How to build an effective chief executive

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 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.’

• 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 but on:
  • 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 individuals leading an organisation. It’s about how to create good teams that work.”

• 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 seeing them 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:

• Purpose;
• 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.