Leading from the front

The NHS is characterised by its complexity and reliance on large numbers of people to achieve aims that span from an individual patient to a whole population.

In any business activity, it is the complexity of the task and its dependence on people interacting that require visible leadership. Leadership is all about providing focus and relevance to the activities people are engaged in, and enabling them to be ‘the best they can be’, whatever part they play.

Therefore, leaders and leadership are needed at all levels of the system. The person providing direction, context, support and inspiration may be the Chief Executive but is equally likely to be the Ward Sister, Consultant, Porter or Therapist. It’s not the title that defines the leader but what they do and what they make it possible for others to achieve.

Leaders help people and the teams within which they work re-frame their thinking and get beyond the rhetoric of the moment to what really matters. All too often, targets are cited as the problem. Whether reducing hospital acquired infection, waiting times, lengths of stay or food wastage, the leader is the person who helps others see the advantage to patients and sets about taking action to achieve the goal. They build an irresistible force for change that others want to follow.

Leaders emerge in organisations in a variety of situations and it’s the job of managers to create an environment in which their skills and motivation can be guided, encouraged, supported and recognised. Improving service quality and the patient experience needs to be seen as the responsibility of the whole organisation and the impact should resonate right through to the bottom line of the balance sheet.

Efficiency drive

Doing things inefficiently robs healthcare organisations and patients of new opportunities for future service developments and threatens the very existence of those that we provide today. It’s the job of leaders to articulate that in a way that staff can relate to. The whole organisation needs to understand the benefits of a philosophy of continuous improvement and its ability to realise real benefits for patients.

Whenever organisations embark on anything that involves change, there will be a high degree of anxiety and sometimes cynicism among staff. Preparation is essential and sticking with it when the going gets tough is fundamental. It’s like the practice of ‘good medicine’ – a lot of art and a bit of science.

The art and science come together at the outset by taking some simple baseline measures of where you are in terms of service delivery and making it clear where you want to be. Clear communications at all levels from leaders is critical. Staff need to understand the big picture just as much as those at the Board level. Indeed, they need to own the vision and accept at times that their efforts may be realised in benefits elsewhere in the organisation.

Making a £50,000 saving in food wastage in year may not result in more money being pumped into the catering budget but may pay for a nurse specialist or avoid the redundancy of another key member of staff. Either of these results would be beneficial to patients.

Similarly, avoiding or reducing prescribing costs, seeing a higher ratio of new patients to follow-up patients in clinics or simply putting the right type of non-clinical waste in the right coloured bag can have dramatic effects and similar benefits. Behavioural change needs to take place at both the individual and organisational level. A 1 per cent improvement from 3,000 staff is worth more than a 20 per cent improvement from thirty staff.

Best in class

Whether in the public or private sector, the ‘best in class’ organisations have a core set of values in common. They pursue customer focus and cost reduction relentlessly to maintain their position as world-class leaders. They focus more on engaging with their staff and learning together than they do on analysing the detail of budgets to the point of endless debate and inaction.

Organisations can’t innovate and stay ahead if they are constantly in a state of retrospective analysis. They get the information they need to a level of ‘good enough’ and then commit to change. They anticipate the need for review and correction along the way to keep them on course.

In any year of a five-year programme of improvement, our organisation will have built in 90-day targets and reviews. Finally, we ensure that we communicate the successes and patient benefits to all staff through face-to-face briefings from Board. In the midst of continuous change, staff need to know how they are doing, and nothing works better than the recognition of success.