Leading Improvement

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Improvement Leaders Guide

Leading improvementPersonal and organisational development

The NHS Modernisation Agency is part of the Department of Health

Crown Copyright 2005

If you require further copies quoteMAILG052 / Improvement Leaders Guides, and contact:

Department of Health PublicationsPO Box 77London SE1 6XH

Tel: 08701 555 455Fax: 01623 724 524E-mail: [email protected]

MAILG052 / Improvement Leaders Guides can also be made available onrequest in braille, on audio-cassette tape, on disk and in large print.

www.modern.nhs.uk


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Leading improvement 1

Improvement Leaders Guides

How you use the Improvement Leaders Guides is not prescriptive. You can startwherever is best for you, however experience has shown us that some of the

Improvement Leaders Guides are best used sequentially.

The ideas and advice in these Improvement Leaders Guides will providea foundation for all your improvement work:

Improvement knowledge and skills

Managing the human dimensions of change

Building and nurturing an improvement culture

Working with groups

Evaluating improvement

Leading improvement

These Improvement Leaders Guides will give you the basic tools andtechniques:

Involving patients and carers

Process mapping, analysis and redesign

Measurement for improvement

Matching capacity and demand

These Improvement Leaders Guides build on the basic tools andtechniques:

Working in systems

Redesigning roles

Improving flow

You will find all these Improvement Leaders Guides atwww.modern.nhs.uk/improvementguides

Every single person is enabled, encouraged and

capable to work with others to improve their part ofthe serviceDiscipline of Improvement in Health and Social Care

DH INFORMATION READER BOX

Policy Estates

HR/Workforce Performance

Management IM&T

Planning Finance

Clinical Partnership Working

Document Purpose Best Practice Guidelines

ROCR Ref: Gateway Ref: 4701

Title Improvement Leaders Guides

Author NHS Modernisation Agency

Publication Date April 2005

Target Audience Medical Directors, Directors of Nursing,

Directors of HR, Allied Health Professionals,Emergency Care Leads, Directors of Modernisation

and Service Improvement

Circulation List

Description A series of guides based on the learning of the

NHS Modernisation Agency. Designed to help

frontline staff improve the delivery of care to

patients and users

Cross Ref: 10 High Impact Changes for Service Improvement

and DeliverySuperseded Docs N/A

Action Required N/A

Timing N/A

Contact Details Jean Penny

NHS Modernisation Agency

4th Floor

St Johns House

East Street

Leicester LE1 6NB

For Recipients Use


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1.What is leadership?

Leadership is about setting direction, opening uppossibilities, helping people achieve, communicationand delivering. It is also about behaviour, what we doas leaders is even more important than what we say.Sir Nigel Crisp

There are thousands of ways to describe leadership, here are just a few.Leadership is:

challenging the process, inspiring a shared vision, enabling others to act andmodelling the way (Clark D, 1997)

transforming followers into leaders themselves (Gill R, 2002)

creating an environment that supports individual team members in beingmaximally effective in achieving those outcomes that are valued by users andtheir supporters (Onyett S, 2002)

something for the many not the top few (Attwood M, 2003)

A leader of improvement needs to have these leadership skills and more.

You will face challenges in creating a shared vision, challenges developing asupportive culture and challenges engaging others in improvement. This guidehas collected together some of the current thinking about the knowledge and

skills a leader of improvement may need.

It will help you to be familiar with the different aspects of improvementdescribed in the three groups of Improvement Leaders Guides:

General improvement skills: introducing a range of basic improvement adviceto help you and your colleagues begin to build and learn from improvementin your everyday work

Process and systems thinking: based on the industrial models of processes,systems and flow

Personal and organisational: focusing on the people and culture that make up

an organisation and the impact on improvement. This group is about thepeople side of change

Contents

1. What is leadership? 3

2. Is leading improvement different? 5

3. The challenges of leading improvement 8

4. Knowledge and skills of improvement 10

5. Creating a shared vision 12

6. Aligning improvement with the vision 14

7. Building a more receptive context for 16improvement

8. Engaging clinical colleagues 18

9. Encourage and support communities of 20

practice for improvement

10. Lessons and experiences from leaders 22of improvement

11. Activities 24


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2. Is leading improvement different?

The Leading Modernisation framework was developed as a theoretical modelfor a national programme. It was derived from research that examined the

knowledge, skills and capabilities leaders need in order to achieve the mostrelevant and sustainable improvements. It has three parts: care delivery systems: the practical realities and future possibilities of how

care is experienced by professionals, patients and the public

leadership: the art of getting things done through others improvement: the study and practice of enhancing the performance of

processes and systems at work

This model says that a leader of improvement needs to not only be a goodleader but also to excel in delivering excellent care or enable others to do so

and promote and support improvement. A leader of improvement needs towork at the intersection of these three domains.

PoliticalAstuteness

SettingDirection

Deliveringthe service

Intellectualflexibility

Holding toaccount

BroadScanning

Effective andstrategic

influencing

EmpoweringOthers

Drive forresults

Seizingthe future

Collaborativeworking

Leading changethrough people

PersonalQualities

Self-beliefSelf-awareness

Self-managementDrive for improvement

Personal integrity

NHS Leadership Qualities framework

Care deliverysystems

Leadership Improvement

Focus of the Leading

Modernisation Programme

Developed for the Leading Modernisation Programme by Paul Plsek

Leadership Qualities Framework

The key characteristics, attitudes and behaviours expected of leaders in the NHSnow and in the future have been pulled together in the NHS leadership

qualities framework. It describes fifteen qualities, arranged around threeclusters: personal qualities, setting direction and delivering the service. You canuse this framework to review your own general leadership abilities, with yourteam or colleagues to establish leadership capability and capacity. You can also

use it to focus for personal development, board development, leadershipprofiling for recruitment and selection, career mapping and succession planning

You can find this framework in full on www.nhsleadershipqualities.nhs.uk


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6. Aligning improvement with the vision

Focusing improvement activity around strategic goals

Improvement wont happen withoutthe energy and enthusiasm of

frontline staff. We know that.Yet, if the maximum benefit is to besecured at the system level, these

energies need to be aligned with thewider communitys strategic aims.

Individual teams are not always bestplaced to set their work in this widercontext. So improvement leaders have

a responsibility to supportimprovement activity as well as theoperational priorities and the strategic

goals of the system.

You may find that working together

and using this matrix is in itselfbeneficial. Within this framework,individual departments, services ororganisations can pursue their own

priorities whilst seeking whole systemssolutions and collaboration toproblems and issues to support the

delivery of seamless care.

14

Case studySuggested simple rules for improvementdevelopment in an SHA in London

really listen to the voice of the patients establish a sense of urgency form powerful coalitions

create a clear and widely understood vision communicate with passion empower others to act on the vision

plan to create short-term improvement and promote what has worked consolidate improvement and produce still more changes institutionalise new approaches

understand how we learn

Strategic aimsDevelop transformational aims that

connect with the values that brought

people into health and social care in the

first place

Measurable goalsDevelop system level, measurable goals

that track progress against

these aims

National targetsShow how externally set targets sit within

the context of the strategic aims to build

ownership to delivery

Improvement workAssess current improvement work against

the system level goals to ensure that effort

is focused in areas of greatest priority

Adapted from Jim Reinerstein and the work of Pursuing PerfectionAdapted from Jim Reinerstein and the work of Pursuing Perfection


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Care Delivery System

4. Stakeholder participation(whole system)

1 Uni-organisational/professional group2 Stakeholders identified3 Stakeholders positively

encouraged to participate4 Stakeholders briefed and

understand the system5 Stakeholders regularly involved

in meetings6 Constructive relationship with

stakeholders involved in actions todeliver project/programme

7 Building on existing relationships,stakeholders take lead on one ormore work strands

5. Clinical Leadership

1 No clinicians involved2 Name(s) identified3 Have attended one meeting4 Attends meetings regularly5 Contributes to project work6 Leads strands of work7 Actively leading and visible with

clinical and non-clinical interfaces

6. Interrelationship with otherstrands of service improvement

recognised and synchronised

1 Overview not considered2 No obvious overlaps3 Potential overlaps recognised4 Overlaps recognised and flagged5 Interface between overlaps

quantified and understood6 Potential for joint work

assessed and agreed

7 Integrated approach evidentand operational

1Low

7High

1Low

7High

1Low

7High

Improvement

7. Involving service users,carers and patients

1 None/no attempt2 Positive decision made to

involve representatives3 Demonstrable action in hand to

identify users etc.4 Pre-briefing and support given5 Occasional involvement as required6 Regular reference type involvement

7 Full participative involvement inwhole project/programme

8. Matching the understandingof the challenge to appropriatemethod of redesign

1 Not considered or discussed2 Discussed, considered not relevant3 Challenge is understood

(including history)4 There is an agreed course of action5 There is full consensus on way ahead6 Redesign lead has skills to match

challenge with method7 Nature of the challenge, relevant approach

and project lead all in place and agreed

9. Clear timely measurablereported outcomes

1 None2 Programme/project has

identified outcomes3 Outcomes reflect the aims4 Outcomes are agreed5 Measures are clear and timely6 Information is available7 Information is collected and reported

against outcome measures atregular intervals

1Low

7High

1Low

7High

1Low

7High


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The Improvement Leaders Guides have been organised into three groups:

General improvement skillsProcess and systems thinkingPersonal and organisational development

Each group of guides will give you a range of ideas, tools and techniques foryou to choose according to what is best for you, your patients and your

organisation. However, they have been designed to be complementary and willbe most effective if used collectively, giving you a set of principles for creatingthe best conditions for improvement in health and social care.

The development of this guide for Improvement Leaders has been a trulycollaborative process. We would like to thank everyone who has contributed by

sharing their experiences, knowledge and case studies.

Design TeamJo Bibby, Sarah Garrett, Cathy Green, Catherine Hannaway, Judy Hargadon,

Elaine Latham, Lynne Maher, Mike McBride, Annette Neath, Jean Penny,Christina Pond, Hugh Rogers, Jonathan Stead. Also all those who haveparticipated in the work of the Pursuing Perfection Programme and Research

into Practice.

To download the PDFs of the guides go to www.modern.nhs.uk/improvementguides

We have taken all reasonable steps to identify the source of information and ideas.

If you feel that anything is wrong or would like to make comments please contact us at

[email protected]

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Leading Improvement