Delivering Quality Through Leadership: NHSScotland Leadership Development Strategy

1.0 INTRODUCTION

The Scottish Government has set out its single overarching purpose: to focus government and public services on creating a more successful country, with opportunities for all Scotland's population to flourish through increasing sustainable economic growth.

It will do that through five strategic objectives that will create a Scotland that is:

• Wealthier and fairer
• Smarter
• Healthier
• Safer and stronger; and,
• Greener

NHSScotland, as a major knowledge and skills based employer and provider of significant Scotland-wide services, has a significant contribution to make to achieving these five objectives and, through those, delivering the Scottish Government's overarching purpose.

The Better Health, Better Care: Action Plan² sets out the Scottish Government's approach to creating a Healthier Scotland. The three main goals of this action plan are:

• Health improvement
• Tackling health inequalities; and,
• Improving the quality of healthcare

A Force for Improvement: The Workforce Response to Better Health, Better Care³ recognises that the workforce has an important role to play in ensuring the delivery of these ambitious goals. Furthermore, it identifies leadership as one of the cross-cutting issues which can "make or break the delivery of this change programme".

1.1 Background

Delivery through Leadership: NHSScotland Leadership Development Framework and Plan⁴ was published in 2005. A great deal has been achieved:

• Working in partnership through the NHS Organisational Development ( OD) leads network, we have a coherent approach in place to support leadership development in NHSScotland
• The leadership qualities and behaviours that we expect from our leaders have been set out and integrated into our recruitment, selection and performance management processes
• A national 360 degree feedback tool has been developed from the leadership qualities and behaviours and is available across the NHS Boards
• We have built capacity for succession planning in the priority areas of future strategic clinical leaders and by re-establishing the Management Training Scheme
• A range of initiatives are in place to support leaders at different levels of the NHS including Board Level, Chief Executives, Executive cohort, Senior Managers and frontline staff
• We have worked with stakeholders and partners across the public services to promote a collaborative approach to leadership development

1.2 The review

In Better Health, Better Care the Government reflected that though the Leadership Framework and Plan "had served NHSScotland well over the past two years" it was time to review the plan "to clarify the leadership qualities and behaviours" required to deliver Government's new priorities. That review was conducted between October 2008 and February 2009 and involved over forty face-to-face or telephone discussions with key stakeholders across the NHS, the Scottish Government and partner organisations (see Appendix 1 for a list of those consulted). The aim of the review was as follows:

• To ensure that the design and delivery of leadership development is aligned with the new strategic direction of NHSScotland and its service priorities; and,
• To inform any incremental changes to the Leadership Development Framework and Plan.

In partnership with stakeholders, the Leadership Development Team sought to clarify the focus, function and form of leadership development appropriate for NHSScotland. Three lines of inquiry were established:

• Reaching clarity about the focus of leadership development requires an understanding of the key drivers for change and how these impact on leaders and the development of leadership within NHSScotland.
• Clarifying the function of leadership development entails understanding what needs to be developed and how the impact can be assessed and measured.
• Clarifying the form of leadership development means assessing the effectiveness of the model of delivery, i.e. the leadership team, its partner arrangements, and the governance and accountability arrangements.

1.3 The strategy

Delivering Quality through Leadership, the strategy for leadership development in NHSScotland is the product from the review. It sets out the direction of travel for leadership development in NHSScotland over the next three years, informed by views gathered during the review and building on what has already been achieved. It clarifies the changing context within which leaders operate ( Section 2.0) and sets out the leadership qualities and behaviours that are required of leaders at every level in NHSScotland ( Section 3.0 and in Appendices 2 and 3). To ensure a balance between the strategic and operational, this strategy includes ways in which the leadership qualities and behaviours can be used nationally and locally to support culture change and the delivery of high quality, safe and effective care.

A number of priorities for action are identified ( Section 4.0). These are aligned with meeting service delivery goals and builds on the progress which has been made. These priorities for action are concentrated around work that: requires to be addressed nationally; and/or, is across public services; and, is of high impact. A detailed Implementation Plan ( Appendix 4) sets out both national and local actions to ensure alignment.

The governance and accountability arrangements for the Leadership Board and National Leadership Unit are outlined in Section 5.0 (and Appendix 5).

1.4 Guiding principles of the strategy

Delivering Quality through Leadership is underpinned by the following guiding principles:

• Effective leadership at all levels is essential to delivering the goals of NHSScotland and ensuring high quality, safe and effective care. It is recognised that leadership development is a life-long activity and not confined to specific levels or groups of the workforce.
• Leadership development needs to span clinical leadership, general management, functional management and professional leadership roles. There should be sufficient scope (alongside the national strategy) for local systems to take forward the leadership development agenda and for professional groups to enhance specific skills.
• Diversity is critical to achieving service priorities. As a mainstream issue, equality and diversity should inform all aspects of leadership development.
• There are core leadership qualities and behaviours required of our leaders and these have been updated and set out in the strategy. The strategy recognises the distinct but complementary roles of management and leadership. Management (transaction) is about coping with complexity.
  Without good management organisations become chaotic in a way that threatens their existence. Leadership (transformation) is about proactively enabling change through people. The strategy relates to both management and leadership development, reflecting that during times of complexity and change both are needed. ⁵
• NHSScotland should work collaboratively locally and nationally, across public services and with partners, to develop leadership capability and capacity. This will be critical in the future in terms of managing resources and avoiding duplication of effort.
• The strategy recognises the extensive local activity that takes place across NHSScotland. It does not intend to replace this but rather to provide a coherent national approach to leadership development which will guide Boards and complement local activity. The priorities for action at a national level focus on issues that could not be provided locally and which make sense in terms of added value and effective use of resources, i.e. Board Development, Chief Executive Development, and succession planning for strategic posts.
• The strategy reflects the key themes that emerged during stakeholder consultation. The approaches adopted reflect best practice in leadership development drawn from the academic literature, collaboration with other experts in leadership development across the public, and private sectors and robust evaluation of development initiatives.
• Review and evaluation of impact are included as an integral part of the action plan.

At the heart of Delivering Quality through Leadership, is a model for leadership development in NHSScotland. This is set out in Figure 1.

Figure 1: Model for Leadership Development across NHSScotland

The model for leadership development recognises that leadership development does not take place in isolation but is critically linked to other processes both locally and nationally.

The model also provides scope for development approaches that concentrate on leadership development,i.e. enhancing collective leadership capability and leader development,i.e. enhancing the development of individual leaders.

The model sets out the strategic context in which leaders across NHSScotland operate. The detail is outlined in section 2.0. This sets the scene for leadership development.

The leadership role is defined and linked to local processes including performance management, personal development planning and application of the Knowledge and Skills Framework.

The required leadership qualities and behaviours required of our leaders are outlined in section 3.0.