Turning leadership on its head

Who comes to mind when you think about leaders in the NHS? Simon Stevens and his top team? Senior clinical colleagues? Chief officers? The answer tends to come from “looking upwards” at the layers of hierarchy above.

This isn’t surprising given how essential senior accountability is to a well-functioning health and care system. However, what if this tendency to “look upwards” in the NHS was squeezing out other sources of leadership – leadership that sits outside the top of the pyramid, and is instead to be found all around us?

Last week, NHS England shared their interim report of the NHS People Plan which goes some way in acknowledging the work that needs to happen to build a workforce fit for the present, let alone the future.

With enormous pressures on retaining staff and filling critical vacancies, the stakes are high and the report outlines some welcome priorities. However, for the NHS to genuinely create a workforce and culture for the future, it needs to go much further, starting from the bottom-up.  

The NHS should turn leadership on its head. The Interim Plan talks of “staff engagement” and improving “leadership culture”, but the overall dynamic still reads as senior leaders reaching out to frontline staff with a mindset of “us and them”.

Front-line practitioners and people who use health and care services have deep expertise in how the system operates and insight into what needs to change, but often little influence or ownership over what happens

It falls short of recognising that the people working closest to delivery in the NHS are themselves the engine of a new culture, capable of driving game-changing improvements. What they need is permission and support.

The opportunity the NHS must seize is to build its leadership culture ground-up from the frontline. Front-line practitioners and people who use health and care services have deep expertise in how the system operates and insight into what needs to change, but often little influence or ownership over what happens.

Not only is this demotivating, but it’s also a colossal waste of system intelligence.

The good news is that there are well-established ways to change this and, contrary to expectations, it doesn’t need to take years. At Nesta, we’ve seen this first hand in over 40 different patches of the health and care system that there are ways of working that unlock the leadership potential in every member of staff by putting them in the driving seat.

Frontline collaboration

We work with local leaders and frontline staff using an approach we call People Powered Results that galvanises frontline collaboration in 100 day challenges with senior backing. These challenges show that in just three months, challenging cultural and performance issues can be tackled in ways that last beyond the 100 days.

In Stockton-on-Tees, the Home Safe, Sooner initiative, was designed and led by frontline staff from the University Hospital of North Tees. It is an integrated and personalised approach to discharge from hospital and led to a 35 per cent drop in delayed discharges and savings of £900,000 from 2017-2018 based on the clinical commissioning group’s data.

It was named best integration project at the North East, Cumbria and Yorkshire and Humber commissioning awards. 

In Tameside, cross-system teams took on the challenge of working differently with people at risk of diabetes. Within a short space of time and through adopting a community development approach giving people personalised information and support, 49 per cent of people within their neighbourhood were no longer classed as pre-diabetic.

What NHS staff need is permission to create and test new ways of working and the support of senior leaders to follow through

People had achieved an average waist measurement reduction of 6cm, and increases in self-reported measurement of wellbeing according to a validated measure (Warwick Edinburgh – average 2 levels increase).

Following the challenge, teams have continued to support people at risk of diabetes, and also used the engagement techniques to successfully reach other groups including people with chronic cardio obstructive pulmonary disease, and people who are clinically obese.

These examples show that to create a performance culture that is positive, collaborative, motivating and effective, the NHS needs to turn leadership on its head and build from the frontline up.

What NHS staff need is permission to create and test new ways of working and the support of senior leaders to follow through. The results will not only improve key system metrics like hospital discharge but create a resilient culture of innovation that’s essential to meeting the challenges buffeting the NHS.

If you’re interested in learning more about participatory leadership approaches – and how to turn leadership on its head – then join us at the Future of People Powered Health event on 15th July, more details can be found here.