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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

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.

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

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.

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

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.

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.

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.

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.

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.

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,

organisational form

and productivity

and efﬁciency.

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.

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.

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:

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 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

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

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,

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

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 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)

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 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

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

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 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

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 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

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 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:

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 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

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 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

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 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

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 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

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 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

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 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

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 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

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 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.

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 40

Lyubovnikova, J., West, M. A., Dawson, J. F., & Carter, M. R. (2015)

24-Karat or fool’s gold? Consequences of real team and co-acting group

membership in healthcare organizations, European Journal of Work and

Organizational Psychology, 24:6, 929–950.

McKee L., West M, Flint R, Grant A, Johnston D, Jones M, and Yule S.

(2010). Understanding the dynamics of organisational culture change:

Creating safe places for patients and staff. Report SDO/92/2005. London,

UK: NIHR SDO.

McLeod and Clarke (2009) engaging for Success: enhancing performance

through employee engagement. London, Department for Business

Innovation and Skills.

Rhoades, L., Eisenberger, R., & Armeli, S. (2001). Affective commitment

to the organization: the contribution of perceived organizational support.

Journal of applied psychology, 86(5), 825. West and Dawson (2012)

Employment engagement and NHS Performance. London. The Kings Fund

Shipton, H., Armstrong, C., West, M.A., Dawson, J. (2008). The impact

of leadership and quality climate on hospital performance, International

Journal for Quality in Health Care, 20, 439–445.

Storey, J and Holti, R, Towards a New Model of Leadership for the NHS,

2013,

Wageman, R., Nunes, D. A., Burruss, J. A. and Hackman, J.R. (2008), Senior

leadership teams: What it takes to make them great. Harvard Business

School Press, Boston, MA.

West M, Topakas A and Dawson, J (2014) climate and culture for

healthcare performance. In Schneider, B and Barbera, K

West, M. A. & Markiewicz, L. (2016). Effective team work in health care.

In E. Ferlie, K. Montgomery, & R. Pedersen (eds.). The Oxford handbook of

health care management (pp 231–252). Oxford: Oxford University Press.

West, M. A., Armit, K., Loewenthal, L., Eckert, R., West, T., & Lee, A.

(2015). Leadership and leadership development in health care: The

evidence base. London: The King’s Fund.

West, M. A., Eckert, R., Steward, K., Pasmore, B. (2014). Developing

collective leadership for health care. The King’s Fund.

West, M. A., Guthrie, J. P., Dawson, J. F., Borrill, C. A. & Carter, M. (2006).

Reducing patient mortality in hospitals: The role of human resource

management. Journal of organizational behaviour, 27, 983–1002

West, M. A., Kaur, M., & Dawson, J. F. (2015). Making the difference:

Diversity and inclusion in the NHS. London: The King’s Fund.

West, M. A., Lyubovnikova, J., Eckert, R., & Denis, J.L., (2014),Collective

leadership for cultures of high quality health care. Journal of Organizational

Effectiveness: People and Performance, 1, 240–260.

West, M.A., Borrill C.S., Dawson, Brodbeck, F., Shapiro, D.A.,& Haward,

B. (2003). Leadership clarity and team innovation in health care. The

Leadership Quarterly, 14, 393–410.

Yukl, G. (2013) Leadership in Organisations ( 8th Ed.). England, Pearson

Education Limited.

Yukl, G., Tracey J. Bruce (1992) Consequences of inﬂuence tactics used

with subordinates, peers, and the boss. Journal of Applied Psychology,

Vol 77(4)

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 41

(Eds.), The Oxford handbook of organisational climate and culture. Oxford

University Press, Oxford, 335–359.

Systems Leadership

Bolden, R., Gulati, A., Ahmad, Y., Burgoyne, J., Chapman, N., Edwards,

G., Green, E., Owen, D., Smith, I. and Spirit, M. (2015) The Difference

that Makes the Difference – Final evaluation of the ﬁrst place-based

programmes for Systems Leadership: Local Vision. Project Report. University

of the West of England, Bristol

Timmins, N. (2015) The Practice of Systems Leadership, The Kings Fund

Vize, R. (2014) The revolution will be improvised, Leadership Centre

West M., Eckert R, Steward K and Pasmore B. (2014) Developing

Collective Leadership for Health Care. The Kings Fund. Center for Creative

Leadership. London

Talent Management

Campbell M, Smith R (2014). High-potential talent: a view from inside the

leadership pipeline Center for Creative Leadership

Gurvis J, McCauley C, and Swofford M, (2016) Putting Experience at the

Center of Talent Management, Centre for Creative Leadership White Paper,

HSJ, (2015) Ending the crisis in NHS leadership a plan for renewal Future of

NHS Leadership, HSJ Future of NHS Leadership Inquiry

Institute of Healthcare Management (2016) Building Future Leaders

Janjua A (2014). Leadership vacancies in the NHS: what can be done about

them? London: The King’s Fund and HSJ Future of NHS Leadership Inquiry.

Kings Fund, Leadership vacancies in the NHS (2014), The King’s Fund and

HSJ Future of NHS Leadership Inquiry

Massie, S. The Kings Fund (2015) Talent management. Developing

leadership not just leaders

NHS East Midlands Leadership Academy, Developing NHS Talent in the East

Midlands, Thematic Analysis of East Midlands Talent Interviews (2016) The

East Midlands Leadership Academy report

NHS Leadership Academy (2014), Board level search and selection from

within the NHS, Board Recruitment Survey March Research

NHS North West Leadership Academy (2016) A Strategic Approach to

Inclusive Talent Management: Talent Management

Roebuck, C (2011), Developing effective leadership in the NHS to maximise

the quality of patient care: The need for urgent action, The Kings Fund

Rowling, E (2011) The Future of Leadership and Management in the NHS,

Kings Fund

Supporting you in partnership to maximise the potential of your workforce

(2014) Health Education West Midlands, Health Education East of England,

NHS Leadership Academy, the East Midlands Leadership Academy

The Hay Group, Talent Matters, Learning for the Future (2010) Central

government talent management report

West Midlands System Talent and Succession Pulse Check (2016) prepared

by West Midlands Leadership Academy for NHS Health Education 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 42

Workforce Directorate, Department of HEalth (2009), Inspiring Leaders:

Leadership for Quality, Best Practice Guidance for talent and leadership

plans, Department of Health

Yarnell J, Lucy D (2015) Is the Nine Box Grid all about being in the top

right? Employee experiences of the Nine Box Grid. Roffey Park Leadership

Institute

Improvement

Allcock, C., Dormon, F., Taunt, R. and Dixon, J. (2015) Constructive

comfort: accelerating change in the NHS. The Health Foundation

Baker, G.R., MacIntosh-Murray, A., Porcellato, C., Dionne, Lynn.,

Stelmacovich, K., and Born, K. (2008) High performing healthcare systems:

delivering quality by design. Longwoods Publishing Corporation, Toronto

Bate, P., Mendel, P.J., and Robert, G. (2007) Organizing for Quality: The

Improvement Journeys of Leading Hospitals in Europe and the United

States. CRC Press

Bohmer, R.M.J. (2016). The hard work of health care transformation.

New Engl J Med 375 (8): pp 709–11

Chassin, M. R. and Loeb, J.M. (2013) High reliability health care: Getting

there from here. The Joint Commission.

De Silva, D. What’s getting in the way? Barriers to improvement in the NHS

(2015). The Health Foundation

De Silva, D. (2012) Quality improvement training for healthcare

professionals. The Health Foundation

Deming, W. E. (1982) Out of the crisis. Massachusetts Institute of

Technology

Dixon-Woods, McNicol, S, Graham, M (2012) Overcoming Challenges to

Improving Quality The Health Foundation

Fulop, N. and Robert, G. (2015) Context for successful quality

improvement. The Health Foundation.

Gabbay, J., le May, A., Connell, C., and Klein, J.H. (2014) Skilled for

improvement? Learning communities and the skills needed to improve care:

an evaluative service development. The Health Foundation.

Ham, C., Berwick, D., and Dixon, J. (2016) improving quality in the English

NHS. The King’s Fund

Institute of Medicine (2009) Crossing the Quality Chasm: A New health

System for the 21st Century. 9th ed. USA: National Academy Press.

Institute of Medicine (2008). To Err is Human. Building a Safer Health

System. 7th ed. USA: National Academy Press.

Jones, B. and Woodhead, T. Building the foundations for improvement.

The Health Foundation

Juran, J.M., and Godfrey, A.B. (1998) Juran’s quality handbook.

(5th Edition). McGraw-Hill, New York

Molloy, A., Martin, S., Gardner, T. and Leatherman, S. (2016) A clear road

ahead: Creating a coherent quality strategy for the English NHS. The Health

Foundation

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 43

Provonost, P.J., Berenholtz, S.M., Goeschel, C.A. Needham, D.M., Sexton,

J.B., Thompson, D.A., Lubomski, L.H., Marsteller, J.A., Makary, M.A. and

Hunt, E. (2006) Creating high reliability in health care organisations. Health

Services Research 41 (4), Part II: pp 1599–1617

Reinertsen, J.L., Bisognano, M., and Pugh, M.D. (2008) Seven Leadership

Points for Organization-Level Improvement in Health Care (Second Edition).

IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare

Improvement

Scoville, R., Little, K., Rakover, J., Luther, K., and Mate, K. (2016) Sustaining

Improvement. IHI White Paper. Cambridge, Massachusetts: Institute for

Healthcare Improvement

The Health Foundation (2011). High reliability Organisation

The Health Foundation (2014) Effective networks for improvement

Key Reports

Berwick, D., National Advisory Group on the Safety of Patients in England

(August 2013), A promise to learn – a commitment to act: Improving the

safety of patients in England, Crown.

Carter, Lord P. (Feb 2016), Operational productivity and performance in

English NHS acute hospitals: Unwarranted variations, Crown.

Dalton, D. (December 2014), Examining new options and opportunities for

providers of NHS care: The Dalton Review, Commissioned by the Secretary

of State for Health

Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust

Public Inquiry. London: The Stationery Ofﬁce.

Rose, Lord S., (October 2014), Better leadership for tomorrow: NHS

Leadership Review. Commissioned by the Secretary of State for Health

Smith, E. (March 2015), Review of centrally funded improvement and

leadership development functions, Final report of review on behalf of NHS

England, Monitor, NHS Trust Development Authority, Health Education

England, Public Health England and the Care Quality Commission.

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

April in

Gothenburg and 29

April at the Health Foundation)



Those who attended the National LDI Strategy Events (14

June in

Manchester and 21

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.

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

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