Delivering Quality Through Leadership: NHSScotland Leadership Development Strategy

Strategy to developing NHSScotland Leadership and so deliver quality.


Before the required leadership qualities and behaviours can be considered, the broad context of change needs to be understood. During the review, stakeholders were asked about the key drivers for change that impact upon leaders and how these translate into areas for development. Some themes endure from the previous framework as follows:

  • Developing and implementing sustainable service strategies to improve health and healthcare delivery.
  • Moving from a focus on institutions to a focus on networks and the continuum of patient care and to a focus on health as well as healthcare.
  • Creating a 'can do' culture for service transformation.

In the context of Better Health, Better Care, emphasis is also placed on the issues which are described below.

2.1 Quality of care

Delivering excellence in service quality and patient care is an enduring priority of the NHS and the key focus of any leadership development activity, i.e. leadership development is not an end in itself but rather a means to an end. While this has always been a priority, stakeholders have highlighted the increasing emphasis on ensuring high quality, safe and effective care. For example, the incidence of hospital acquired infections ( HAI) provides the impetus for individuals at all levels to understand the part they have to play and to step up to their leadership role.

2.2 Mutuality and public engagement

With increasing public demand, scrutiny and awareness there comes a need for a heightened focus on patients and the public as 'customers' and 'owners' of the NHS, i.e. the mutuality agenda. This requires leaders to adopt different ways of thinking about shaping patient pathways, to engage with the public in an authentic and credible way and to engage in 'social marketing', i.e. marketing services so that they are truly valued by the public.

2.3 Workforce and succession planning

A Force for Improvement identifies five over-arching workforce challenges for the 21st century: tackling health inequalities; shifting the balance of care; ensuring a quality workforce; delivering best value across the workforce; and, moving towards an integrated workforce. In the context of demographic pressure and legislative and regulatory frameworks for staff, leadership development is seen as essential in tackling these workforce challenges, in particular aligning service needs with the shape of the current and future workforce.

We need to identify people with potential and nurture the leaders of the future. In doing so, we need to be even more open to equality and diversity. To enable this, more clarity is required about the challenge of leadership roles and what is required of leaders at all levels.

2.4 Achieving public value

Leaders across NHSScotland need a sharper business focus while remaining aligned with public sector values. Within the context of tightening public resources, they need to be able to think differently and to have highly developed business and financial acumen. The global economic recession simply sharpens this focus and increases the pressure on resources. However, achieving public value is an enduring driver for change which requires leaders to focus on outcomes and be prepared to foster new ways of working. In relation to leadership development, this means being smarter about how we evaluate the impact on the 'bottom line' and added value. It also means being open to learning from other national and international contexts and benchmarking NHSScotland leadership performance.

2.5 Resource management

Achieving a sharper business focus requires more highly developed resource management (or 'hard') skills including: financial management; service improvement; critical analysis; strategic thinking; and, planning. How these skills are put into practice is critical in the context of economic recession and pressure on public spending, i.e. thinking about the return on capital employed and thinking differently about business planning.

2.6 Cross-working and complexity

Senior managers in the NHS need the ability to work in complex systems. Public policy drivers, including single outcome agreements, mean that there is an even greater need for working across health organisations ( i.e. not in silos) as well as across the public services. In relation to developing leadership, we should be thinking about developing public sector leaders and we should be collaborating more across the public services on leadership development.

2.7 Partnership working and influencing

Working more effectively in partnership across, and with, other organisations requires leaders who can use a range of influencing strategies and who can work in a truly collaborative way.

2.8 Diversity and equality

Just as diversity and equality need to be embedded in service delivery, so they need to be integral to how we scope, commission and deliver leadership development. This links to the need to address health inequalities and to deliver health improvement (as outlined in A Force for Improvement).

Links to other processes and resources:

The challenges of the leadership role (at all levels) comprise:

  • Service objectives,i.e. what leaders are required to do - as set out in local Performance Management ( PM) processes.
  • Role-specific knowledge and skills, i.e. what leaders need to know to do their role - as set out in the Knowledge and Skills Framework ( KSF) or Personal Development Plans for senior managers.

Note: Implementation of the strategy is critically linked to these other local processes including Performance Management, personal development planning, and application of the Knowledge and Skills Framework.

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