close to), people shared things that left me humbled, I made friendships for life and learnt more about myself and what it is to lead in adversity than I thought possible. The quality of my peers on the programme was phenomenal.
While the Praxis Group was the highlight of the programme, there were numerous other aspects which contributed to my development (and at a time when I was rather arrogantly unconvinced what development was left or required to succeed as a chief executive). Guest speakers were invaluable and refreshingly candid and open with their insights and opinions; importantly, all were willing to share the numerous things they had got wrong in the beginning, middle and end of their careers. This knowledge – that even the best people struggle sometimes – became a lifeline as I made mistake after mistake as a new chief executive.
Overall, I cannot recommend the programme highly enough. The things that it explored will stay with me for as long as I have the chance to lead, the friendships forged continue to keep me afloat me during the inevitable dark days, and I believe I am a better chief executive for having done the programme. Though of course, others will be the judge of that.
The Aspiring Chief Executive programme is a collaboration between NHS Providers, the NHS Leadership Academy and NHS Improvement. It was created in 2014 to ensure a strong, ongoing, pipeline of candidates for the role of NHS trust chief executive. The programme is designed to prepare those with the potential to become chief executives in the next 12-24 months for these key roles. The programme has had two cohorts – one which graduated in early 2017 and one nearing completion. Of the 28 participants so far, 10 have gone on to become trust chief executives. Providing the right leadership support for these individuals will be key to ensure they have the right skills, attitudes and behaviours to build a better NHS. Find out more about the Aspiring Chief Executive programme.