Effective leadership delivers improvements in the quality of care that patients receive.  I have always known this but in my current position, working with the NHS Institute of Innovation and Improvement on Rapid Improvement Programmes, this has been reinforced and has become very real.  It is startling to see just how significantly people differ in their leadership and management ability and consequently the differences in service delivery, quality of care and improvements achieved.  This should not be underestimated.      

Put simplistically if organisations have dynamic management and strong medical leadership there is a common aim within a wider team to improve and enhance quality; there is vision, drive, team work, a working accountability structure and results.  When I say results I mean improved services and quality for patients.

For organisations which do not have such strong management and partly engaged medical leadership the cohesiveness is missing.   Often significant team members do not seem to realise that the success, scale or speed of change is anything to do with their leadership.

Good (general) management is about being articulate, having a clear vision, setting goals, drive and accountability but what I think makes people stand out is whether they have the personal skills to drive change by enthusing teams, holding people to account whilst supporting them at the same time which brings an energy and glue to the team.  

Whilst comparisons are odious if I were to compare trusts the difference in what can be achieved in a matter of weeks can be drastic and it’s to do with the leadership, energy and drive.  If the quality of care that patients receive is directly attributable to the leadership of the services then it is essential that the right people are on the bus, this does not just mean the managers.

People roll their eyes when I talk about getting the right people on the bus.   If the wrong people are on the bus they should be dropped off at the next stop, they might need to catch a different bus.  If you need to pick someone up to fill the empty seat on the bus but the person at the bus stop isn’t the right person to fill the seat, drive on to the next bus stop.  We (the NHS) can be overly nervous about spare seats.

Easy?  No, of course not, but no one goes into NHS management because it’s easy.  Possible?   Yes, but with hard work, commitment and sometimes holding your nerve. 

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