Strategic Leadership Development at an NHS Trust
Warwick delivers senior leader programme with NHS Trust
Application
and Integration at UHCW, was impressed. “It’s all about reframing the problem,” he says. “The issue may be defined as ‘we’re not hitting our targets’ but the root cause of the problem itself might be something entirely different. The way something is defined and solved might be the source of the problem itself.” He credits the double loop concept with informing his decisions on a major project he has been leading on for the Trust – the transfer of community services to the emergency and acute service provision to join up services governed through the creation of one integrated care board. “It hasn’t just been about coming up with a strategic document – a manifesto, if you like, that everyone follows. It has been about engaging with others and understanding where they are coming from and what drives them. Then it is about reframing issues in response and coming up with new solutions.”
On a cold winter’s night, we are all relieved to find the central heating coming on as the thermostat follows its instructions to hit 20 degrees centigrade, or whatever temperature we have set it at. But what if the thermostat could question itself about whether it should really be set at 20 degrees or whether another solution should be sought for in-house heating. What if it could question our programming decisions, and the underlying assumptions that underpin them.
UHCW approached WBS to scope out a development programme for senior executives who manage the seven ‘directorates’ that make up the Trust. The result has been a programme that focuses on building capability around Systems Thinking and Systems Leadership delivered over three modules, each taught residentially over two days at the School. “The leadership environment in healthcare is constantly changing as the needs of our patients and communities change,” says Andy Hardy, Chief Executive of UHCW. “Therefore our leaders need to be able to improve, grow and innovate to continue to develop services that meet that need. This is even more important for senior leaders that lead across organisations and health and social care systems.”
Applying the theory he has learnt on the course to his practice has been key for Deas, as it has been for his fellow delegates. Edward Hartley, Group Clinical Director for Emergency Medicine and consultant in emergency medicine, believes that some of the learning on becoming a strategic leader in the first module in October 2023 influenced his approach to the trust-wide implementation of electronic patient record (EPR) and led him to recommend delaying the trust launch to the summer of 2024. It was in the autumn of 2023 that he and his two fellow senior executives in the Emergency Medicine Directorate decided to “separate out the implementation of EPR from the rest of our governance”. “We set up a separate operational implementation group and a range of different task groups which meant that we were picking up a better appreciation of risk. “Because we concentrated on outcomes rather than general NHS targets, I think we are now in a much safer place.” Meanwhile, Beth Harrison, Group Clinical Director of the Clinical Diagnostics Group, points to two areas – histopathology and breast screening – where the Leadership Programme has made a difference. “Our learning on strategy and performance encouraged us to sit down as a triumvirate during the Warwick meet-ups and on a weekly basis at UHCW to try and create a more detailed support structure for these two areas, especially histopathology where there can be a real mismatch between demand and workforce.”
Then, we would say that it was capable of double loop learning.
This type of learning has been just one of the key concepts under consideration on the Leadership Programme that Warwick Business School (WBS) has been running for the University Hospitals of Coventry & Warwickshire (UHCW) NHS Trust since the autumn of 2023.
And that double loop learning? Course delegate Jamie Deas, Director of Strategy
“The leadership environment in healthcare is constantly changing as the needs of our patients and communities change.”
Andy Hardy, Chief Executive of UHCW
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Time out with purpose
Effective leadership styles
The programme: its origins and objectives University Hospitals of Coventry & Warwickshire NHS Trust is made up of seven Groups, which have devolved responsibility for most of the operational and strategic management of the organisation. Each of these Groups has a leadership team with a Group Clinical Director (generally a medical doctor), Group Director of Nursing and Allied Health Professionals and Director of Operations. This triumvirate provides leadership to the Group, with the Clinical Director being in a ‘first among equals’ relationship with their two colleagues. The Trust approached Warwick Business School to scope the potential for a senior executive programme, designed to support the individual and collective development of the triumvirate appointees. The programme focuses on building capability around Systems Thinking and Systems Leadership as well as prioritising the need for succession planning into senior roles within the Trust and the Health system. An additional golden thread is that of diversity and inclusion, acknowledging that any successful system requires curiosity, inclusion, and diversity of thinking. “Supporting leadership development is a key part of our People Strategy, ‘Valuing and Enabling our People’, which runs to 2030,” says Donna Griffiths, Chief People Officer at UHCW. “We believe that leaders that are equipped with knowledge, skill and the right behaviours will support the development of a compassionate, innovative and inclusive culture across our organisation, ensuring the very best care and experiences for the communities we serve.”
Each of UHCW’s Groups are led by a ‘triumvirate’ of professionals made up of a Group Clinical Director (generally a medical doctor), a Group Director of Nursing and Allied Health Professionals, and a Director of Operations; and the idea of triumvirates working together has been the driving force behind the Leadership Programme with WBS. However, the programme also made an impact on a very personal level, influencing individual leadership styles. “It encouraged me to be more curious, exploratory, and to seek broader inclusion,” one delegate said. Another said that they would “consider the motivations of others” and adapt their leadership approach accordingly, as a result of their learning. For Beth Harrison, a clinical haematologist, the one-to-one coaching sessions offered by the course helped her imagine herself more effectively into a leadership role that has not traditionally been her core skill set. “Understanding teams and workforces is not my natural area but the coaching helped to reinforce my personal leadership style which is focused on the big strategic picture on the one hand, and on lots of small conversations with colleagues on the other.” “I was also helped by Professor Pietro Micheli’s masterclass in Leading a High-Performance Organisation in the third module, which was interesting and thought-provoking.”
For other delegates, it was the session led by another WBS academic that stood out. “Professor Helen Bevan’s theoretical model on leadership in the second module resonated for me,” says Jamie Deas. “As a member of the Corporate Directors Grouping, and as a Director of Strategy, you’d think my main concern would be strategy, but the emphasis “One day you might be acting as a Strategist, but another you might be acting as an Expert, or Achiever, according to Bevan’s seven categories of leadership. On another day altogether, you might be taking on the mantle of Alchemist – someone who is a change maker.” “There are opportunities to go up and down this transformation ladder, and I feel this is what we did in the real world with the merger of acute and emergency of Helen Bevan’s masterclass was Understanding Action Logics and for me that was transformative.”
All in all, delegates on the Leadership Programme believe that spending time out with senior colleagues on a residential basis at the University of Warwick has been a very useful exercise. “The opportunity to jump off the NHS treadmill and refocus with colleagues from the other triumvirates without the need to report back to our Chief Officers was invaluable,” says Jamie Deas. “I also appreciated the way outside speakers like Liv Garfield, the CEO of Severn Trent, were brought in to share their thoughts on leadership too. I was struck by her leadership style, in particular, because it is so people-focused. “The programme gave us that opportunity to learn about other leaders, and space to reflect about yourself as a leader.” For Edward Hartley, the opportunity to meet up with Corporate Directors such as Jamie Deas was a major bonus. “The mixture of Clinical leaders and Corporate leaders was a real plus point because all together you had people there doing the doing, and others whose core mission was to facilitate that doing.”
with community services. We got out there, spoke to people doing the work on the ground, reframed our approaches to problems and kept people motivated. I went from Strategist to Manager and back again.” For Edward Hartley, though, it was more a case of a greater appreciation of his team’s strengths. “I don’t think it would be possible for me to inhabit some of the spaces in Helen Bevan’s hierarchy,” he says. “Understanding this theoretical model helped me to recognise the different skills people in my own team have, and the importance of having a balanced team of different talents. There are also some people in my team who definitely have the aptitude – personality-wise – to move informally between different leadership positions, and it’s important to recognise that.” Interrogating personality is definitely something new in healthcare management, the Clinical Director adds. “In the old days, you gained a leadership position through virtue of no-one else wanting it, and if you didn’t hash it up you’d be asked to step up again. “Now, though, it’s all much more considered, and the programme at WBS has been part of that careful consideration.”
But above all, Edward Hartley appreciated the opportunity the programme gave him to “explore strategy and new approaches to old problems”. “I am not one who says ‘Oh, I must apply so-and-so’s theory of change to this problem’. That’s not how my brain works,” he says. “But the WBS programme has definitely given me a framework to fall back on. I now have the tools to think my way through any issues that the Emergency Medicine Directorate might face.” Summing up her experience, Clinical Director Beth Harrison thought that the programme was well-paced and well-targeted. “The triumvirates lead high-performing teams. We need to learn at pace, and that’s what we did.” She would recommend the programme to other NHS professionals. “I think there is definitely a need to cascade this type of leadership development to future leaders.” One thing is certain: with winters in the NHS famously long, well-trained and adaptive leaders able to analyse and act upon the pressures facing the service during those times of high demand, and outside them too, will always be needed.
Professor Pietro Micheli Professor of Business performance and innovation
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Jane Cryer Programme leader
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Breaking out of the echo chamber
Tangible action
Taken on their own, though, new ideas are never enough. “The real hope is that they don’t just stay in the classroom,” says Pearce. “The expectation is that they translate into tangible action.” For that very reason, there was also a good deal of group work during the second two modules of the programme, enabling delegates from clinical triumvirates and colleagues from the corporate divisions to share plans of action on particular projects. “This is the accountability loop,” says Cryer. “The design of the programme has thrown down ideas and challenges. The question was what delegates were going to do with them. What were they going to do next?” The answers arrived quickly. Some delegates had been using the programme to inform their efforts to improve the breast screening service in Coventry and Warwickshire, securing new equipment and more staff. Others were working on bringing all community health services in the region under the same umbrella as the acute University Hospitals Trust, so that all services were managed under one integrated care board, with better patient experience of coordinated care and health outcomes as a result. Delegates such as Strategic Director Jamie Deas were able to use the programme to rehearse and reframe all the issues involved in bringing a multitude of services under one roof before the official launch of the Coventry & Warwickshire Integrated Care Board on 1 July, 2024. Ultimately, says Cryer, the Leadership Programme was aimed at achieving real change at the UHCW Trust, and fostering “a culture of continuous improvement across the healthcare system”. 2*
“There are so many daily challenges facing NHS hospitals and clinics that it can all become quite reactive,” says Dan Pearce, Director of Organisational Development at the University Hospitals of Coventry & Warwickshire NHS Trust (UHCW). “So often, we see hard-working professionals with their gaze fixed on the urgent matters needing their immediate attention and, as a result, losing sight of the bigger picture.” “Really, the only way we can regain that focus on the big picture is to create a space for people to talk and think differently”. That space during 2023 and 2024 was provided by the Leadership Programme designed by Warwick Business School’s Professor Bernard Crump 1* and Jane Cryer, and delivered by the School’s academics. “As an outsider who has also been on the inside, I know how the NHS can become mired in operational weeds and how difficult it is to get a head up and think more strategically,” says Cryer, a former NHS Manager and Director who has been designing and delivering leadership programmes for the past 15 years.
“But the aim of the WBS programme has been to emphasise to senior leaders at UHCW that they have agency, and to provide them with the right ‘provocations’ to act upon that agency.” Those ‘provocations’ have come in the form of a series of modules in the WBS programme designed specifically to “get people thinking”. There was a focus on Compassionate Leadership in the context of the NHS’s own values framework in a session led by Tamara Friedrich, Associate Professor of Entrepreneurship and Innovation, in the first module held in the autumn of 2023; while Helen Bevan, Professor of Practice, led on Systems Leadership in the second module. In the following module held in May 2024, Pietro Micheli, Professor of Business Performance and Innovation, joined Cryer to take delegates through various aspects of Managing Performance. These aspects included the communication of strategy, measurement systems, behavioural thinking, the creation of a culture of performance, as well as exploring the links between performance, improvement and innovation.
Widening the breadth of thinking was not only the remit of the modules. It was also the focus of three coaching sessions offered to each individual during the programme, as well as action learning sets. The coaching sessions included 360-degree assessments in which delegates received confidential, anonymous evaluations from their peers, while the action learning sets saw small breakout groups gather together to share insights on the challenges they were facing in the workplace. The groups consisted not only of clinical leaders but also coaches and corporate leaders. “It was all about stretching our thinking,” says Dan Pearce. “NHS leaders can spend so much time in an echo chamber with the same ideas and approaches to problems reverberating around us that it was good to meet in another forum where there was free licence for new ideas to emerge.
“It is all about a collective and compassionate learning culture where people are more respectful and understanding of each other as they embrace new ways of doing things. “From this culture, a community of senior leaders in the organisation emerges which can create a supportive environment for their staff and ultimately a better service for service users.” A community of senior leaders definitely took shape during the WBS Leadership Programme, she notes, as more senior UHCW leaders joined up in the second and third modules. Dan Pearce joined up after the first module after his predecessor at UHCW retired. Hardeep Bagga, Director of Pharmacy, and Matt Wright of Clinical Support Services were new faces on the third. As delegates left and joined the modules over the year, and triumvirate leaders moved roles over that time, creating new dynamics between the cohort, the programme had to be agile More newcomers will undoubtedly follow as Warwick Business School designs further modules on leadership and system-wide change, and UHCW continues to develop a leadership that can meet the challenges of the coming years. 1* The late Professor Bernard Crump was instrumental in creating the Triumvirate Programme and was UHCW Programme Director until May 2024 2* This draws inspiration from the five- year long partnership concluded in 2021 between the NHS and the Virginia Mason Institute (VMI), of the US. The goal of the partnership was to implement a systematic approach to quality improvement in five English hospital systems (NHS trusts). in its delivery of effective and participant-centred learning.
“I could see valuable new ideas sparking up, and real shifts in our thinking.”
The aim of the WBS programme has been to emphasise to senior leaders at UHCW that they have agency, and to provide them with the right ‘provocations’ to act upon that agency.”
Jane Cryer, Programme Leader
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