This article was originally published on the Health Service Journal (April 2019)
In this blog Stephen Hart explores how recent research from the NHS Leadership Academy has provided a rare opportunity to see the impact that chief executives developed through the Aspiring chief executive programme have on patients, staff and the systems they work in.
The NHS faces a leadership challenge, particularly at the most senior levels; provider trusts report difficulties in recruiting and average tenure of just three years – little time in which to make a difference. Senior leaders point to the isolation of the CEO role, and the risks in taking it on within what’s seen as a blame culture.
The Aspiring chief executive programme – launched in collaboration with NHS Improvement and NHS Providers – was established to increase the number of potential chief executives and improve their effectiveness across the system.An independent evaluation by the Institute for Employment Studies (IES) explores the impact of the programme’s first two cohorts from the perspectives of a cross-section of chairs, CEOs, alumni and system leaders and the study points to six key areas of impact:
- Diversity and inclusion: Participants say the programme has had a major impact on their understanding of the inclusion agenda and on sustained change in their behaviour in this area. They realised that simply championing the agenda wasn’t enough; they had to actively drive it forward. Participants described being more mindful of putting their positional authority behind it:
“Behind the scenes, in every action that I take, I’m pushing people who have influence to look very hard to see if we can’t find someone from a more diverse background, assuming they have the right skillset as well.”
- Personal leadership style and purpose: The programme challenged how participants looked at the world, unpicking their assumptions, biases and beliefs to crystallise what their leadership stands for. The programme enabled them to adopt a more ‘thoughtful, mature and rounded’ approach, considering their behaviours, impact and presence. Participants described a process of understanding themselves first and using themselves as a resource in their relationships with others, as well as developing a very proactive style of leadership. All participants work throughout with a patient partner and receive reverse mentoring from a junior member of staff within their organisations. Some felt that that these relationships gave the man extra edge to support their development and sense of purpose. All considered that an open and inclusive style of leadership contributed to their effectiveness. They typically involve people at all levels in the organisation, as well as patients, families and partners from the wider system. They were very clear that actively role-modelling the behaviours they expected from others strengthened their personal effectiveness. Participants believed in the need to be ‘disruptive’, take risks and challenge the status quo.
“It gets you to think really hard about who you are. What am I here for? What am I hoping to achieve? What kind of leader do I want to be? How does it feel to be on the receiving end of me?”
- Networking: The programme facilitates the development of invaluable, robust networks which combat potential isolation.Participants point to the importance of the network, during and after the programme. “The programme provided me with the support network and resilience to do the job. All these things were needed in a tough first year [as CEO]. I could have walked away.”
- Strategic thinking about NHS leadership: Participants valued how the programme enabled them to recognise and develop their thinking around strategic areas that would be critical levers for successful leadership in the NHS. The perspective helped them to prioritise ‘where and how to put effort in’ and ‘gave insight into the key elements underpinning a CEO role’. There was a marked consistency in their belief that leadership is not just down to individuals buton:
- Solid relationships within their organisations and in the wider health system
- Building an effective executive team
- A constructive relationship with their chair
They contrasted this approach to that of the command and control approach of heroic leadership.
“I don’t believe in heroic and individuals leading an organisation. It’s about how to create good teams that work.”
- Accelerating readiness: The report found the intensive nature of the programme accelerated readiness for the role. Participants, all of whom were experienced executive directors, say the programme enabled them to ‘get there quicker’ in terms of preparation for a CEO role, indicating that it provided an excellent job preview and, for many, was ‘perfectly timed’ for their career stage
- Accessibility and visibility: The programme led a number of participants to take conscious steps to become more visible and approachable, consistent with their recognition of their impact as role models. They cited adopting an open door policy, holding regular breakfasts to meet with staff, writing blogs, being on Twitter, everyone being able to directly email them and regularly being out in the Trust and the wider system. Some participants worked hard to show the human side of a chief executive; staff from one trust describe seeing the CEO in their jeans on a Sunday working alongside a cleaning team. A colleague of another notes:
“One of the things that [the CEO] does differently since the programme is showing more of them as a person within the role. They have found that people seeingt hem as a rounded person, rather than a figurehead, has helped them to build the kind of relationships that a chief executive needs to be really effective.”
Both CEOs who had graduated from the programme and those who hadn’t were asked what evidence of their effectiveness they would point to. The most common included:
- Improved accident and emergency waiting times
- Improved referral to treatment targets
- Reduced mortality rates
- Wait for cancer treatment
- Improvements in the staff survey
- Reductions in staff turnover
Asked to articulate what makes for an effective NHS chief executive, the same three facets underpinning effectiveness came up:
- Values and motivations
- Personal attributes and leadership behaviours
The majority of interviewees felt that the characteristics required to be an effective chief executive were:
- ‘Thinking about system and organisation sustainability’
- ‘The ability to navigate and work across different sectors’
- ‘A style of leadership that is much more relationship-based than power- or hierarchy-based’
- ‘Being much more aligned to system success than organisation success’
Leaders contributing to this study consistently made the connection between personal leadership with purpose, behaviours which engage others and impact on operational indicators of performance. It’s heartening to see alignment between how people regard effectiveness in a CEO and the direction of travel of the NHS. It’s also heartening to see a demonstration of how investment in the development of CEOs can build that effectiveness.
Find out more about the Aspiring Chief Executive programme.
An evaluation of the NHS Leadership Academy’s Aspiring chief executive programme has highlighted themes around what makes an effective CEO and highlights tensions in the context in which they lead. View the report.