Delivering Quality Through Leadership: NHSScotland Leadership Development Strategy

Strategy to developing NHSScotland Leadership and so deliver quality.


How leaders act and behave can help make or break delivery of the change agenda in health. The set of leadership qualities summarised in Figure 2 and detailed in Appendix 2 has been drawn from a wide range of NHS, public sector, private sector and contemporary academic thinking and models. (See references in Appendix 6 of Delivery through Leadership).

The review of Delivery through Leadership confirmed that stakeholders agree with having a framework of leadership qualities and behaviours. They also feel that the particular qualities and behaviours are still largely appropriate, with some modifications. The personal qualities are re-positioned at the heart of the leadership framework, supporting the notion of authentic leadership. Resilience in particular is a critical personal quality for NHS leaders who need to be able to manage upwards as well as across the organisation, to manage ambiguity, to take difficult decisions and have difficult conversations.

Leaders in the NHS have to cope with the paradox of the leadership role: striking the balance between a long-term focus on health improvement with the short-term imperative of meeting HEAT targets; managing the tension between innovation and risk; and, managing corporate governance and performance while being supportive and enabling people to succeed. These themes apply equally to leadership at all levels - from the top in the Scottish Government and the Boards through to the frontline. There is a need for a consistency of approach across all levels.

The model of 'heroic leadership' is no longer appropriate. What is required is 'engaging leadership': "a commitment to building shared visions with a range of different internal and external stakeholder… [which] exploits the diversity of perspectives and the wealth of experiences, strengths and potential that exists within the organisation, and with partners and other stakeholders". 6 In essence, it is a model of leadership which focuses on building capacity and capability in people and organisations. It is leadership which is underpinned by the shared NHS and public service values of: quality of service; equity of access; respect for diversity; mutuality and partnership; integrity; and, consistency.

3.1 Leadership qualities

As it was noted in Delivery through Leadership in 2005, "the leadership qualities outlined will evolve, but they are deliberately succinct". The framework is essentially the same with some incremental changes which are intended to:

  • Reflect changes in the context of NHSScotland and challenges facing leaders.
  • Ensure that the language and concepts used are sensitive to diversity.
  • Aid understanding and use of the model.

The overall model (figure 1) and the framework of leadership qualities (figure 2) provide a basis for further local development to support:

  • Role profiles and person specifications to recruit leaders
  • Assessment frameworks for leadership appointments
  • Personal and team development planning and review
  • Individual/team performance planning and review
  • Design of leadership development initiatives
  • A potential contractual commitment to personal governance.

Figure 2: Summary of leadership qualities

Figure 2: Summary of leadership qualities

Application of the leadership qualities should be linked with other processes, including performance management and personal development planning, as outlined in figure 1.

Our understanding of leadership needs to be progressive which is why more contemporary thinking was reflected in the original design of this framework. As we have confirmed through the review, leadership in NHSScotland (as elsewhere) is about delivery through complex systems and by engaging partners in the pursuit of major, transformational change.

Delivering Quality through Leadership continues the approach set out in the original framework: the consistent and universal application of these qualities as a common approach and language across NHSScotland. It is to be adapted locally to suit local circumstances and specific roles.

3.2 Code of personal governance

Personal qualities are at the heart of the leadership qualities, including Personal Governance. The Code of Personal Governance (outlined in Appendix 3) provides a code of practice for all leaders and managers in NHSScotland and is part of the governance portfolio for NHSScotland. It is based primarily on work done (originally in 2005) by the Institute of Healthcare Management and the NHS Confederation to support the development of similar Codes elsewhere in the NHS.

The Code provides a measure against which individuals can test their decisions and actions. It also provides reassurance to all those served by NHSScotland of the professional standards leaders and managers use in making complex and balanced judgements.

3.3 Using the leadership qualities and behaviours

Inherent within the leadership qualities is the need for consistent use of positive behaviours by leaders. These are summarised in the updated version of the leadership qualities framework in Appendix 2.

The summary of behaviours recognises that performance is not simply about getting things done regardless of how. Fully effective performance requires balancing what needs to be done with how it gets done. It should be used as part of the performance review and personal development planning processes.

There is an on-line 360° feedback diagnostic tool available to support the use and development of the leadership qualities and behaviours. (For further information on the 360° tool contact your Board Development lead or the National Leadership Unit.)

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