By Dr Nicky Eddison, Catherine McKeown, Katie Woodward, and Claire Flatt

The most critical resource in any organisation is people. The leadership staff receive is vital to their job satisfaction and in healthcare, it is decisive in influencing the quality of care¹. It is essential to every aspect of the organisation, and it is the glue that holds everything together². A leadership culture that promotes an enabling and psychologically safe environment, and the capacity, time, and skills for people to learn and experiment is the true driver for change². To achieve a leadership culture leaders must navigate complex challenges which demand effective team-based working within and across traditional organisation and sector boundaries. They must be innovative and experiment to find new ways of delivering care, demonstrating collaboration and compassion³. With the NHS attempting a cultural shift towards a more psychosocial model of care approach which considers the wider determinants of health, it is clear leadership will be key to realising this goal². The NHS long-term plan⁴ devotes less than two pages to leadership yet we know that the effect of poor leadership can have catastrophic long-term consequences for individuals, teams, and organisations⁵.

The literature shows that there is a mismatch between demand and resources, putting leaders under immense pressure and fearful of blame¹. To achieve effective and sustainable leadership across the NHS, staff must be equipped with the skills and tools required for these complex roles. This article will explore the leadership experiences of two of our allied health professional (AHP) leaders.

Katie Woodward’s leadership experience

Qualifying as a physiotherapist back in 2008, there were very few opportunities to develop as an AHP into a leadership role.  Whilst there was a great focus on clinical skill development to meet the needs of our profession, there was very little focus on leadership.  Leadership skill and knowledge is something that has certainly evolved since, although it is still not standardised or measured.  I have gained most of my leadership skills via on-the-job learning.  I am now considering accessing more formalised training.

I feel privileged to have recently taken up the first post in the Trust as a Clinical Lead Therapist in stroke and neurology, for physiotherapy and occupational therapy.  The COVID-19 pandemic shaped my current view and journey into clinical leadership, as never was there such a need to be able to influence and support those around me.  My vision once was solely of a clinical focus, now it is far wider reaching than that.  I now recognise the need more than ever for widening perspectives, managing talent within our workforce, considering culture, creating greater confidence, and considering the practicalities of continuing to deliver the highest level of clinical care at a time that is challenging for the NHS.

There are challenges already, and I am certain more will follow.  There are challenges in trying to earn respect and be heard at a senior level, as well as challenges around meeting some of the operational requirements of the post, whilst balancing these with the need to draw a much wider, larger team together across pathways. In addition to meeting the day-to-day clinical need.  Although the requirements of the role are challenging it is important to remember the potential impact of such a post.  It provides the opportunity to inform change at a higher level⁶. It can enable change through engagement with co-production and allows leadership with a focus on transforming healthcare to improve pathways and systems for the greater benefit of the patients we serve, and in doing so improve overall productivity.  There is also a requirement to consider the evolution of roles, sustainability, and expansion of our workforce, ensuring recognition of talent at every level.  The role gives me new challenges every day, but it also inspires me and brings me joy; it is indeed the greatest privilege.

Catherine McKeown’s leadership experience

Clinical Leadership within the NHS is fraught with complexities. The need to provide a high standard of clinical care, along with the pressures of meeting operational targets and demands while accounting for the well-being of team members can be a difficult balancing act with many perils faced along the way.  The magnitude of these responsibilities can sometimes weigh heavily.

Since becoming an AHP leader in 2018 my view of myself, our service, patients, and the team, has changed; my previous tunnel vision has become panoramic, and I now have an increased awareness of wider issues.  I have learned that effective leadership is synonymous with teamwork, which itself is multifaceted. The need for staff to feel valued, respected, engaged, and supported at work is vital⁷ as this subsequently has a positive impact on patient care.

The most recent AHP strategy⁸ outlines the importance of diverse and inclusive clinical leadership for us to maximise our contribution. Collaborative working is necessary for us to achieve more but clinical leadership can be incredibly difficult in circumstances where underlying political agendas are at large and doing the “right thing” isn’t necessarily always possible, or certainly doesn’t feel as though it is. As AHPs, despite our abilities to work across organisational boundaries and along all stages of care pathways our contributions to outcomes can often be misunderstood⁹ and this can be incredibly frustrating.

As AHP leaders we are required to have the skills and technical knowledge to enable good quality and efficient care at the frontline, whilst also being able to strategically plan for successful future service delivery⁶. It is also vital that we empathetically manage the multitude of scenarios that present daily and impact our staff’s health and well-being. These challenges require a multitude of skills. My experience of leadership training has been mixed.  I did have access to the Mary Seacole Leadership Course and I have also attended a couple of Trust-led management and leadership courses. However, the training didn’t furnish me will all the skills required.

The responsibilities and accountabilities I have as a leader can sometimes feel overwhelming but I’m also conscious of the opportunities my leadership as an AHP has in establishing change and improvement. Despite the challenges, I also consider my role a privilege, to be in a position which has the potential to impact so positively upon so many people I meet daily.

Summary

This article explores the experience of leadership from two experienced AHP leaders. It is clear from the literature and from the experiences outlined here that leadership is challenging and requires a particular skill set.  Yet, the development of quality leadership and management is not adequately embedded or institutionalised in the NHS, rather, it often exists through the endeavours of an individual rather than as a consequence of proper talent management¹⁰. A recent NHS report stated that senior clinicians must get training in civility, human factors,  and leadership⁵. The culture of promoting clinicians to leadership positions without adequate training must be reviewed. The support and training the current generation of leaders require must also be considered.  We wouldn’t put a clinician in a clinical role without robust, standardised training, yet it is common practice to put staff into leadership roles without any leadership training, despite the complexity of the role and the huge impact poor leadership has on staff morale and patient care^2,5,10. Thus, the NHS must address the absolute necessity to consider the next generation of leaders⁴.

A recent UK government review on leadership in the NHS reported that we “must confront the fact that there has developed over time an institutional inadequacy in the way that leadership and management is trained, developed, and valued”¹⁰. The review recommends “a single set of unified, core leadership and management standards for managers and training and development bundles to meet these standards”¹⁰.

 Leadership training at the Royal Wolverhampton NHS Trust

At the Royal Wolverhampton NHS Trust (RWT), there has been an increased focus on leadership development and ensuring staff of all levels and disciplines are equipped with the knowledge and skills to develop as leaders across the organisation. In addition to the lead for people development, two additional roles have been embedded into the team to focus on medical, nursing, midwifery, and AHP leadership, recognising the different challenges clinicians face in patient-facing roles. Whilst also addressing the need for a greater emphasis on collaborative leadership skills for leaders and managers at all levels to ensure more effective working across the broader healthcare system¹¹.

The experiences of Katie and Catherine are not unusual in the NHS; ensuring a standardised and accessible approach to leadership development is vital. In Spring 2023, the training and education team are due to launch a new people development framework which will encompass a clear leadership development structure, offering courses for all staff groups to support them from emerging to established leaders. The framework has four domains: culture, talent, growth, and collaboration. Offering a wide range of courses, workshops, programmes, and e-learning packages to help develop and embed ‘cultures of compassion, inclusion, and collaboration’⁴ at RWT. In addition to the leadership framework, there will also be a clear structure for management skills and signposting to apprenticeships and accredited programmes. Developing a culture of coaching within the organisation is a crucial element of the new framework. Staff will have access to a range of coaches, mentors and supervision via a newly developed app and can also develop their skills around coaching conversations and mentorship.

Launching this new clear and structured development framework is the first step in prioritising people development to support new and established leaders within the organisation. It will help enable staff to take ownership of their leadership and career development, with support from managers with the necessary coaching and mentoring skills, which are vital in supporting leaders reach their full potential to achieve personal and professional success¹².

References

1. Kline R. Leadership in the NHS. BMJ Lead. 2019;3(4):129-132. doi:10.1136/leader-2019-000159
2. Fuller C. Next Steps for Integrating Primary Care: Fuller Stocktake Report.; 2022.
3. NHS. Clinical Leadership – a Framework for Action: A Guide for Senior Leaders on Developing Professional Diversity at Board Level. NHS Improv. Published online 2019. https://improvement.nhs.uk/documents/3702/Clinical_leadership_-_framework_Jan2019.pdf
4. The National Health Service. The NHS Long Term Plan.; 2019. doi:10.12968/jprp.2019.1.3.114
5. Ockenden D. Findings, Conclusions, and Essential Actions from the Independent Review of Maternity Services at The Shrewsbury and Telford Hospital NHS Trust.; 2022. Accessed September 22, 2022. www.gov.uk/official-documents.
6. Mountford, J., & Webb C. When Clinicians Lead. McKinsey & Company. Published 2009. Accessed November 2, 2022. https://www.scirp.org/(S(lz5mqp453ed snp55rrgjct55))/reference/referencespapers.aspx?referenceid=2979924
7. Dixon-Woods M, Baker R, Charles K, et al. Culture and behaviour in the English National Health Service: Overview of lessons from a large multimethod study. BMJ Qual Saf. 2014;23(2):106-115. doi:10.1136/bmjqs-2013-001947
8. Chief Allied Health Professions Office. The Allied Health Professions (AHPs) Strategy for England The AHP Strategy for England?: AHPs Deliver 2022 – 2027. Published 2022. https://www.england.nhs.uk/wp-content/uploads/2022/06/allied-health-professions-strategy-for-england-ahps-deliver.pdf
9. NHS Improvement. Leadership of allied health professions in trusts: what exists and what matters. 2018;(June):1-16. https://improvement.nhs.uk/documents/2904/Leadership_of_AHPs_in_trusts.pdf
10. Messenger G. Leadership for a Collaborative and Inclusive Future.; 2022. https://www.gov.uk/government/publications/health-and-social-care-review-leadership-for-a-collaborative-and-inclusive-future/leadership-for-a-collaborative-and-inclusive-future
11. Jones B, Horton T, Home J. Strengthening NHS management and leadership. The Health Foundation. Published 2022. Accessed November 16, 2022. https://www.health.org.uk/publications/long-reads/strengthening-nhs-management-and-leadership
12. NHS Leadership Academy. Coaching and Mentoring – Leadership Academy. NHS Leadership Academy. Published 2020. Accessed November 16, 2022. https://www.leadershipacademy.nhs.uk/career-development/coaching-register/