Developing People –
Improving Care
A national framework for action on
improvement and leadership development
in NHS-funded services
National Improvement and Leadership Development Board
Contents Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services
1
Contents
Summary ........................................................................ 2
Views from the service ....................................................... 4
1. Explaining the framework ................................................ 6
Overview ......................................................................... 6
1.1 Background to the framework ............................................. 6
1.2 Why this framework is a priority ........................................... 7
1.3 Changing demands create people development needs ................. 8
1.4 An adaptive framework for action ........................................ 9
1.5 Actions and resources .................................................... 10
1.6 What’s new? .............................................................. 12
1.7 Tracking and evaluating progress ........................................ 13
2. The framework in graphics ............................................. 14
Diagram 1: The framework ................................................... 15
Diagram 2: Proposed actions – driver diagram view ....................... 16
Diagram 3: Proposed actions – circular view ................................ 17
3. Conditions and proposed actions ..................................... 18
Condition 1: Leaders equipped to develop high quality local
health and care systems in partnership
...................................... 18
Condition 2: Compassionate, inclusive and effective
leaders at all levels
............................................................ 20
Condition 3: Knowledge of improvement methods and how
to use them at all levels
....................................................... 28
Condition 4: Support systems for learning at local, regional
and national levels
............................................................ 32
Condition 5: Enabling, supportive and aligned regulation
and oversight
.................................................................. 34
Annex 1: Bibliography ...................................................... 39
Annex 2: Stakeholders ..................................................... 44
Annex 3: Glossary of terms ................................................ 45
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 2
Summary
What is this framework? It’s the first version of a national framework to
guide local, regional and national action on developing NHS-funded staff.
Its sponsors are the main national organisations with NHS responsibilities.
1
The framework applies to everyone in NHS-funded roles in all professions
and skill areas, clinical and otherwise. Future updates are expected to cover
people in social care as well.
What is the framework’s purpose? To equip and encourage people in
NHS-funded roles to deliver continuous improvement in local health and
care systems and gain pride and joy from their work. To that end, the
framework aims to guide team leaders at every level of the NHS to develop
a critical set of improvement and leadership capabilities among their staff
and themselves.
Who is this document for? This document is directed primarily at the
senior management teams of all organisations and partnerships responsible
for NHS-funded activity. The idea is to release regular updates, improved by
feedback from teams using the framework.
Why? Evidence and experience from high performing health and care
systems shows that having these capabilities enables teams to continuously
improve population health, patient care, and value for money. Developing
these capabilities and giving people the time and support required to see
them bear fruit is a reliable strategy for closing the three gaps identified in
the NHS Five Year Forward View.
What are the critical capabilities to develop?
Systems leadership skills for leaders improving local health and care
systems, whether through sustainability and transformation plans,
vanguards, or other new care models. These skills help leaders to build
trusting relationships, agree shared system goals and collaborate across
organisational and professional boundaries.
Improvement skills for staff at all levels. Chief executives of the
majority of provider trusts rated ‘outstanding’ by the Care Quality
Commission credit established quality improvement (QI) methods
2
for
improvement in their operational performance, staff satisfaction and
quality outcomes.
Compassionate, inclusive leadership skills for leaders at all levels.
Compassionate leadership means paying close attention to all the
people you lead, understanding the situations they face, responding
empathetically and taking thoughtful and appropriate action to help.
Inclusive leadership means progressing equality, valuing diversity and
challenging power imbalances. These leadership behaviours create just,
1 Department of Health, NHS Improvement, Health Education England, NHS England, NHS Leadership Academy, National Institute for Health and Care Excellence, Public Health England and the Care Quality
Commission, with input from the Local Government Association, Skills for Care, NHS Providers, NHS Clinical Commissioners and NHS Confederation.
2 Established QI approaches include Total Quality Management (TQM), Model for Improvement, Statistical Process Control, Six Sigma, Lean, Experienced-based Co-design, Theory of Constraints, and
Business Process Re-engineering. www.health.org.uk/sites/health/files/QualityImprovementMadeSimple.pdf
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 3
learning cultures where improvement methods can engage colleagues,
patients and carers, deliver cumulative performance improvements, and
make health and care organisations great places to work.
Talent management to fill current senior vacancies and future
leadership pipelines with the right numbers of diverse, appropriately
developed people.
What’s the next step? All leadership teams (boards of national
organisations included) to review their people development strategies and
revise priorities and budgets to target building these capabilities for their
staff and themselves.
Is there any new money? In today’s climate, there won’t be much
new funding for this. But a lot of money is currently invested in people
development across the NHS. The challenge is to maximise the impact of
that investment on care for individuals, population health and value for
money.
Where will the support come from? A lot can be done in-house if
leadership teams can devote more of their time and attention to people
development, working with existing organisational development teams
and networks. In addition, NHS functions that provide such support
are extending their offer to support action in line with the framework.
See Section 3 for details.
Will regulators and inspectors back the framework? Yes. We’re
changing the rules and how we oversee them to back it up (see Section 3,
Condition 5 for details). But we understand there may be scepticism about
our ability to demonstrate the compassionate leadership called for by the
framework. To show our conviction, we’re making three pledges. Please
hold us to account for keeping them:
We will model in all our dealings with the service and in our own
organisations the inclusive, compassionate leadership and attention to
people development that establish continuous improvement cultures.
We will support local decision-makers through collectively reshaping
the regulatory and oversight environment. In particular, we owe local
organisations and systems time and space to establish continuous
improvement cultures.
We will use the framework as a guide when we do anything at
a national level concerning leadership, improvement and talent
management so we engage across the service with one voice.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 4
Views from the service
Perspectives from across the service on the importance of leadership and improvement
Shahnaz Aziz
Patient and Public Leadership Lead
East Midlands Academic Health Science Network
An inclusive NHS requires strong and sustained commitment
from the top and throughout our NHS systems. It must go
beyond paying lip service to adopting positive action approaches
which embrace, develop and empower diverse views and ideas. It must unlock
talent and innovations from staff at all levels and involve patients and citizens.
Dr Rebecca Hewitson
Paediatric Registrar
North Middlesex University Hospital NHS Trust
Leadership doesn’t come from a job title, it comes from a frame
of mind. Giving support to patients, families and staff members
who want to lead positive changes within healthcare can have
inspiring results. For me, continual improvement is about being open-minded,
having humility and not forgetting to celebrate and learn from excellence.
Valerie Freestone
Specialist Clinical Dementia Nurse
Cambridge University Hospitals NHS Foundation Trust
I have worked with some incredible leaders in my time with the
NHS, from ward managers and team leaders during my training,
who taught me that leadership was less about hierarchy and
more about team work, to more recent leaders who taught me to believe that
I can be more than I think I can.
Rebecca McGheehan
Matron, Inpatient Cancer Services
Sheffield Teaching Hospitals NHS Foundation Trust
Leadership and improvement ensure we constantly provide the
best quality care and treatment to our patients. Change one
small thing every day and in a week you will have made a bigger
change: imagine what you could change in a year.
Dr Gilbert Ozuzu
Lead Clinician and Consultant Eye Surgeon
University Hospitals of Morecambe Bay NHS Foundation Trust
I am passionate about good leadership because it leads to safe
and good quality care for patients. Here in Morecambe Bay we
have seen how good leadership can transform an organisation
from low to high performance. We have witnessed a change in culture resulting
from a leadership style that is inclusive, humble, open and engaging. Inclusive
leadership is not just about fairness and equity. It is about getting the best out
of ALL our staff for the benefit of ALL our patients.
Ruth Speare
Speciality Trainee in Public Health
Yorkshire and Humber
I view leadership as an enabling role, giving others the
confidence and permission to innovate and develop. Individual,
small-scale changes to improve the health of the public can add
up to have a significant impact across a city or region. Effective leadership has
to be collaborative and inclusive, not organisationally partisan, to focus on
population need across the whole health and social care system.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 5
Perspectives from across the service on the importance of leadership and improvement
Ian Perry
Leadership and Management Development Lead
The Orders of St John Care Trust
We’re encouraging and supporting our leaders at all levels to
have a different kind of dialogue with teams and colleagues,
to have more appreciative and coaching conversations, to raise
their awareness of their own leadership style and increase their confidence to
challenge and innovate. Leadership, whether as a carer, an autonomous nurse,
care leader, home manager, or in a support or senior management role, is vitally
important to making the trust a great place to live and work.
Dr Jeremy Rushmer
Consultant in ICM and Medical Director
Northumbria Healthcare NHS Foundation Trust
Looking back now, 16 years after I nervously stuck my head over
the parapet as a young consultant and aspiring Clinical Director
who wanted to make a difference, I feel lucky to have done
that in an organisation that wanted to develop me, challenge me and take me
places I’d never been before (literally and metaphorically) with a cohort of like-
minded colleagues who currently make a very effective team. I’m now enjoying
talent spotting and developing my replacements.
Hein Scheffer
Director of Workforce
Herts Valleys CCG
Leadership is about inspiring others to be the best they can be.
This is not achieved through fear, but through support, learning
and clarity of direction.
Keeley Sheldon
General Manager for Adults
Nottinghamshire Healthcare NHS Foundation Trust
Learning about service improvement techniques has given me
the confidence to transform the way we deliver our services.
The techniques have had a positive impact on patient care and
experience, and on the productivity and efficiency of the service models.
Dr Yuvraj Pattni
GP Registrar
London Deanery
Leadership and improvement is already part and parcel of
being a clinician in the NHS today and, increasingly, the NHS of
tomorrow. To drive improvement we need good leadership at
every level within our organisations, not just at the top. If we refuse to accept
leadership as our responsibility too, then we risk failing to do what is right not
just for our patients but for the wider community.
Mark Rogers
Chief Executive and STP Lead
Birmingham City Council and Birmingham and Solihull STP
Great leadership has four facets: exhibiting empathy or being
willing and able to see things from others’ perspectives; building
a common purpose, and developing teams and teamwork
accordingly; encouraging “followship” or empowering others to rise to
opportunities and challenges and to share in the leadership; but above all, the
best leaders in class show humility and courage. When all these facets coalesce,
improvement will be secured and sustained.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 6
1. Explaining the framework
Overview
This document presents the first version of an evidence-based national
framework to guide action on improvement skill-building, leadership
development and talent management in NHS-funded services. The purpose
of the framework is to equip and encourage people in NHS-funded roles
to deliver continuous improvement in local health and care systems and
gain pride and joy from their work. The framework applies to everyone in
NHS-funded roles in all professions and skill areas, clinical and otherwise.
The document is directed primarily at the senior management teams of all
organisations and systems that do NHS-funded work – from the smallest
GP partnerships to the largest national organisations – to inform their
decisions on developing people. It will be updated regularly, using feedback
from people testing the framework.
1.1 Background to the framework
Across England, people in local health and care organisations are
working in partnership to dissolve barriers between primary care
services and hospitals, between physical and mental health, and
between health and social care.
1
Currently through sustainability and
transformation plans (STPs), they are striving to build local health
and care systems where people put the shared aims of improving
care for individuals, improving population health and well-being, and
improving value for money before organisational interests.
These complex tasks place new demands on the leadership, skills
and morale of the 1.5 million people
2
who do NHS-funded work in
already demanding circumstances. On top of mounting patient need
and continued funding constraints, they are being asked to take
on big changes in the way they work. ‘Here and now’ pressures on
leaders leave little time for them to reflect on their leadership and
how best to lead change. Partly for these reasons, the number of
senior health service vacancies remains high and candidates scarce.
3
As representatives of national health and care organisations, we
have been listening to people across local health and care systems
to understand these new demands and the changes in development
and support that people need. We are learning from examples of
inspiring people development in health and care around the United
Kingdom and from extensive existing research and expertise in
developing high quality health and care systems.
4
This document presents the result: a framework for action on
skill-building in improvement, leadership development and
1 Five Year Forward View www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf
2 Source: NHS choices
3 An estimated 10% for NHS providers and 2% for CCGs. Source: NHS snapshot surveys of provider trusts (January 2016) and CCGs (March 2016)
4 To avoid overloading this document with references, key evidence and research informing the framework is referenced in the bibliography.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 7
talent management at local, regional and national levels.
5
The
purpose of the framework is to equip and encourage people in
NHS-funded roles to deliver continuous improvement in local
health and care systems and gain pride and joy from their work.
The framework and initial actions proposed here are designed to
be adapted and improved, in the spirit of continuous learning and
quality improvement methods.
6
We intend to iterate the framework
and actions in short cycles, reflecting the feedback, measurements
and suggestions we receive, for as long as it takes to build cultures
of continuous improvement in all NHS-funded services.
The framework applies to everyone doing NHS-funded work in
all professions or skill areas, clinical and otherwise, and wherever
they work in the service. It covers people working in public health,
primary care, mental health, community, ambulance and acute
services, as well as in clinical commissioning groups (CCGs), other
commissioners, and regulatory and oversight groups. For the
moment, proposed actions involving NHS resources necessarily focus
on NHS staff. But we recognise that NHS and social care colleagues
work increasingly closely and fruitfully in partnership, with each
other and with their patients and service users. The NHS has much
to learn from local authorities’ and care organisations’ experience of
developing leaders and improving services under financial pressure.
We expect future iterations of the framework to be able to address
health and social care staff jointly and reflect more of this experience.
1.2 Why this framework is a priority
The framework emphasises compassionate and inclusive leadership.
This means paying close attention to all the people you lead,
understanding in detail the situations they face, responding
empathetically and taking thoughtful and appropriate action to
help. It means progressing equality, valuing diversity and challenging
existing power imbalances. This may sound a curiously ‘soft’ and
timeless leadership approach to prioritise when health and care
services face unprecedented, urgent pressures. But compassionate
and inclusive leadership is embedded in high quality, high performing
systems because it is the right way to behave evidence shows it is
also the right way to unleash people’s full potential to improve care
working with patients and service users, improve population health
and well-being, and improve value for money.
Taking action in line with the framework is therefore a reliable
strategy for closing the three gaps identified in the NHS Five Year
Forward View. This makes action in line with the framework a priority
for all health and care system decision-makers. It may be a long,
tough journey for some, given limited resources and competing
demands for investment. But there are many examples to learn from
5 Developing strategies on these issues was recommended by the 2015 Smith review of centrally-funded improvement and leadership development functions www.england.nhs.uk/wp-content/
uploads/2015/09/improv-ldrshp-dev-rev-sept15.pdf. Lord Rose’s 2015 review Better Leadership for Tomorrow also made recommendations on NHS leadership covered in this framework
www.england.nhs.uk/wp-content/uploads/2015/09/improv-ldrshp-dev-rev-sept15.pdf
6 Explained in ‘Quality Improvement Made Simple’ from the Health Foundation. Established quality improvement approaches include Total Quality Management (TQM), Model for Improvement (including
Plan Do Study Act or PDSA), Statistical Process Control, Six Sigma, Lean, Experienced-based Co-design, Theory of Constraints, and Business Process Re-engineering. See www.health.org.uk/sites/health/
files/QualityImprovementMadeSimple.pdf
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 8
where people are making rapid progress in difficult circumstances.
Moreover, returns to investment in line with the framework will
be cumulative and measurable in terms of better outcomes for
patients, improving health and well-being in the local community,
more productive use of resources and greater staff engagement
and satisfaction.
Acting in line with the framework is a priority for all of us in the
national organisations. We have tried to model compassionate
leadership in developing the framework but we know we have
much further to go. Effective quality management requires a balance
between quality planning, improvement and control.
7
We recognise
the national organisations could do more to support improvement.
Many of the support systems for leaders that used to exist are no
longer there. We are committed to rebalancing our approach to give
more support to health and care leaders planning and improving
their local systems.
1.3 Changing demands create people development needs
As well as collaborating with local partners to develop local health
and care systems, health organisations are again making greater use
of quality improvement methods introduced to the NHS from other
sectors. They are also carrying out recommendations made in recent
reviews of NHS leadership,
8
organisational form
9
and productivity
and efficiency.
10
All these initiatives are creating specific people
development needs.
Leaders of organisations need system leadership skills to build the
local health and care systems of tomorrow. They need to build
trusting relationships with peers to work on STPs, lead collaborative
change management and manage the inevitable conflicts between
organisations competing for public resources, both money and
people.
Much is expected of CCGs and primary care providers in building
future systems. Primary care, community and voluntary service
leadership is central to the joined up local health and care systems
of tomorrow. Radical innovation with entrepreneurial leadership in
primary care in particular has immense potential to improve value
for patients and taxpayers. New primary care structures provide
an opportunity to develop leaders with the skills to influence and
change system thinking beyond the constraints of organisational
boundaries. Yet implementing wide-ranging changes to care, teams
and organisations presents an unprecedented leadership challenge
for commissioners and primary care providers. There has never been
a greater need to develop improvement and leadership capabilities in
these areas.
Successful reshaping of local health systems depends heavily on
the leadership of clinicians, working with partners in social care.
7 See the Juran Triangle http://www.juran.com/elifeline/elifefiles/2009/09/Juran-Trilogy-Model.doc
8 The Rose Review www.gov.uk/government/uploads/system/uploads/attachment_data/file/445738/Lord_Rose_NHS_Report_acc.pdf
9 The Dalton Review www.gov.uk/government/uploads/system/uploads/attachment_data/file/384126/Dalton_Review.pdf
10 The Carter Review www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 9
But clinicians are rarely trained in the major change management
skills they need for the task. Moreover, they get little career
support for challenging perceived boundaries between clinical and
management roles. Consequently the systems leadership roles where
clinicians can make such a big difference may not appear to them as
attractive or feasible career opportunities.
Many more people working in health and care services want to
learn improvement methods and how to use them in partnership
with patients, families and carers. Not only do these methods
deliver results in terms of quality and value for money, they also
have tremendous power to engage, energise and motivate staff
by recognising their individual and collective strengths and trusting
them to work with patients and communities to make health and
care systems better. However, these methods only deliver results
from teams led by people skilled in compassionate and inclusive
leadership, one reason this framework addresses leadership
development and improvement together. More leaders with these
qualities are needed at every level of health and care. Compassionate
and inclusive behaviours are the key to creating cultures that engage
and support all staff and teams, so that continuous improvement in
performance becomes the norm.
Meeting these large-scale development needs is a huge new
challenge for those responsible for system and organisation
development (OD) in health and care services. For all the reasons
above, people equipped with system leadership strengths,
compassionate and inclusive leadership qualities and improvement
leadership skills are at a premium in the NHS today. However, those
suitably equipped are not always deployed to best effect. Altogether
there is little systematic management of talent – that is, procedures
for attracting, identifying, developing, appointing and supporting
potential and existing leaders – across NHS-funded organisations and
between local, regional and national levels.
Developing the leadership capabilities needed to achieve greater
equality, diversity and inclusion at all levels is a further urgent need
across NHS-funded activities. The talents of many staff who differ
from the majority of leaders in race, gender, or other characteristics
are frequently overlooked. As a result, the pool of people equipped
to lead continuously improving teams, organisations and systems
is neither big enough nor diverse enough to fill critical leadership
roles. As noted above, inclusive leadership is not only right but
essential to making the most of resources available to local health
and care systems.
1.4 An adaptive framework for action
This situation calls for thoughtful action to build skills, develop
current and future leaders and manage talent. The framework we
propose for guiding such action is based on evidence and experience
from high quality health and care systems. It identifies five conditions
common to high quality systems that interact to produce a culture of
continuous learning and improvement. We then propose actions to
drive these five conditions in local, regional and national health and
care systems across England. The actions will help to meet today’s
pressing people development needs.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 10
The five conditions are:
1. Leaders equipped to develop high quality local health and
care systems in partnership. Leaders of organisations in local
health and care systems are able to collaborate with partners
including patient leaders across organisational, professional and
geographical boundaries in trusting relationships to achieve the
same clear, shared system goals for their communities.
2. Compassionate, inclusive and effective leaders at all
levels. Leaders demonstrate inclusion and compassion in all
their interactions. They develop their own and their staff’s
skills and capacity to improve health services. They also have
the specific management skills they need to meet today’s
challenges. Leadership is collective, in the sense that everyone
feels responsible for making their bit of the system work better.
Leadership development and talent management systems are
sufficiently inclusive and organised to make the pool of people
equipped to lead continuously improving teams big enough and
diverse enough to fill critical leadership roles. Leadership at every
level of the system truly reflects the talents and diversity of people
working in the system and the communities they serve.
3. Knowledge of improvement methods and how to use them
at all levels. Individuals and teams at every level know established
improvement methods and are using them in partnership
with patients, communities and citizens to improve their work
processes and systems. There are enough people able to lead
improvement project teams to release the full benefits of this
knowledge.
11
4. Support systems for learning at local, regional and national
levels. There is sufficient training, coaching and organisation
development capacity to meet development needs and support
learning and improvement. Data and knowledge-sharing systems
to support improvement and leadership development are in place
and there are networks for sharing improvement knowledge and
experience locally, regionally and nationally.
5. Enabling, supportive and aligned regulation and oversight.
The regulation and oversight system gives local organisations and
systems control of driving learning and improvement. At the same
time, national organisations help local systems find the support
and resources they need. The constituent parts of the regulation
and oversight system behave consistently and ‘speak with one
voice’.
1.5 Actions and resources
Action is needed at every level of health and care systems in England
to develop the leaders and skills that will protect and improve
services in the short term and for the next 20 years. Resources are
tight, but building continuous improvement capability is a priority.
11 For case studies showing how five NHS foundation trusts built quality improvement capability at scale within their organisations, see the Health Foundation’s Building the foundations for improvement
at www.health.org.uk/publication/building-foundations-improvement
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 11
1.5.1 Actions
To create conditions 1, 2 and 3 of the framework, all of us in teams
directing NHS-funded work – from partners in the smallest general
practice to boards of the largest national organisation – need to
review our people development strategies and revise priorities,
systems and budgets to target:
building improvement skills among all our people
developing current and future leaders with the
compassionate, inclusive leadership qualities, improvement
leadership skills and system leadership strengths as well as the
specific management skills they need to meet today’s challenges.
managing talent to fill future leadership pipelines with the right
numbers of diverse, appropriately developed people.
In short, the framework is a call to leadership teams to prioritise
building the capacity and capability for organisational development
in organisations and systems. We can do a lot of this ourselves by
devoting more time and attention to developing people, working
with our existing organisational development teams and networks.
For instance, senior managers report having gained 70% of their
development from experience on the job in different roles. So future
leaders can be substantially developed by expressly managing the
variety and content of their roles as their careers progress.
That said, many organisations and systems will be looking for
support in reshaping their people development activities. The
nationally funded NHS functions that provide such support have
been closely involved in the work behind this framework. They are
tailoring and extending their offer to meet the support needs of local
organisations and systems (Condition 4). The national organisations
shaping the oversight and regulatory environment are also taking
action to align this environment with the conditions that drive
continuous improvement (Condition 5). Section 3 gives more detail
on the five conditions and actions proposed to help achieve them,
including who is proposing to do what by when.
1.5.2 Resources
Given the current constraints on resources, new funding to support
these actions will be hard to find. However, across NHS-funded
organisations a considerable amount is currently invested in people
development. The challenge is to maximise the impact of that
investment on creating continuous improvement capability.
For the national organisations involved, this means revisiting and
reallocating some current spending as well as finding new resources
wherever we can. For local organisations, we know prioritising
investment in people will be hard in this period of extreme financial
pressure. On the other hand, engaging people and developing
their capability for continuous improvement is the surest way to
meet today’s pressures and sustain success. And where people
development is concerned, time, senior attention and imagination
are often the critical resources. Across the country we need to share
ideas and experience and learn from each other how to maximise the
return on our investment in people.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 12
1.6 What’s new?
Many will remember the push to disseminate improvement skills
across the NHS in the early 2000s. It helped to achieve some great
results but didn’t gain sufficient national momentum and many
considered it overly centralised. There have been earlier central
initiatives to promote leadership development too.
This framework aims to be different, in response to what people
working in the service are asking for. It depends on local decision-
makers taking local actions, supported by national and other NHS-
funded organisations. The STP team members and the boards,
management teams and accountable officers of local NHS providers
and commissioners will take the decisions that really make it happen.
Sharing ideas for improvement, leadership development and talent
management with each other will drive progress. The job of the
national organisations is to help, not to direct.
The framework’s ultimate potential rests on the extraordinary
commitment of individuals working in health and care to caring
for patients and service users – the reason most people join the
NHS and social care services. Its impact will come from equipping,
empowering and trusting people to fulfil that mission and celebrating
their success.
We know that everyone in health and care services must be able to
count on people in the national organisations to act consistently in
line with the framework. To this end, we make three pledges:
1. We will model in all our dealings with the service and in our
own organisations the inclusive, compassionate leadership and
attention to people development that establish continuous
improvement cultures.
2. We will support local decision-makers through collectively
reshaping the regulatory and oversight environment. In particular,
we owe local organisations and systems time and space to
establish continuous improvement cultures.
3. We will use the framework as a guide when we do anything at
a national level concerning leadership, improvement and talent
management so we engage across the service with one voice.
We recognise that honouring these pledges means big changes
in how we behave. We understand the biggest risk facing the
framework is scepticism about the gap between the compassionate
leadership it advocates and the experience of many of you in your
interactions with us. We know some of these changes will take time.
But we ask you to hold us to account for getting better. Please let us
know how we are doing and where we could improve.
We understand the scale of the challenge that significant system
redesign and service reconfiguration will present to local leaders
for the next few years. We are committed to helping every part of
England create productive coalitions for change in health and care
systems, and supporting rapid service redesign in primary care.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 13
1.7 Tracking and evaluating progress
People responsible for actions in line with the National Improvement
and Leadership Development (NILD) framework at local, regional or
national levels will need to track the impact of those actions, evaluate
them and adjust them accordingly.
The first part of the framework’s purpose is to build across the service
the capability ‘to deliver continuous improvement in local health and
care systems’. Performance data already collected and reported will
help track the impact of framework actions against this goal. Local
organisations and systems can expect the impact of actions to show
up in, for example, changes in A&E waiting times and referral to
treatment times, in their financial performance against organisation
and system control totals, and in their metrics monitoring health
outcomes and care redesign.
12
The impact of local actions will show
up in changes in aggregate system performance data.
The second part of the framework’s purpose is ‘to equip and
encourage people in NHS-funded roles to consistently gain pride and
joy from their work’. The results of existing patient experience and
staff engagement surveys, measures of discrimination and inclusion
and other barometers of morale that are already in place will largely
track the progress of action in line with the framework against this
critical goal. Therefore tracking the impact of actions in line with the
framework should not add to the service’s current burden of data
collection and reporting.
The national organisations are committed to tracking implementation
of the actions we have taken responsibility for in this first version of
the framework. The NILD board will hold us to account for carrying
them out.
Evaluating actions and adjusting them will require more reflection,
in particular to understand the extent to which any improvements
in quantitative and qualitative performance data from organisations
and systems result from actions in line with the framework. We are
asking for advice on how to do this from specialists in this area and
will share it across the service. Even more important to building this
understanding will be rapidly sharing learning within and between
organisations and systems about what is and isn’t working. We
will incorporate this learning in future iterations of the framework
(another reason for making the framework iterative) so the actions
that people experience as having the biggest impact on the ground
can be more easily spread across the sector.
12 Source: core baseline STP metrics listed in NHS Planning Guidance 2016/17.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
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Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 14
2. The framework in graphics
The three diagrams that follow illustrate how the elements of high
performing health and care systems fit together to make them capable
of continuous improvement. The diagrams aim to help teams and
organisations to identify how their particular initiatives contribute to
achieving that aim. The information in the diagrams is drawn from
evidence and experience of high performing health and care systems.
Diagram 1 (The framework) is a driver diagram of the kind used in
improvement projects. It shows the five conditions as the primary drivers
of the framework’s aim – continuous improvement in care for people,
population health and value for money. The secondary drivers are the
main components of each condition.
Diagram 2 (Proposed actions – driver diagram view) and Diagram 3
(Proposed actions – circular view) summarise the actions proposed in this
first iteration of the framework that together will strengthen and further
develop the secondary drivers of the five conditions.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 15
Support systems for
learning at local, regional
and national levels
Overall aim of the
framework
The five conditions
(Primary drivers)
Secondary drivers
A joint ambition: clear aims for health and healthcare
Positive relationships and trust in place at all levels
Governance structures to enable local decision-making
Knowledge and practice of compassionate, inclusive high impact leadership behaviours
Development and support for all staff
A system and approaches for attracting, identifying and deploying the right people into the right jobs
Leadership for improvement in practice
Applied training in improvement methods (from micro-systems to system transformation)
Partnering with staff, patients and communities for improvement
Improvement and support systems in organisations
Data systems to support improvement
Systems and networks for sharing improvement work locally, regionally and nationally
Leaders equipped to develop
high quality local health and
care systems in partnership
Compassionate, inclusive
and effective leaders at
all levels
Knowledge of improvement
methods and how to use
them at all levels
Enabling, supportive
and aligned regulation
and oversight
Diagram 1: The framework
National bodies working effectively together
Local systems and providers in control of, and accountable for, driving improvement
Helpful interventions and support offers from the national bodies to local systems
C
U
L
T
U
R
E
Continuous
improvement
in care for
people,
population
health and value
for money
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 16
Support systems for
learning at local, regional
and national levels
Overall aim of the
framework
The five conditions Proposed actions
Leaders equipped to develop
high quality local health and
care systems in partnership
Compassionate, inclusive
and effective leaders at
all levels
Knowledge of improvement
methods and how to use
them at all levels
Enabling, supportive
and aligned regulation
and oversight
Diagram 2: Proposed actions – driver diagram view
3. Develop compassionate and inclusive leadership for all staff at every level
4. Embed inclusion in leadership development and talent management initiatives
5. Support organisations and systems to deliver effective talent management
6. Improve senior level recruitment and support across NHS-funded services
9. Ensure easy access to improvement and leadership development resources
10. Support peer-to-peer learning and exchange of ideas
11. Create a consistent supportive regulation and oversight approach
12. Streamline and automate requests for information
13. Balance measurement for improvement and judgement
7. Build improvement capability among providers, commissioners, patients and communities
8. Embed improvement and leadership development in curricula, revalidation and award schemes
1. Support development of system leadership capability and capacity
2. Develop and implement strategies for leadership and talent development
C
U
L
T
U
R
E
Continuous
improvement
in care for
people,
population
health and value
for money
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 17
Diagram 3: Proposed actions –
circular view
Continuous
improvement in
care for people,
population health
and value for
money
Enabling,
supportive and
aligned regulation
and oversight
Compassionate,
inclusive and
effective leaders
at all levels
Leaders equipped
to develop high
quality local health
and care systems
in partnership
Support systems
for learning at local,
regional and
national levels
Knowledge
of improvement
methods and
how to use them
at all levels
1. Support development
of system
leadership capability
and capacity
2. Develop and implement
strategies for
leadership and talent
development
4. Embed inclusion in
leadership development
and talent management
initiatives
6. Improve senior
level recruitment
and support across
NHS-funded services
5. Support organisations
and systems to
deliver effective talent
management
3. Develop compassionate
and inclusive
leadership for all staff
at every level
8. Embed improvement
and leadership development
in curricula, revalidation
and award schemes
7. Build improvement
capability among providers,
commissioners, patients
and communities
9. Ensure easy access
to improvement and
leadership development
resources
10. Support peer-to-peer
learning and exchange
of ideas
13. Balance measurement
for improvement and
judgement
12. Streamline and
automate requests
for information
11. Create a consistent
supportive regulation
and oversight approach
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 18
3. Conditions and proposed actions
This section explains the conditions in more detail and lists actions
proposed at this stage to achieve each condition across the NHS-funded
workforce. As this is the first version of the document, the list of actions
is not yet complete. We know from engagement across health and care
services that there is more to be done in certain areas and much to clarify
in the next iteration, for example, on clinical leadership, time for leaders
to reflect, learning relevant to improvement,
13
and how patients’ and
service users’ knowledge and experience drive system improvement.
Feedback from and discussion with people across the service as they adopt
the framework will shape the content of future iterations (see Section 3,
proposed action 11).
Condition 1:
Leaders equipped to develop high quality
local health and care systems in partnership
The task of improving local health and care systems requires senior system
leaders to bring together a wide range of stakeholders, including patient
leaders, to agree aims and plan changes. Skills that equip them for the
task include communication, collaboration, staff engagement, conflict
management, holding challenging conversations about complex issues, and
improvement methods including measurement for improvement.
Another skill critical to making joint decisions is the ability to pull together
and interpret information from a health and care system, including
the information on outcomes that shows the impact of changes. This
information requirement puts a premium on knowing how to measure
outcomes. Systems leaders are also looking for advice on how to integrate
governance for this new collective responsibility and shared leadership.
To help them develop these skills and build trusting and stable
relationships, system leaders need opportunities to train with leaders from
different professions, sectors, levels and places. Local and national providers
of leadership development need to tailor their support to meet the critical
development needs system leaders face in a coherent and co-ordinated,
‘place-based’ approach. To speed the improvement of local health and care
systems there is also an urgent need to support and champion existing OD
teams across primary and secondary health and social care and to develop
their capacity and capability.
Proposed actions
The NHS Leadership Academy, as part of Heath Education England
(HEE), is already working with NHS Improvement, Public Health England,
NHS England and other partners to make specific systems leadership
development support available to each STP footprint. In addition, the
following actions are proposed.
13 As described in W. Edwards Deming’s system of profound knowledge www.qihub.scot.nhs.uk/quality-and-efficiency/2020-framework-for-quality-efficiency-and-value/improve/deming%E2%80%99s-
system-of-profound-knowledge.aspx
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 19
Proposed action Intended outcomes Detailed actions Responsible
1: Support
development of
system leadership
capability and
capacity
Next 12
months
System leaders and leadership teams know about and
can access coherent and co-ordinated place-based
support for developing their system leadership skills.
STP teams will have discussed this issue and include
their own systems leadership development in their
planning
Local leadership academies will advise on the support available
to individual system leaders and to sustainability and transformation
leadership teams
HEE (NHS
Leadership
Academy)
In 1–3
years
All organisations across primary and secondary health
and care have good enough OD capability to enable
effective team and inter-team working within and
between organisations across health and care systems
Local leadership academies will help senior teams to build OD
capacity and capability within their organisations and systems,
working with current OD networks. Where such networks do not yet
exist, local leadership academies will help to build them and develop
the colleagues that the networks connect
HEE (NHS
Leadership
Academy) with
all NHS funded
organisations
Local leadership academies will work with NHS England partners to
map OD capacity and capability across primary care and agree a
development plan and process
NHS England
Colleagues across primary and secondary care and
commissioning are building trusting relationships that
progress changes planned in their respective STPs
Local leadership academies will facilitate forums for leaders in
each STP area to help progress implementing their STPs, including
implementing the OD plans for their local system
HEE (NHS
Leadership
Academy), with
NHS England
and NHS
Improvement
2: Develop and
implement
strategies for
leadership
and talent
development
Next 12
months
Leadership and talent development and planning
become core strategic activities for all organisations
and local health and care systems
All NHS-funded organisations, including national organisations,
develop their own leadership and talent development strategies
to create cultures of continuous improvement, with inclusive,
compassionate leadership, delivering high quality care
All NHS funded
organisations
In 1–3
years
All organisations understand why they should make
leadership and talent development and planning core
strategic activities, and are supported in developing
high quality strategies
Support organisations and systems to develop and implement
leadership and talent development strategies. This entails
extending and linking relevant communities of practice, and particularly
encouraging clinicians and other professions to be integral to
developing the strategies
HEE with NHS
Improvement
and NHS
England
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 20
Condition 2:
Compassionate, inclusive and effective
leaders at all levels
A healthcare organisation’s culture – ‘the way we do things around here’
– shapes the behaviour of everyone in the organisation and directly affects
the quality of care they provide. Research shows the most powerful factor
influencing culture is leadership. Leaders who model compassion, inclusion
and dedication to improvement in all their interactions are the key to
creating cultures of continuous improvement in health and care.
Compassionate and inclusive leadership creates an environment where
there is no bullying, and where learning and quality improvement become
the norm. Continuous improvement depends on staff feeling safe and
empowered to apply improvement methods in partnership with patients,
families and communities. Where leaders act with compassion, staff feel
valued, engaged and enabled to show compassion themselves. They
feel obliged to speak up when something is wrong and empowered to
continuously improve.
It is widely acknowledged that what happened in Mid-Staffordshire NHS
Foundation Trust was caused by a range of factors, not least allowing
a culture of fear and poor style of leadership to take hold. Among the
recommendations of the Francis report and subsequent Berwick and
Rose reports, the need for improved leadership, leadership behaviours,
values and competencies was repeatedly highlighted. Compassionate and
inclusive leadership is embedded in high quality, high performing systems
and drives improvement in their overall performance – better outcomes for
patients, better population health and better value for money.
Achieving this condition rests on three factors:
Developing a common understanding of the knowledge and
practice of good leadership
A variety of frameworks are used across the NHS to develop, assess,
select, promote and regulate leaders and leadership, and they are often
incongruent. People across the system need to agree on ‘what good
leadership looks like’ at different levels and develop consistent descriptions,
using language common to all organisations and systems.
Ensuring lifelong learning for all staff
The leaders of health organisations are responsible for ensuring that
the individuals and teams they lead receive appropriate skills and career
development at the right time to fulfil their potential. According to
research, senior executives report their sources of key development as
learning from experience in role and on the job (70%), learning from
others, especially mentors, coaches and learning sets (20%), and formal
coursework and training (10%). At present, there are examples of excellent
leadership and career development in different areas of NHS-funded
activity, but evidence shows the offer is not consistent across the service or
throughout people’s careers. All staff need to receive regular high quality
appraisal conversations and career development opportunities. Health
organisations would benefit from greater sharing of existing good practice.
Everyone in the service, regardless of where they work in NHS-funded care,
would benefit from more consistent access to affordable and high quality
development offers, predominantly on-the-job learning, combined with
other learning support.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 21
Developing inclusive systems for managing talent
High quality health and care systems are able to attract, identify and
develop people with the potential for good leadership and to match them
to opportunities as they arise, fitting the right talent to operational needs.
Systems for matching people to roles where they can have the most impact
are essential, both within and across health and care organisations. Such
systems rest on strategic planning to make sure the supply of appropriately
developed people matches trends in demand for senior leaders and other
critical roles across the system. Planning needs to include creating the
conditions in which equality, diversity and inclusion thrive in all teams
and organisations across health and care services to speed progress
towards a truly inclusive health and care leadership. Evidence shows that
organisations with a diverse leadership perform better, with higher levels
of staff morale.
We have heard clearly that people in leadership roles often feel isolated
and insufficiently supported and valued. The ambition is to create an
inclusive system of managed talent pipelines which can effectively and cost-
efficiently identify, develop, and supply suitable candidates for vacant roles
as well as support potential leaders as their careers progress and when they
are in senior posts. Such a system will increase the diversity of background
and skill sets among candidates for each role; make it easier for people
to move around health and social care; and support the development of
leaders who can work across sectors.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 22
Proposed actions
Proposed action Intended outcomes Detailed actions Responsible
3: Develop
compassionate
and inclusive
leadership for all
staff at every level
Next 12
months
All health and care organisations have a common
understanding of ‘what good leadership looks
like’, and are using it to guide the identification,
development, assessment, appointment and support
of leaders internally and across the system
More strong candidates are ready and willing to put
themselves forward for challenging NHS leadership
roles, as national bodies make sure the regulatory
regime consistently encourages improvement and
compassionate, inclusive leadership (proposed action
11) and potential leaders in NHS-funded roles are
better developed
Work with organisations at all levels to co-design a guide for health
and care leadership for use across the system. The guide will include
what good leadership looks like (knowledge, skills, attitudes and
behaviours at different levels), how to identify talent and how to
help individuals and organisations assess and meet their leadership
development needs. Alongside this develop a consistent approach
to senior level appraisals that reinforces the values, behaviours and
practices of compassionate and inclusive leadership. This work will
be reflected in the next update of the Well-Led Framework, due in
April 2017
HEE (NHS
Leadership
Academy),
with CQC, NHS
Improvement,
NHS England
and Skills for
Care
Develop the role of local leadership academies (LLAs) to enable,
promote and improve leadership development delivered locally
(in-organisations). LLAs will support local organisations in co-designing
and delivering high quality leadership development, signpost them
to assured development providers, and kite-mark in-organisation
leadership development activities. Local leadership development
support will focus on teams, leaders of teams and emerging
clinical leaders
HEE (NHS
Leadership
Academy)
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 23
Proposed action Intended outcomes Detailed actions Responsible
3: Develop
compassionate
and inclusive
leadership for all
staff at every level
In 1–3
years
Greater national consistency and quality in leadership
development, as well as better local support for
leadership development and talent management,
results in:
a bigger pool of current and future leaders with
the knowledge, skills, attitudes and behaviours to
create cultures of continuous improvement
improved staff engagement and reduced levels
of discrimination and bullying (evidenced in staff
survey results)
a bigger pool of aspiring senior leaders including
clinical leaders, a higher number of qualified
candidates per leadership vacancy, and fewer such
vacancies
In collaboration with local and national partners, review and revise
the design and delivery of development for senior and mid-level
leaders across the system, especially in primary care. Ensure national
consistency and quality in leadership development for aspiring directors
and above, in line with enhanced talent management. Development
for senior leaders to be designed and delivered nationally; development
for mid-level leaders aspiring to senior roles to be designed nationally
and delivered regionally
HEE (NHS
Leadership
Academy)
Ensure digital access to open source resources and tools on
compassionate and inclusive leadership across health and care
HEE (NHS
Leadership
Academy)
with NHS
Improvement
and NHS
England
A bigger pool of high potential leaders with the
knowledge, skills, attitudes and habits to be
compassionate, inclusive leaders and the skills and
experience to work across health and care, and who
receive improved career support
Work with health and social care colleagues to develop a joint
graduate management training scheme, in addition to the NHS
graduate management training scheme, that is appropriate to the
future landscape of health and care
HEE (NHS
Leadership
Academy)/Skills
for Care
Double the size of the NHS graduate management training
scheme by 2020 and provide more continuing career support for all
trainees and training scheme alumni. Evaluate training schemes tailored
to specific entrants as a model for attracting and rapidly developing
high potential managers at later stages of their careers
HEE (NHS
Leadership
Academy)
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 24
Proposed action Intended outcomes Detailed actions Responsible
4: Embed inclusion
in leadership
development
and talent
management
initiatives
Next 12
months
Improved leadership capabilities are driving greater
levels of equality, diversity and inclusion at all levels
There is equal access to opportunities for career
progression and people have the development
support they need to pursue them. Line managers
identify, encourage and support those from under-
represented groups
Working closely with the NHS Equality and Diversity Council (EDC),
launch a system-wide intervention to address discrimination against
those with protected characteristics. The intervention will equip future
leaders to accelerate inclusion and create just cultures that ensure
inclusion is sustained. It will use action research to identify, design and
implement the leadership development and leadership practices that
are achieving inclusion. This work will itself be a programme of action
that engages leaders across health and care
HEE (NHS
Leadership
Academy)
In 1–3
years
All organisations cultivate the knowledge, skills
and capabilities that create the conditions where
equality, diversity and inclusion thrive. There is
measurable progress towards a senior leadership
group that represents the health and care workforce
and wider population it serves. Evidence shows such
representative leadership leads to more patient-
centred care and better staff morale
Publicise ambitious targets to improve diversity at every level of
NHS organisations and publish the impact of organisations’ action on
diversity. Encourage stakeholder forums and recruitment and exchange
schemes to improve the diversity of future leaders, meaning diversity
in skills, thinking, experience and background as well as in protected
characteristics
NHS Equality
and Diversity
Council
(EDC) and
NHS national
organisations
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 25
Proposed action Intended outcomes Detailed actions Responsible
5: Support
organisations and
systems to deliver
effective talent
management
Next 12
months
All NHS-funded organisations know how to deliver
effective, inclusive talent management
Building on existing evidence and materials, co-produce a clear
statement of what ‘good’ and inclusive talent management looks like
across the NHS system. All members of the NILD Board will publicly
commit to putting good talent management in place in their own
organisations. The impact and quality of these initiatives will be
measured and results published annually
HEE (NHS
Leadership
Academy), with
all members of
the NILD Board
Organisations and line managers have easy access
to guidance and advice on how to implement better
talent management
Co-design a programme supporting organisations to do talent
management better at all levels. This entails building on existing
regional talent management networks, which increase access to
training and resources, and developing learning collaboratives which
share best practice and support peer-to-peer learning
HEE (NHS
Leadership
Academy) with
all members of
the NILD Board
In 1–3
years
All staff at all levels are provided with meaningful
feedback and the support they need to fulfil their
potential, making them feel more valued. Effective
talent pipelines are in place, ensuring that the highest
performing individuals across NHS-funded services
are identified and adequately supported to become
future leaders
Support local organisation leaders to establish pilot talent
management forums at regional and local system levels. Such
forums can take a partnership approach to strategically identifying and
developing diverse talent across all the organisations they represent.
The aim is for the pilots collectively to drive local talent development
strategies and sustainable succession planning
HEE (NHS
Leadership
Academy)
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 26
Proposed action Intended outcomes Detailed actions Responsible
6: Improve senior
level recruitment
and support across
NHS-funded
services
Next 12
months
Senior leaders in NHS-funded services feel more
valued and continually supported to reach their full
potential
There is progress towards strategic and coherent
talent management at the national level, ensuring
effective succession-planning for the most senior roles
across the health system
Continue work to align and make better use of all existing NHS
resource involved in senior level development and recruitment. This
work is aimed at offering more coherent national talent management
support, covering executive, non-executive and interim board posts.
The offer will include monitoring national talent pools; providing career
management advice to rising talent; and supporting employers in
targeting and appointing appropriately developed senior leaders
HEE (NHS
Leadership
Academy)
Establish a national senior leaders support function (SLSF) with
representatives from the health and care system. This team will
inform and oversee senior talent management initiatives at national
level. The SLSF will systematically source and use talent management
data relevant to board level posts to inform national planning and
investment decisions concerning the senior leadership pipelines for
all professions. This will include regularly collecting new supply and
demand data from across the NHS system along with analytical
modelling
HEE (NHS
Leadership
Academy)
Commission a senior systems leaders scheme as part of a nationally
coordinated talent management programme to support leaders
currently in the most senior roles, to attract and retain future senior
leaders, and ensure effective succession planning for the most senior
roles across the health system
HEE (NHS
Leadership
Academy)
Continue to deliver or commission a set of development
programmes for aspiring senior leaders across NHS-funded
services and those already in post, particularly for future clinical
leaders (for example, running another cohort through an executive fast
track programme that prepares clinicians to take up chief executive
posts) and for future leaders in primary care and commissioning
HEE (NHS
Leadership
Academy) with
NHS England
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framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Glossary of terms
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 27
Proposed action Intended outcomes Detailed actions Responsible
6: Improve senior
level recruitment
and support across
NHS-funded
services
In 1–3
years
There is a sustainable and diverse pipeline of senior
leaders for NHS-funded services and vacancies are
filled quickly with leaders who have the right skills.
Improved recruitment support and processes reduce
reliance on commercial recruitment firms and deliver
better value for money
Expand NHS recruitment support to board-level roles and establish a
national framework of preferred executive search agencies that
secures better value for money for NHS organisations
HEE (NHS
Leadership
Academy)
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1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 28
Condition 3:
Knowledge of improvement methods
and how to use them at all levels
Chief executives of the majority of provider trusts rated ‘outstanding’ by
the Care Quality Commission (CQC) have stated their commitment to
quality improvement methods and continuous learning, which they credit
with achieving improvements in operational performance, staff satisfaction
and quality outcomes. Leaders of CCGs and primary care providers have
given similar endorsements. The ambition inspired by this condition is for
all NHS-funded organisations across England, with regional and national
partners, to invest in building skills in quality improvement and continual
learning among all their teams. The aim is for continuous improvement to
be core to everyday work for everyone working in NHS-funded services.
Extending this capability into primary, community and social care is vital to
performance improvement across health and care systems.
There are several approaches to improvement methods
14
but all share the
same basic principles. As the Berwick review identified, not everyone needs
to be expert in an approach, but all staff and teams should understand
the principles and all organisations should have enough staff with the
leadership and expert analytical skills to lead and sustain improvement
work through coaching teams. All teams should have the opportunity and
time to apply improvement skills in their daily work, as well as access to
on-going support and shared knowledge. Achieving this condition rests
on senior leadership teams committing their organisations and systems
to developing staff in improvement methods; making the substantial and
sustained commitment of time and resources that success requires; and
embedding training in improvement methods, alongside training in related
managerial, team-working and leadership skills, in the training curricula
and re-validation processes of all health and care staff.
Research into the factors driving high quality health systems shows that
board and executive teams’ understanding of leading for improvement is
crucial. Leading for improvement includes allocating adequate resources,
giving teams time for improvement activities (reducing less value-adding
activities where possible), role-modelling improvement principles in leaders’
own behaviour and celebrating successes.
There are a number of regional networks that support provider and
commissioning organisations in building improvement capability very well.
However, the extent, quality and availability of training and support vary
across the country. A more coherent and co-ordinated offer at regional and
local level is needed. Some NHS-funded organisations that have embedded
improvement approaches already support peers: the national organisations
involved in this framework are committed to supporting the development
of improvement capability and peer-to-peer learning across England.
Patients, service users, families and communities should always be involved
as equal partners with professionals in re-designing and improving
processes and systems. Many healthcare organisations across England
do this systematically, with impressive results. To extend this level of
involvement across NHS-funded care depends on communicating its
benefits to health and care teams, including patients, carers and other
partners, and equipping them with the skills to do it well.
14 Established quality improvement approaches include Total Quality Management (TQM), Model for Improvement (including Plan Do Study Act or PDSA), Statistical Process Control, Six Sigma, Lean,
Experienced-based Co-design, Theory of Constraints, and Business Process Re-engineering. See www.health.org.uk/sites/health/files/QualityImprovementMadeSimple.pdf
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framework
2. The framework
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3. Conditions and
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Annex 3:
Glossary of terms
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 29
Proposed actions
Proposed action Intended outcomes Detailed actions Responsible
7: Build
improvement
capability among
providers,
commissioners,
patients and
communities
Next 12
months
All leaders of healthcare organisations and systems,
across primary, secondary and community care as well
as commissioning and national bodies, have access
to the knowledge and skills they need to lead quality
improvement
Develop programmes for boards and executive teams of provider and
commissioning organisations on leading for improvement, designed
in collaboration with regional, national and international organisations
experienced in this area
NHS
Improvement
with NHS
England
Co-design with primary care practitioners a training offer for
primary care building on current good practice and aligned with the
‘leading for improvement’ programme, which is co-ordinated by NHS
Improvement
NHS England
(Primary Care
Team)
Embed leading for improvement in all core leadership development
programmes
HEE (NHS
Leadership
Academy)
Issue guidance for providers indicating the scale of training required
to embed quality improvement capability in their organisations,
ie what proportion of staff need training in improvement methods at
each level, over what period, and the particular improvement skills they
need to learn
NHS
Improvement
Regional and national improvement organisations
have a better understanding of the type and level of
improvement training and support available to local
organisations and systems. They can clearly signpost
such support, and address gaps in the existing
training and support infrastructure
Identify the current training and support infrastructure in relation
to improvement, in close co-operation with regional improvement
organisations and networks
NHS
Improvement
and NHS
England, with
academic
health science
networks and
other regional
improvement
organisations
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 30
Proposed action Intended outcomes Detailed actions Responsible
7: Build
improvement
capability among
providers,
commissioners,
patients and
communities
Next 12
months
Patients and communities are involved as equal
partners in the re-design of processes and systems
All members of the NILD Board will develop their organisations’
approaches to involving patients and/or carers in their work and
governance processes, working with existing advisory groups (eg Five
Year Forward View People and communities Board) and sharing their
experiences
All NILD Board
members
In 1–3
years
All providers and commissioners are supported in
building improvement capability by a coherent and
co-ordinated support offer at regional and local level,
ensuring good value for money
Develop a procurement framework for specialist providers of
improvement training and support
NHS
Improvement
Provide guidance to organisations on how to build organisational
and systems improvement capability and work with improvement
organisations to offer regional support
NHS
Improvement,
with NHS
England
All senior leaders are embedding an improvement
mind-set in their organisations and model this. By
2020, all candidates appointed as chief executives to
trusts and CCGs will need to demonstrate knowledge
of, and experience in, applying improvement
approaches, as well as compassionate, inclusive
leadership
Support boards and executive teams’ access to relevant
improvement training through the ‘leading for improvement’
programmes, using local and regional partners. The programme’s aim is
to reach 25% of trust/CCG boards and executive teams by 2018, and
75% of this target group by 2020
NHS
Improvement,
with NHS
England
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 31
Proposed action Intended outcomes Detailed actions Responsible
8: Embed
improvement
and leadership
development
in curricula,
revalidation and
award schemes
Next 12
months
Training in quality improvement (QI) science and
methods, as well as in managerial and leadership
skills, are systematically and comprehensively
embedded in training curricula for all health staff,
clinical and non-clinical.
With the Medical Royal Colleges, the Academy of Medical Royal
Colleges and other relevant professional groups, develop a strategy for
implementing the recommendations of Quality Improvement –
Training for Better Outcomes (Academy of Medical Royal Colleges
2016), in close co-operation with universities and training regulators
HEE
Individuals and teams are strongly incentivised to
improve health and care and rewarded for their
contributions
Establish a working group to review Clinical Excellence Awards,
with a view to designing an incentive and reward scheme focused on
quality improvement and leadership development
Department
of Health
In 1–3
years
A substantial and increasing share of the NHS-funded
workforce is skilled in QI methodology and sees
continuous improvement as a normal component
of everyday work, rather than an add on. Include
knowledge of QI in revalidation processes and
appraiser training for all health staff
Continue work with the Medical Royal Colleges, professional regulators
and other professional groups to implement new curricula and re-
validation processes that include core improvement, team working
and leadership development skills
HEE
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
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Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 32
Condition 4:
Support systems for learning at local,
regional and national levels
Getting full benefit from investments in improvement skills, leadership
and talent management made in line with the framework depends on
the underpinning support systems for these three areas. Several actions
to extend infrastructure and learning systems to support all three appear
under conditions 1, 2 and 3. Actions proposed under this condition
promote essential resource and knowledge sharing.
To illustrate, thousands of people have already been trained in
improvement methods across the health and care system in England.
But not all of them have the support they need to apply their skills, such
as help with data analysis. Having access to support and coaching from
improvement experts, who help with the set-up and management of
improvement projects and in sharing learning, has been shown to help
embed improvement skills. There are also good examples of smaller
commissioning or provider organisations sharing expert resources and
infrastructure to support improvement teams working across their local
system. Expert support is often crucial in ensuring the involvement of
patients, carers and the wider community in improvement projects.
Sharing resources, knowledge and learning depends on building systems
and networks locally, regionally and nationally. Being able to connect with
teams working on similar projects offers much-needed support and peer-
to-peer learning and also avoids wasting scarce resources on problems
that others have already solved. Support for networks will help teams
working on improvement skill-building, leadership development and talent
management in England to connect with peers and experts in the rest of
the UK and beyond.
Improvement and leadership development practitioners and teams across
health and care often find pertinent evidence-based resources hard to
locate. Action is also needed to make guidance and information on both
leadership development and improvement easier to find and use.
Proposed actions
As a result of the Smith review of nationally funded improvement and
leadership development functions (2015), several changes have already
been made to the nationally funded improvement and leadership
development functions, including moving the Leadership Academy under
HEE and integrating NHS Improving Quality functions into NHS England.
The actions proposed below build on the changes already made.
Summary Views from the service
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framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 33
Proposed action Intended outcomes Detailed actions Responsible
9: Ensure
easy access to
improvement
and leadership
development
resources
Next 12
months
All staff in health and care organisations have easy
access to improvement, leadership development and
talent management resources, guidance, tools and
best practice methods
Develop a shared approach to knowledge spread and adoption
encouraging local organisations and systems to develop communities
of practice, share case studies and make evidence from local, national
and international research easily available through digital channels
HEE, NHS
Improvement,
NHS England
In 1–3
years
All staff in health organisations have easy access to
cost-efficient, online improvement technology to
aid them in the set-up, management and sharing of
improvement projects
With partners across the system, build on existing online improvement
platforms to create a national platform that helps people to plan,
manage and share learning from their improvement projects
NHS
Improvement,
with NHS
England
10: Support peer-
to-peer learning
and exchange of
ideas
Next 12
months
Organisations better understand what support
patient leaders and NHS-funded staff need to share
experience
Build networks of practitioners in patient and public involvement to
raise awareness and share knowledge
NHS England
(Public and
Patient
Engagement
Directorate)
and NHS
Improvement
(Faculty of
Improvement)
Individuals involved in improvement work (from
policy to practice in every part of the health and care
system) belong to improvement communities
Continue to develop the Q Initiative with the Health Foundation
and other partners as a pan-UK network for individuals involved in
improvement, which supports and advances their work
NHS
Improvement
In 1–3
years
Effective networks thrive across the health and care
system, enabling the flow of improvement ideas,
advice, tools and peer support across England, and
proactive connections with the rest of the UK and
beyond
Identify and align suitable development support for a wider range
of existing and emerging networks supporting improvement,
leadership development and talent management
NHS England,
NHS
Improvement,
HEE (NHS
Leadership
Academy)
Summary Views from the service
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framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 34
Condition 5:
Enabling, supportive and aligned
regulation and oversight
Targeted investment in skill-building, leadership development and
talent management at all levels will only have the desired impact if local
organisations and systems are in control of driving their learning and
improvement to suit the needs of their local communities. The regulatory
and oversight bodies that set the national priorities for local organisations
and systems must allow them that control and give them the space and
support they need to succeed.
The purpose of regulating and overseeing local organisations is to make
sure patients and other service-users receive the best care possible.
Regulatory and oversight bodies do this by ensuring core standards are
met, and making appropriate interventions when serious problems are
identified. There is increasing recognition that the national bodies’ and
commissioners’ general response to a worsening operational environment
has been to increase their grip on local organisations and focus on short-
term performance management interventions. Those subject to the various
regimes sometimes regard the different bodies’ individual responses
as inconsistent and unco-ordinated. Although any inconsistencies are
unintended, they can divert local management attention to responding
to regulators and local oversight bodies at the expense of focusing on
operations.
The regulatory and oversight bodies take these views seriously. We are
working on more supportive approaches that focus on building the
capability of people across the health and care system. For example:
an aligned regulation and oversight approach between NHS
Improvement, CQC and NHS England for accountable care organisations
and new care models
joint work between CQC and NHS Improvement on updating and fully
aligning the Well-Led Framework, based on a single shared view of
quality that draws on the same sources of evidence
the Shared Commitment to Quality developed by the National Quality
Board (NQB), which re-affirms and signals the commitment of the
FYFV national leadership to quality and makes clear the collective
commitment of the national bodies to safeguarding and driving
improvements in quality
implementing NHS Improvement’s Single Oversight Framework, which
directs support for improvement to trusts.
As a priority, we seek to ensure that the regulatory and oversight system
does not stand in the way but encourages professionals, organisations,
teams and local systems to improve patient care and outcomes. The
national organisations, our regional presences and local oversight bodies
must remove any unnecessary hurdles and burden, and make sure we all
work closely together. Local organisations should not be asked to submit
information more than once. Staff submitting data should understand why
it is collected and be able to access it in a meaningful format for improving
performance. Regional and national bodies should work together with local
organisations and systems to share data and information, minimise data
requests and explain such requests clearly.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 35
Putting local systems and providers in control of driving improvement and
making them accountable for it necessitates delegating priority-setting
and decision-making to the local level. New models of local system leaders
jointly planning and delivering services for local populations are already
emerging. Some of these challenge existing regulatory and oversight
structures and practice. Leaders at all levels need to collaborate to remove
barriers to innovation and beneficial change. Local organisations and
systems should be confident that they can have open discussions with
national bodies on how to overcome such barriers.
Our aim is for regulation and oversight to be more consistent, supportive
and fully aligned in the way it looks at and intervenes in performance
and improvement across providers, commissioners and local health and
care systems. As national bodies, this means we need to improve our
understanding of the often complex factors driving outcomes, so we can
offer support to commissioners and providers that adds real value and
assess the extent of its impact. The support we provide should also help
build capability for the long term across local health and care systems,
beyond meeting short-term operational objectives. This change in horizon
needs to be demonstrated in the actions the different regulation and
oversight bodies take to prioritise and support leadership development
and improvement.
Proposed action
We intend to use this framework as our collective guide in a process that
will require many of us to question the ‘way things are done’. Working
through the process will take time and some outcomes will only be
measurable in the medium term. However, work in many areas is already
underway.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Annex 3:
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Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 36
Proposed action Intended outcomes Detailed actions Responsible
11: Create a
consistent
supportive
regulatory
approach
Next 12
months
All national bodies share a clear understanding of
the changes in their approaches needed to make
sure the regulatory regime consistently encourages
improvement and compassionate, inclusive leadership
Continue and strengthen inclusive dialogue across the system to
explore how regulatory and oversight approaches used in the NHS can
be aligned to the strategic framework over time. A critical topic is the
metrics used to measure progress. All national regulatory and oversight
bodies will commit to act on insights generated by use of this and
future iterations of the framework
CQC, NHS
England, NHS
Improvement
Work with partners in the system to establish mechanisms for
organisations to feed back constructively experiences in their
dealings with national bodies that are not in keeping with the
framework’s expectations, and to make sure this information is
regularly reviewed and acted upon. This action will build on existing
processes in national organisations and evidence on what works best
NHS
Improvement,
with all National
Board members
In 1–3
years
Progress has been made towards a fully aligned
regulatory approach, with all stakeholders from
the system involved. Provider and commissioning
organisations find interactions with national
regulation and oversight organisations (and their local
and regional teams) increasingly supportive and in line
with the framework’s ambitions
Update each organisation’s regulatory or oversight approaches
to prioritise the strategic framework’s ambitions. For example, the CQC
and NHS Improvement are doing this for their next release of the Well-
Led Framework, due in April 2017
CQC, NHS
Improvement,
NHS England
All national regulatory and oversight bodies ensure that their
organisational development approach supports and enables all
their staff to behave in line with the principles of the National
Improvement and Leadership Development framework, including
development in holding supportive conversations and understanding
improvement methods
CQC, NHS
England, NHS
Improvement
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framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 37
Proposed action Intended outcomes Detailed actions Responsible
12: Streamline and
automate requests
for information
Next 12
months
All national organisations own a cross-sector plan to
minimise the burden associated with their information
requests, with measurable targets
Develop a joint initiative to assess current measurement activity
(including performance targets and associated metrics) and a strategy
for ‘measuring what matters’. This will include understanding local
commissioner behaviour and how this may be influenced to reduce the
data burden arising from local information requests for commissioning
purposes. This action will be aligned with the work of the Burden
Reduction Challenge Panel (DH), on-going work by NHS Digital, the
initiative ‘Paperless by 2020’ (NIB) and the NQB’s ‘Measuring Quality’
working group
National
Quality Board,
NILD Board
and National
Information
Board (NIB)
In 1–3
years
Provider organisations experience a measurable
reduction in the data burden associated with the
collection and submission of data for regulatory and
commissioning purposes
Implement the cross-sector strategy to ‘measure what matters’
and associated actions to minimise the data burden, with regular
assessment of the impact on providers
NQB, NILD
Board and NIB
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framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 38
Proposed action Intended outcomes Detailed actions Responsible
13: Balance
measurement for
improvement and
judgement
Next 12
months
All provider and commissioning organisations
have easy access to guidance and support on
understanding measurement for improvement and
how to implement it
In partnership with local organisations develop guidance on good
practice in combining measurement for judgement and measurement
for improvement, based on national and international good practice
NHS
Improvement,
NHS England
All provider and commissioning organisations, as well
as regional and national regulation and oversight
bodies, are putting suitable systems in place to
measure for improvement
Select a pilot priority area (eg cancer service delivery) to design
and implement a comprehensive measurement strategy for the area
across all levels (national regulation and oversight bodies and their
regional teams; providers and CCGs), working with local partners in
development and implementation
NHS England,
NHS
Improvement,
CQC
All provider, commissioning and regulation and
oversight organisations plan/ start to develop
sufficient analytical capability to design, analyse and
interpret relevant measures to support improvement
Include analytical skill building as an explicit element of the ‘Leading
for Improvement’ training offers. This will link with relevant work
being done by the NIB (such as the Building a Digital-Ready Workforce
programme), and work by NHS Digital relating to NHS England’s
personalised health and care 2020 strategy, as well as planned and
new capability building offers for primary care and commissioners (such
as NHS England’s Right Care programme)
NHS
Improvement,
NHS England
In 1–3
years
Provider and commissioning organisations, as well as
regional and national regulation and oversight bodies,
have suitable systems to measure for improvement
All members of the NILD Board review their internal board
reporting to check that measures used give an adequate
understanding of the organisation’s trajectory of performance, and
whether changes believed to be leading to improvements are having
the intended impact
NHS Improvement and NHS England will ensure that providers and
commissioners are supported in adopting good practice on measuring
for improvement, and signpost them to other support
NHS
Improvement,
NHS England
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1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 39
Annex 1: Bibliography
Introduction
The programme team consisted of three sub-teams focussing on
different elements of the strategy. The team consulted a wide range of
subject experts and research documents and resources. This bibliography
represents some of the resources the teams drew on for this first version of
the framework.
Leadership Development, Culture and Team-working
Atkins and Parker (2012) Understanding Individual Compassion in
Organizations: The role of Appraisals and psychological Flexibility. Academy
of Management Review 37, 4, 524–546
Baker, D.P., Day, R., & Salas, E. (2006) Teamwork as an essential component
of high reliability organisations. Health Service Research 41, 1576–1598
Dawson, J.F., West, M.A., Admasachew, L. and Topakas, A. (2011), NHS
Staff Management and Health Service Quality: Results from the NHS Staff
Survey and related data, Department of Health, London.
Dixon-Woods M, Baker R, Charles K., Dawson J, Jerzembek G, Martin G,
McCarthy I, McKee, L., Minion, J., Ozieranski P, Willars J., Wilkie P. and
West M. (2013), “Culture and behaviour in the English National Health
Service: overview of lessons from a large multimethod study”, British
Medical Journal Quality and Safety, 23 No. 2,106–15.
Ham C, (2014) Reforming the NHS from within. The King’s Fund
Ham C, Berwick D, Dixon J (2016) Improving quality in the English NHS:
A strategy for action. The King’s Fund
King, E., Dawson, J. F., West, M. A., Penny, C., Gilrane, V., & Bastin,
L. (2011). Why organizational and community diversity matter:
Representativeness and the emergence of incivility and organizational
performance. Academy of Management Journal, 54, (6), 1103–1118. 2012
Saroj Parasuraman Outstanding Publication Award from the Gender and
Diversity in Organizations Division of the Academy of Management.
Kline, R. (2014, The “snowy white peaks” of the NHS: a survey of
discrimination in governance and leadership and the potential impact on
patient care in London and England, Middlesex University, London
KPMG International (2016) What Works. The trillion dollar quest... How the
worlds best healthcare organisations develop managers and leaders
Locke, E.A. and Latham, G.P. (2013). New developments in goal setting
and task performance.
Lyubovnikova, J. & West, M. A. (2013). Why teamwork matters: Enabling
health care team effectiveness for the delivery of high quality patient care.
In E. Salas, S. I. Tannembaum, D. Cohen, & G. Latham (eds.). Developing
and enhancing teamwork in organizations (pp.331–372). San Francisco:
Jossey Bass.
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framework
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in graphics
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Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 40
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framework
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in graphics
3. Conditions and
proposed actions
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Stakeholders
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Glossary of terms
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2. The framework
in graphics
3. Conditions and
proposed actions
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Annex 2:
Stakeholders
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Glossary of terms
Contents
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1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 43
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Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 44
Annex 2: Stakeholders
Our thanks go to all the people who kindly gave their time
and expertise to develop this first version of the framework.
NHS Provider and CCG leaders, specialists, and staff members
Patient/user representative organisations
Professional bodies
Professional networks
Royal colleges
National NHS organisations
Arms-length government bodies
Research and academic organisations
Think tanks
Local delivery partners
Academic health science networks
Improvement organisations
Private sector talent management specialists
Public sector bodies including MoD and civil service talent support
Networks/associations
Our colleagues at NHS Scotland, NHS Wales, and Department of Health
Northern Ireland who arranged informative visits for us to learn about
their experience
The NILD board, ALB working group, and all those on the
Programme Team
Events/Surveys
Those who attended the TM workshops and Lets Talk Talent national
engagement events (7 July and 7 September)
People who responded to the Let’s Talk Talent online survey and took
time to have one to one conversations with the team
Those who attended the workshops to support the development of the
national improvement and leadership development strategy (15
th
April in
Gothenburg and 29
th
April at the Health Foundation)
Those who attended the National LDI Strategy Events (14
th
June in
Manchester and 21
st
June in London)
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 45
Annex 3: Glossary of terms
Continuous learning: constantly expanding skills through learning and
increasing knowledge. For organisations, directing people’s continuous
learning towards relevant skills equips individuals and the organisation as a
whole to adapt to a changing environment quickly, flexibly and successfully.
Cultures of continuous improvement: in health organisations,
these exist where people ‘have a rational understanding of how small
improvements compound to make big differences; they love improving –
both because they are passionate about the importance of their work and
because it feels so good to move to a new level of performance; and they
have enough confidence in their colleagues to believe the organization is
capable of making progress.’ (from George C. Halvorson, Chairman and
CEO of Kaiser Permanente, the largest U.S. nonprofit health plan and
hospital system, at https://hbr.org/2013/07/the-culture-to-cultivate)
Framework: a structure of interlinked items that guides action to achieve
a particular purpose. A framework can be improved to reflect experience
of using it by adding, deleting or adapting items.
Improvement: designing and redesigning work processes and systems
that deliver healthcare with better outcomes and lower cost, wherever
this can be achieved. Established improvement methods can be used
to improve single processes and systems within organisations and also
multiple processes and systems that may cross organisational boundaries,
as in transformational change programmes and service reconfigurations
across local health systems.
Leadership development: developing individuals for positions of
responsibility and authority, supporting them in these roles, and developing
the capacity of groups and organisations for leadership as a shared,
collective process.
Measurement for improvement: shows whether work to improve
a process or system is achieving its intended results. Measurement for
improvement comprises measures that demonstrate current (baseline)
performance in terms of quality and cost, performance goals for the
process or system and the impact of improvement work on progress
towards those goals. In health care, measurements are often used for
reporting aggregate quality and cost results to oversight and regulatory
bodies that “judge” the data against specific standards or rules.
Measurements for judgement generally differ from measurements for
improvement, although both types of measurement are important.
Organisational culture: the ‘way we do things around here’, influenced
in particular by how leaders do six things: communicate the organisation’s
vision; translate the vision into practical objectives; manage people; make
sure the organisation is just and fair; work in teams; and express core
human values. (From the work of Professor Michael West, Head of Thought
Leadership at the King’s Fund see
https://www.kingsfund.org.uk/blog/2016/01/if-it%E2%80%99s-about-
culture-it%E2%80%99s-about-leadership).
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 46
Organisation development: enabling people to transform systems. OD
applies behavioural science to organisational and systems issues to align
their strategy with their capability. It enhances the effectiveness of systems
by providing interventions that build people’s collective capacity and
capability to achieve shared goals. (For more information, see:
http://nhsemployers.org/campaigns/organisational-development/what-is-
organisational-development)
Quality: what matters most to service users concerning quality is that
services are safe, effective, caring and responsive (good experience) and
person-centred. Providers and commissioners that deliver such high quality
services are well-led, use resources sustainably and are equitable. (Source:
A Shared Commitment to Quality developed by the National Quality Board)
Sustainability and transformation plans: plans that show how local
services will evolve and become sustainable over the next five years. The
NHS Shared Planning Guidance 16/17–20/21 issued in December 2015
called for every health and care system in England to produce a five-
year sustainability and transformation plan (STP). The health and care
organisations within 44 defined geographic ‘footprints’, covering all areas
of NHS spending in England, are collaborating on these plans, led by a
named leader in each footprint. The plans cover improving quality and
developing new models of care, improving health and wellbeing, and
improving efficiency of services. While the guidance focuses mainly on
NHS-funded services, STPs will also cover better integration with local
authority services.
Talent management: the systematic attraction, identification,
development, engagement and retention of talent in an organisation or
system. Talent refers to individuals who can make a particular difference
to organisational performance, either because of their high potential
or because they are fulfilling their potential in critical roles (Source: the
Chartered Institute of Personnel Development).
Talent pipelines: these provide the pools of candidates able to fill posts at
each level of an organisation’s staffing when those posts fall vacant or the
organisation expands. Posts at different levels will require candidates with
different competencies, knowledge and experience. Organisations need
to equip their talent with the skills and experience to fill higher level roles
while these individuals are in the talent pipelines leading to those roles.
Summary Views from the service
1. Explaining the
framework
2. The framework
in graphics
3. Conditions and
proposed actions
Annex 1:
Bibliography
Annex 2:
Stakeholders
Annex 3:
Glossary of terms
Contents
Developing People – Improving Care: A national framework for action on improvement and leadership development in NHS-funded services 47
The National Improvement and Leadership Development Board: the
NILD board was formed by six arms-length government bodies and the
Department of Health to oversee the work set out by the Smith review
of centrally funded improvement and leadership development functions
in 2015.
15
The board reports to the NHS Five Year Forward View Board
consisting of the chief executives from the main leadership bodies involved
in healthcare. The original NILD board was soon expanded to include
other relevant organisations, such as the Local Government Association.
Organisations currently represented on the NILD board and sending
advisors to it are listed below.
Members of the NILD board comprise:
Care Quality Commission
Department of Health
Health Education England
National Institute for Health and Care Excellence
NHS England
NHS Improvement
Public Health England
Organisations attending the NILD board:
Local Government Association
NHS Clinical Commissioners
NHS Confederation
NHS Leadership Academy
NHS Providers
Skills for Care
15 www.england.nhs.uk/wp-content/uploads/2015/09/improv-ldrshp-dev-rev-sept15.pdf
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