Leadership is the embodiment of culture

Michael West

30 / 10 / 2013 3.31pm

The task for OD...

Is to make sure an organisation has and will have the leadership needed to deliver the vision, provide supportive people management, promote staff engagement, build effective team working and ensure the organisation fulfils its vision of delivering consistently high quality, compassionate and safe patient care. But I often feel overwhelmed by all the material about leadership. In conjunction with the King’s Fund, the Faculty of Medical Leadership and Management and the Centre for Creative Leadership, I have been reviewing all the published research on leadership in health care. The prescriptions below offer a summary of this knowledge and understanding.

CCL describe how leadership ensures clarity of direction, alignment and commitment in the organisation.

Direction: agreement and pride among people on what the organisation is trying to achieve together, consistent with vision, values and strategy.

Alignment: refers to senior leaders’ effective coordination and integration of the work.

Leadership: ensures commitment such that everyone in the organisation takes responsibility and makes it a personal priority to ensure the success of the organisation as a whole, rather than focusing only on their individual or immediate team’s success in isolation.

How can this be achieved?

To achieve this requires every NHS organisation to have an effective leadership strategy in place. The King’s Fund is working with CCL to develop templates of leadership strategies for NHS organisations (please contact me for further detail at m.a.west@lancaster.ac.uk). The leadership strategy will address:

  • The number of leaders needed in each area of the organisation over the forseeable future e.g., the next five years.
  • Qualities required of these leaders - skills, competencies, knowledge specific to their level/area to meet challenges.
  • The desired leadership culture, including required skills, values and behaviours needed to achieve the vision such as improving high quality care, compassion, equality, engaging staff, commitment to learning, positivity, openness.
  • Collective leadership capabilities and strategies - leaders acting together to implement organisation strategies and  nurture cultures (that individual leaders working alone cannot accomplish).

This then informs the production of an appropriate leadership development strategy (derived from the leadership strategy) that takes account of the trust/organisation context.  Leadership development in the most effective organisations is tightly linked to organisation vision, values and strategy. Leadership development is planned, evidence-based, tailored for the organisation, fulfils all elements of the leadership strategy, progress is evaluated and regularly reviewed by Board. Such a strategy also draws from the NHS Leadership Framework and Healthcare Leadership Model as appropriate. The effect is to ensure there is increasing leadership (and especially clinical leadership) capacity year on year.


Effective organisations promote leadership behaviours at every level that reinforce the values and vision of the organisation. This includes:

  • Asserting safe, high quality, compassionate care as the top priority for all.
  • Having oversight of and take action on dignity and compassion for patients.
  • Providing supportive, motivating, fair, compassionate leadership
    Promoting participation and involvement as the core leadership strategy.
  • Ensuring delegation, empowerment and team responsibility for decision making.
  • Promoting staff autonomy, proactivity and accountability.
  • Ensuring the voices of all staff are encouraged, heard and acted on, including all equality groups.
  • Ensuring a full and diverse range of patient views are encouraged, heard and acted on, including all equality groups.
  • Encouraging positive, appreciative and supportive relationships among staff.
  • Modeling compassion in dealing with patients and staff.

Effective leadership 

Drawing on the previous blogs in this series, involves:

  • Agreeing a small number of clear, challenging, prioritised, improvement objectives for all departments teams and staff.
  • Dealing swiftly and effectively with poor performance, conflicts and inappropriate behaviours.
  • Modeling, ensuring and taking action on equality of opportunity and treatment for all patients and staff.
  • Ensuring accountability of all staff for performance.
  • Building effective team, inter-team and X-boundary cooperation.
  • Addressing systems problems that hinder staff in their work – making it easier for staff to do their jobs.
  • Promoting continuous development of staff skills.

At board level

Leadership in NHS organisations is highly dependent on the leadership behaviours of the Board. It is vital therefore that the Board:

  • Enacts the vision and values.
  • Seeks and responds to patient and staff ‘voices’.
  • Ensures strategies for developing leadership and culture are implemented and evaluated.
  • Promotes staff participation and proactivity.
  • Models and ensures equality of opportunity and treatment for all patients and staff.
  • Ensures data is converted into actionable knowledge and fed back to front line staff.
  • Does not rely inappropriately on single initiatives – ‘magic bullets’
  • Leads, encourages and enables innovation to improve services for patients.
  • Engages a wide range of external stakeholders effectively.

Leadership values shape culture. In the next blog, I will describe the values that must underpin leadership of NHS organisations for them to achieve the visions of high quality, compassionate care they pursue.  

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