Leadership
Shared vision: The five hospital partners aspire to be the safest in the country and facilitate wider sharing of learning across the wider health system, demonstrating how culture change, alongside stable leadership, can improve patient care and save money.
Regulator responsibilities
Hospital responsibilities
Creating the right environment ■ Act in a way that is respectful, open, and transparent, with a commitment to early warning and no surprises; ■ When under pressure on wider delivery, look to the method as part of the solution, not a barrier; ■ Work with the wider system so they have understanding of method, process, and what is required to maximise benefits. Leadership ■ Support board stability and longevity; ■ Ensure systematic engagement of the whole board (including non-executives) in delivery; ■ Chief executives to personally lead the programme and visibly role-model the approach; ■ Keep commitment to deliverables, timelines, and measurement; ■ Stick to the ‘lean’ management system across the organisation; ■ Acknowledge collective responsibility with the regulator and other hospital partners around delivery of the programme and the duty to support each other. Listening, communicating and influencing ■ Maintain clear two-way communications between hospital partners and the regulator, seeking and providing feedback; ■ Foster effective internal and external relationships built on trust and agreement; ■ Ask for help and support when needed; ■ Be advocates for improvement work nationally. ■ Provide the tools and information necessary to improve practice; ■ Draw on the talents and expertise of staff across all grades and disciplines. Fostering excellence ■ Promote ambition, innovation, and continuous improvement, celebrating success and learning from setbacks:
Creating the right environment ■ Behave in a positive, respectful, and consistent way at all levels of interaction with hospitals, and be open and transparent; ■ Maintain integrity in positive partnership working even when under external pressure, and show empathy with hospital issues; ■ Be candid in offering constructive criticism and receptive in receiving it – always assuming good intent; ■ Ensure that regulator staff have sufficient understanding of the programme to interact with hospital partners in a consistent way. Fostering excellence ■ Enable and support the coaching and development of CEOs in exchange for commitment to remain in post; ■ Make available specialist expertise, knowledge, and tools to support partner hospitals. Leadership ■ Demonstrate full commitment to the programme and champion it across the whole organisation; ■ Be clear, reasonable, and consistent regarding expectations on pace and progress; ■ Facilitate consistent behaviours of other stakeholders in the hospital environment; ■ Provide professional leadership support across executive and non-executive board positions; ■ Commit to support hospital leadership and maintaining board stability, and explore avenues to reinforce that. ■ Communicate regularly and clearly with hospital partners and advocate for the programme with stakeholders and the public; ■ Build a coalition of support from the wider system to help hospital partners to implement the method and to realise the potential nationally. Listening, communicating and influencing ■ Listen and act in the spirit of shared endeavour and mutual learning to support solutions;
Commitment: The explicit psychological contract (EPC) underpinned a new relationship between the hospital CEOs and their regulator NHS Improvement
This is a reflexive process in which the regulator not only monitors hospitals but also monitors itself. Developing closer relationships with those they regulate allows them to ‘hold up a mirror’ to their own practices and how they influence a hospital’s capacity for improvement. The goal is to move beyond traditional
oversight by learning to adjust their own behaviours to better support hospital leaders in nurturing a culture of continuous improvement within their organisations. However, this shift requires a foundation that is often missing in hierarchical oversight: mutual trust. Our study, published in Public Administration Review , assessed
a five-year partnership that offers one way to enable a meta-regulatory approach that could be applied across other public-sector services. This partnership brought together the regulator NHS Improvement, five hospital providers in England, and the Virginia Mason Institute, a US consultancy that specialises in helping healthcare organisations
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