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Designing a leadership programme to boost quality


Abigail Masterson and Pippa Gough on The Health Foundation’s upcoming priorities

Mahatma Gandhi famously said: ‘You must be the change you want to see in the world.’

While not wishing to reduce the great man’s words to somewhat parochial concerns, it is a phrase that has had particular significance during the process that has occupied us since starting our job-share - designing a new leadership for quality improvement programme.

The Health Foundation recruited us in late 2008 as assistant director, clinical quality. This role included reviewing the portfolio of leadership development schemes the foundation offered in the context of current policy and investment in clinical quality. The job-share is something we want to explore further, but this will keep for the future.

The invitation to tender for delivery of the new leadership for quality improvement programme by skilled technical providers has now gone out, and represents a huge effort over many months to identify and clarify what we think is important in developing leadership ability.

The question here is not so much what leadership is - although this is relevant - but rather the interventions that will enable the development of leadership ability and skill in others with the specific aim of improving quality.

It’s one of those questions that, despite our many years of experience in the field, can be rather baffling.

The answer is either so complex and overwhelming that it is unfathomable or so simple that it’s really not worth having to spell out over 20 pages of an invitation to tender.

‘The question is not so much what leadership is – although this is relevant – but rather the interventions that enable the development of leadership ability and skill’

The basic question is: what is it we want the technical providers to deliver? A simple enough question, surely?

But we need to be clear: first, about what we think leadership actually is in the context of quality improvement; second, what our beliefs are as to how people learn to become leaders; and third, what is the nature of the curriculum and what needs to be studied?

Pretty quickly in this process the question starts to emerge as to whether leaders are born or made (is leadership an inherent quality or can it be taught?), and once you reach this point you then find yourself in a rather uncertain position.

But over the past six months of enquiry and conversation on this matter, we have accepted that we are both reasonably
happy to reduce our understanding about leadership and leadership development to a fundamental notion.

Namely, to be a good leader you must be trustworthy and able to communicate a vision. Flowing from this concise premise
is a litany of ideas about authenticity, embodiment of values, ability to set culture, communication skills, political nous, emotional intelligence,setting strategy, motivating staff, reflective practice, negotiating and influencing, and so on.

And this is where Gandhi kicks in. To be trustworthy and able to create a vision that others will buy into, you need to be showing the way, setting an example, role-modelling how your vision can work. You are demonstrating and implementing the change you want to see.

This isn’t, however, just a statement about what we expect of the participants on the leadership for quality improvement programme.

This is also about what we as commissioners are demanding of our technical providers. Standing in front of a class and as a teaching team, we want them to always be working towards being the change they want to see in the programme’s participants.

And this desire for coherence goes further. We too, as The Health Foundation, need to be showing the way, role-modelling certain behaviours, attitudes and approaches in our assessment and selection of the technical team.

This process of awarding a contract to a provider will be completed by mid-July. We will then settle down to co-designing with the new technical team the details of the programme - how it will be unwrapped from day to day. Through this joint working we hope to become clearer about what’s involved in learning how to lead for improvement. That is, what does this look like in a fully worked-out programme - one that enables individuals to embrace and enhance behaviours associated with integrity, garner respect from their team, and set direction.

We plan to launch the new scheme and recruit the first cohort of sixteen participants at the end of the year, with the first module scheduled to start in March 2010. It promises to be an interesting journey and, we hope, a creative, challenging, provocative and happy one.

As we begin, it is worth noting two other contributions from Gandhi that may be pertinent: ‘Happiness is when what you think, what you say and what you do are in harmony’; and ‘Honest differences are often a healthy sign of progress’.

We hope that through this column we can have an open and vigorous debate on such issues.

Abigail Masterson and Pippa Gough are assistant directors, clinical quality, The Health Foundation


Readers' comments (3)

  • You want to boost quality?

    Then forget about useless things like 'leadership' or 'management' programmes, forget about directors or facilitators or coordinators or idiots with fancy job titles and huge pay packets but not much else.

    And instead, how about concentrating on Nursing SKILLS, anatomy and physiology, medication knowledge, pathophysiology, you know, the little things that are important in a MEDICAL career?

    Just a thought.

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  • I agree with the above poster.

    You won't get improvements in quality by selling a vision and being trustworthy.

    Quality is something that needs to designed-in. So improving the work improves quality.

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  • The huge joke [which is not remotely amusing] is that we are constantly bombarded with new approaches to this or new ways of doing that cascading from a great height by the great unseen but we don't even have a budget that supports address of our most basic patients needs.

    It's difficult to take anything seriously, qualified or not when the basic elements aren't in place.

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