Creating a well led organisation - new guidance for boards

Steven Weeks

20 / 11 / 2014 2.29pm

The Kings Fund has produced a new briefing 'Exploring CQCs well led domain'  aimed at NHS Board members on assessing whether organisations are ‘well led’. This briefing links to the lines of enquiry used by the Care Quality Commission (CQC) in making their assessment of an organisation. There is clear research evidence that ‘well led’ organisations with high degrees of staff engagement provide higher quality care.

Key areas

The Kings Fund looks at the questions for board members to ask in five key areas:

  • overall performance
  • quality and safety
  • staff engagement
  • values and culture
  • innovation.

By using the briefing as a checklist, organisations will be able to assess how far they are “well led” as defined by the CQC. 

Overall performance

The CQC argue that it's essential that there is a clear strategy for the organisation and that all staff are aware of how their role contributes to achieving these goals. An issue that the CQC has picked up in some inspections, is the danger of a ’gap’ between the plans at the top of the organisation and the day to day pressures and objectives at ward level.  In order to avoid such a mismatch, senior leaders need to work as a group to ensure the overall strategy is clear and coherent, and is communicated in a meaningful way throughout the organisation.

Human Resources professionals have an essential role to play in ensuring the performance management system supports this objective, for example making sure appraisals demonstrate the link between organisational plans and individual objectives.

Other recommendations

The report also recommends a range of other actions by boards:

  • They need to have means of assessing performance, quality and safety, and in particular, ensure that staff are able to speak up on areas of concern.
  • They should develop leaders throughout their organisations and create strong cultures, based on values and expected behaviours.
  • Ensure that staff are engaged in the work of the organisation and that the experiences and views of patients are understood and acted on.
  • On staff engagement the report recommends that the organisation assesses trends in staff engagement and take action on concerns raised. Organisations should also assess patient experience and compare with other organisations. They should look at patient surveys but also at other methods of hearing from patients such as board members receiving feedback directly from patients.


Overall the report recommends that based on the work of Professor Mike West and others on how to develop a safety culture,  boards need to develop cultures of continuous learning and improvement to support staff to provide the best possible care within the resources available.

In each of these areas the report highlights examples from trusts including Oxleas, Northumbria Healthcare, Salford Royal, Sheffield Teaching Hospitals and Frimley Park.  The IPA report Meeting the Challenge - successful employee engagement in the NHS also uses some of these trusts as examples.

NHS Employers has additional examples on staff engagement from a range of other organisations including Wrightington Wigan & Leigh5 Borough Partnership and Medway Community Healthcare. In addition we have produced a guidance note on how the CQC assesses staff engagement.

If you have examples you would like to share please contact

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