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Improvement Leaders Guide
Leading improvementPersonal and organisational development
The NHS Modernisation Agency is part of the Department of Health
Crown Copyright 2005
If you require further copies quoteMAILG052 / Improvement Leaders Guides, and contact:
Department of Health PublicationsPO Box 77London SE1 6XH
Tel: 08701 555 455Fax: 01623 724 524E-mail: [email protected]
MAILG052 / Improvement Leaders Guides can also be made available onrequest in braille, on audio-cassette tape, on disk and in large print.
www.modern.nhs.uk
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Leading improvement 1
Improvement Leaders Guides
How you use the Improvement Leaders Guides is not prescriptive. You can startwherever is best for you, however experience has shown us that some of the
Improvement Leaders Guides are best used sequentially.
The ideas and advice in these Improvement Leaders Guides will providea foundation for all your improvement work:
Improvement knowledge and skills
Managing the human dimensions of change
Building and nurturing an improvement culture
Working with groups
Evaluating improvement
Leading improvement
These Improvement Leaders Guides will give you the basic tools andtechniques:
Involving patients and carers
Process mapping, analysis and redesign
Measurement for improvement
Matching capacity and demand
These Improvement Leaders Guides build on the basic tools andtechniques:
Working in systems
Redesigning roles
Improving flow
You will find all these Improvement Leaders Guides atwww.modern.nhs.uk/improvementguides
Every single person is enabled, encouraged and
capable to work with others to improve their part ofthe serviceDiscipline of Improvement in Health and Social Care
DH INFORMATION READER BOX
Policy Estates
HR/Workforce Performance
Management IM&T
Planning Finance
Clinical Partnership Working
Document Purpose Best Practice Guidelines
ROCR Ref: Gateway Ref: 4701
Title Improvement Leaders Guides
Author NHS Modernisation Agency
Publication Date April 2005
Target Audience Medical Directors, Directors of Nursing,
Directors of HR, Allied Health Professionals,Emergency Care Leads, Directors of Modernisation
and Service Improvement
Circulation List
Description A series of guides based on the learning of the
NHS Modernisation Agency. Designed to help
frontline staff improve the delivery of care to
patients and users
Cross Ref: 10 High Impact Changes for Service Improvement
and DeliverySuperseded Docs N/A
Action Required N/A
Timing N/A
Contact Details Jean Penny
NHS Modernisation Agency
4th Floor
St Johns House
East Street
Leicester LE1 6NB
For Recipients Use
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2 Leading improvement 3
1.What is leadership?
Leadership is about setting direction, opening uppossibilities, helping people achieve, communicationand delivering. It is also about behaviour, what we doas leaders is even more important than what we say.Sir Nigel Crisp
There are thousands of ways to describe leadership, here are just a few.Leadership is:
challenging the process, inspiring a shared vision, enabling others to act andmodelling the way (Clark D, 1997)
transforming followers into leaders themselves (Gill R, 2002)
creating an environment that supports individual team members in beingmaximally effective in achieving those outcomes that are valued by users andtheir supporters (Onyett S, 2002)
something for the many not the top few (Attwood M, 2003)
A leader of improvement needs to have these leadership skills and more.
You will face challenges in creating a shared vision, challenges developing asupportive culture and challenges engaging others in improvement. This guidehas collected together some of the current thinking about the knowledge and
skills a leader of improvement may need.
It will help you to be familiar with the different aspects of improvementdescribed in the three groups of Improvement Leaders Guides:
General improvement skills: introducing a range of basic improvement adviceto help you and your colleagues begin to build and learn from improvementin your everyday work
Process and systems thinking: based on the industrial models of processes,systems and flow
Personal and organisational: focusing on the people and culture that make up
an organisation and the impact on improvement. This group is about thepeople side of change
Contents
1. What is leadership? 3
2. Is leading improvement different? 5
3. The challenges of leading improvement 8
4. Knowledge and skills of improvement 10
5. Creating a shared vision 12
6. Aligning improvement with the vision 14
7. Building a more receptive context for 16improvement
8. Engaging clinical colleagues 18
9. Encourage and support communities of 20
practice for improvement
10. Lessons and experiences from leaders 22of improvement
11. Activities 24
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2. Is leading improvement different?
The Leading Modernisation framework was developed as a theoretical modelfor a national programme. It was derived from research that examined the
knowledge, skills and capabilities leaders need in order to achieve the mostrelevant and sustainable improvements. It has three parts: care delivery systems: the practical realities and future possibilities of how
care is experienced by professionals, patients and the public
leadership: the art of getting things done through others improvement: the study and practice of enhancing the performance of
processes and systems at work
This model says that a leader of improvement needs to not only be a goodleader but also to excel in delivering excellent care or enable others to do so
and promote and support improvement. A leader of improvement needs towork at the intersection of these three domains.
PoliticalAstuteness
SettingDirection
Deliveringthe service
Intellectualflexibility
Holding toaccount
BroadScanning
Effective andstrategic
influencing
EmpoweringOthers
Drive forresults
Seizingthe future
Collaborativeworking
Leading changethrough people
PersonalQualities
Self-beliefSelf-awareness
Self-managementDrive for improvement
Personal integrity
NHS Leadership Qualities framework
Care deliverysystems
Leadership Improvement
Focus of the Leading
Modernisation Programme
Developed for the Leading Modernisation Programme by Paul Plsek
Leadership Qualities Framework
The key characteristics, attitudes and behaviours expected of leaders in the NHSnow and in the future have been pulled together in the NHS leadership
qualities framework. It describes fifteen qualities, arranged around threeclusters: personal qualities, setting direction and delivering the service. You canuse this framework to review your own general leadership abilities, with yourteam or colleagues to establish leadership capability and capacity. You can also
use it to focus for personal development, board development, leadershipprofiling for recruitment and selection, career mapping and succession planning
You can find this framework in full on www.nhsleadershipqualities.nhs.uk
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6. Aligning improvement with the vision
Focusing improvement activity around strategic goals
Improvement wont happen withoutthe energy and enthusiasm of
frontline staff. We know that.Yet, if the maximum benefit is to besecured at the system level, these
energies need to be aligned with thewider communitys strategic aims.
Individual teams are not always bestplaced to set their work in this widercontext. So improvement leaders have
a responsibility to supportimprovement activity as well as theoperational priorities and the strategic
goals of the system.
You may find that working together
and using this matrix is in itselfbeneficial. Within this framework,individual departments, services ororganisations can pursue their own
priorities whilst seeking whole systemssolutions and collaboration toproblems and issues to support the
delivery of seamless care.
14
Case studySuggested simple rules for improvementdevelopment in an SHA in London
really listen to the voice of the patients establish a sense of urgency form powerful coalitions
create a clear and widely understood vision communicate with passion empower others to act on the vision
plan to create short-term improvement and promote what has worked consolidate improvement and produce still more changes institutionalise new approaches
understand how we learn
Strategic aimsDevelop transformational aims that
connect with the values that brought
people into health and social care in the
first place
Measurable goalsDevelop system level, measurable goals
that track progress against
these aims
National targetsShow how externally set targets sit within
the context of the strategic aims to build
ownership to delivery
Improvement workAssess current improvement work against
the system level goals to ensure that effort
is focused in areas of greatest priority
Adapted from Jim Reinerstein and the work of Pursuing PerfectionAdapted from Jim Reinerstein and the work of Pursuing Perfection
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Care Delivery System
4. Stakeholder participation(whole system)
1 Uni-organisational/professional group2 Stakeholders identified3 Stakeholders positively
encouraged to participate4 Stakeholders briefed and
understand the system5 Stakeholders regularly involved
in meetings6 Constructive relationship with
stakeholders involved in actions todeliver project/programme
7 Building on existing relationships,stakeholders take lead on one ormore work strands
5. Clinical Leadership
1 No clinicians involved2 Name(s) identified3 Have attended one meeting4 Attends meetings regularly5 Contributes to project work6 Leads strands of work7 Actively leading and visible with
clinical and non-clinical interfaces
6. Interrelationship with otherstrands of service improvement
recognised and synchronised
1 Overview not considered2 No obvious overlaps3 Potential overlaps recognised4 Overlaps recognised and flagged5 Interface between overlaps
quantified and understood6 Potential for joint work
assessed and agreed
7 Integrated approach evidentand operational
1Low
7High
1Low
7High
1Low
7High
Improvement
7. Involving service users,carers and patients
1 None/no attempt2 Positive decision made to
involve representatives3 Demonstrable action in hand to
identify users etc.4 Pre-briefing and support given5 Occasional involvement as required6 Regular reference type involvement
7 Full participative involvement inwhole project/programme
8. Matching the understandingof the challenge to appropriatemethod of redesign
1 Not considered or discussed2 Discussed, considered not relevant3 Challenge is understood
(including history)4 There is an agreed course of action5 There is full consensus on way ahead6 Redesign lead has skills to match
challenge with method7 Nature of the challenge, relevant approach
and project lead all in place and agreed
9. Clear timely measurablereported outcomes
1 None2 Programme/project has
identified outcomes3 Outcomes reflect the aims4 Outcomes are agreed5 Measures are clear and timely6 Information is available7 Information is collected and reported
against outcome measures atregular intervals
1Low
7High
1Low
7High
1Low
7High
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The Improvement Leaders Guides have been organised into three groups:
General improvement skillsProcess and systems thinkingPersonal and organisational development
Each group of guides will give you a range of ideas, tools and techniques foryou to choose according to what is best for you, your patients and your
organisation. However, they have been designed to be complementary and willbe most effective if used collectively, giving you a set of principles for creatingthe best conditions for improvement in health and social care.
The development of this guide for Improvement Leaders has been a trulycollaborative process. We would like to thank everyone who has contributed by
sharing their experiences, knowledge and case studies.
Design TeamJo Bibby, Sarah Garrett, Cathy Green, Catherine Hannaway, Judy Hargadon,
Elaine Latham, Lynne Maher, Mike McBride, Annette Neath, Jean Penny,Christina Pond, Hugh Rogers, Jonathan Stead. Also all those who haveparticipated in the work of the Pursuing Perfection Programme and Research
into Practice.
To download the PDFs of the guides go to www.modern.nhs.uk/improvementguides
We have taken all reasonable steps to identify the source of information and ideas.
If you feel that anything is wrong or would like to make comments please contact us at