From super-hero to super-connector, changing the ­leadership culture in the NHS

Abstract

The NHS Long Term Plan recently published recognises the critical role of leadership to the delivery of high-quality, sustainable healthcare and sets out an ambition for compassionate and inclusive leadership behaviours. There is good evidence that the biggest influence on organisational culture is the quality of leadership, affecting patient outcomes and staff experience. However, the current NHS staff survey paints a sobering picture of the current experience of the 1.2 million staff who work in the NHS in England. Changing culture requires leadership effort and behavioural change at every level of the system, from the clinical microsystem to the national arms-length bodies. Leaders can take positive action by regularly seeking feedback, paying attention to the leadership behaviours within their team and finding ways to ensure the team can reflect and improve their team working. This opinion article offers an introduction to compassionate and inclusive leadership in healthcare. Our intention is to provide the reader with a sense of agency to act and improve local culture for the benefits of patients and staff. The NHS Long Term Plan (LTP) states that the ability of the NHS to deliver high-quality care and transform services depends on 'great leadership' at all levels of the health and care system. 1 What does great leadership look like? There is a growing evidence base and a range of case studies in both the public and private sectors, that compassionate, inclusive leadership and the organisational deployment of quality improvement methodologies can lead to improved performance. 2,3 While there is a clear moral case to address diversity and inclusion, research by McKinsey shows higher financial performance in large companies where there is a greater ABSTRACT proportion of women and a more mixed ethnic and cultural composition. 4 In healthcare, where the triple aim is to improve care, health and cost, West also suggests that compassionate leadership and the development of high performing teams with an improvement focus is associated with lower mortality rates. 5,6 The LTP sets out a vision for leadership that is both compassionate and diverse and suggests that while this is present in some parts of the NHS, it is 'not yet commonplace'. We think this is an overly generous assessment. The NHS Staff Survey paints a quite different picture suggesting that discrimination, bullying and harassment are routinely experienced by one in four staff from their colleagues. 7 While there is no way to analyse these results to know whether this is from peers or managers, in 2018 the British Medical Association published their review of the existing evidence on workplace bullying and harassment and made several policy recommendations, one of which was to help create a 'supportive and inclusive culture' including 'compassionate leadership from the very top and … throughout the NHS system'. 8