Leadership Development Needs, Delphi Project Report - Prepared by: Amanda Rodney and Professor Laura Serrant-Green, School of Health and ...
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Leadership
Development
Needs, Delphi
Project Report
Prepared by:
Amanda Rodney and Professor Laura Serrant-Green,
School of Health and Wellbeing, University of Wolverhampton
July 2013
Leadership Development Needs, Delphi Project Report, July 2013
CONTENTS
Chapter 1: Executive Summary pg. 3
Chapter 2: Introduction pg. 7
Chapter 3: Project Context pg. 7
3.1: Project aims
3.2: Project objectives
Chapter 4: Project Outline and Process pg. 8
4.1: Participants
Chapter 5: Findings Delphi Round One pg. 10
Chapter 6: Findings Delphi Round Two pg. 19
Chapter 7: Key Recommendations pg. 44
References pg. 45
APPENDICES
Appendix 1: Questions from Round 1 and 2 pg. 46
Appendix 2: Table of statements pg. 48
Contacts pg. 51
2Leadership Development Needs, Delphi Project Report, July 2013
Chapter 1: Executive Summary
Introduction:
The NHS has had a long history of staff development and improvement activities as a strategy for implementing
stronger management and leadership qualities. Health Education England (HEE), which operates 13 local education
and training boards (LETBs) has been set up to provide education and training to those in health and social care.
The focus on improving leadership training within the NHS has been a particular focal point within the NHS. This is
particularly significant given the radical changes that are set to be delivered in healthcare over the next decade.
Research by Topakas A, Admasachew L, Dawson (2011) has highlighted the importance of effective leadership and
confirms the link between quality of leadership, staff engagement and outcomes. The focus on leadership training
within the NHS has therefore become increasingly important. The Frances Inquiry report (2013) also highlighted the
importance of developing clinical leaders at all levels and therefore adopting a more inclusive approach to leadership
training. These reports and papers all have underlined the importance of “good” leadership in order to deliver high
quality health care within the NHS. There is therefore a need to identify leadership needs and priorities in local
contexts in order to develop appropriate training programmes that will inevitably produce quality leaders for the
future.
Project aim:
To utilise a Delphi framework approach to elicit consensus amongst key stakeholders across the West Midlands in
relation to regional priorities for leadership development in the West Midlands at a region-wide and LETC (local
education and training council) level.
Project objectives:
1. Identify consensus on leadership needs and priorities across the West Midlands
2. Provide comparative data on priorities identified across key professional and organisational groups
3. Identify generic or ‘big ticket’ items that have the potential to be addressed region-wide
4. Identify any local or LETC specific needs
5. Provide a qualitative analysis of stakeholder views in relation to how the and Leadership Directorate can best
support them locally
Methods:
In this study a two round, online, Delphi survey was used. The Delphi technique uses a systematic structural
approach in order to facilitate communication around a group of experts to provide a consensus. The data identifies
information where there is a gap or a problem about a specific topic (Hasson, Keeney & Mckenna 2000). The online
process of distribution and the decision to implement a two round process was devised in response to the time
constraints and to optimise ease of access to respondents at a tie of organisational change.
In a Delphi technique a questionnaire is distributed to a group of experts anonymously in order to identify areas of
consensus amongst the expert group. Consensus “is defined as an agreement in the judgment or opinion reached by
the group as a whole” (Princeton University 2006). Experts agree that gaining 100 per cent consensus is unlikely and
the few studies that have been identified on this issue have been “arbitrary and ranged widely from 51%-
80%”(Keeney S, Hasson F, McKenna H 2006). This study will aim to achieve a majority of over 50% agreement within
2 rounds. The first round consisted of questions directly imported from the paper based questionnaire provided by
the WMSHA as this had already been used for some stakeholders, which they wanted to include in the Delphi. In the
second round the respondents were resent the questions from round one with some modifications and indications
of views from round one.
3Leadership Development Needs, Delphi Project Report, July 2013
Key findings:
Seventy-three respondents completed the survey. A summary of the findings is presented below;
1. One of the main themes that the respondents identified was the need for greater “clarity and clearer
objectives” from the organisation. Comments were made such as “Clearer vision of the programme and its
benefits”. This was felt to be particularly important due to the current and uncertain changes occurring
within the NHS.
2. Accessibility was another area of concern as many expressed a need for greater access to programmes for
all cohorts and not just the “chosen few”. There was also a need for greater accessibility for all organisations
– utilising clinical networks.
3. Practical issues about the programme design and delivery were also raised, for example programmes
needed to incorporate enough time to “demonstrate appropriate skills”. Realistic time frames and periods
were also highlighted as essential by the respondents.
4. Integrated Approach to leadership – respondents highlighted a need for NHS organisations to continually
work closer together, for example sharing information about what works and what doesn’t across
organisations.
5. A need for measurable objectives was identified by many respondents in order to assess the benefits of
the programme. Many felt the need to evaluate and obtain feedback from both the trainee and the sponsor
and others also included patient feedback to be vital.
6. Coaching and mentoring were two areas that were highlighted as requiring greater inclusion.
Ninety-seven respondents completed round 2. Respondents highlighted similar concerns that were expressed in the
first round of the Delphi. The follow findings represent additional areas highlighted from the first round of the
Delphi.
1. “Programmes need to be specifically tailored to the new roles and organisations with the NHS.” This
highlights the importance for commissioners to ensure that any programme should be relevant, applicable
and effective within the current “changeable” environment.
2. A significant number referred to the importance of the development and focus of “team leaders” as this
group was felt to have the potential to make “real” practical and cultural changes. Some also explained that
team manager roles were “highly demanding and critical to sustaining delivery of high quality services amidst
constant change”. This group was therefore felt to be critical in shaping front line staff while simultaneously
having the potential to being future directors and executives.
3. Talent management was another area mentioned as a mechanism for being able to track people in the long
term in order to see what difference the programme may or may not have made.
4. Others reflected that resources and time out alliance was “currently inadequate”. This area was felt to be
important particularly given the progressively reduced resources and workforce numbers – “resources will be
key”.
4Leadership Development Needs, Delphi Project Report, July 2013
5. Many felt that in the long term – it was important to develop a robust “feedback loop” to provide continuous
assessment of the impact of the training.
6. Generally respondents felt that some type of feedback from both patients and staff were necessary in order
to measure and track the impact of future programmes.
7. Business acumen, political experience along with a patient focus was identified by some respondents as
being vital areas to ensure effective leadership in the future. “Resilience training” was another area that
many respondents felt needed to be developed given the current unsettled structure of the NHS.
8. Team working was also seen as an essential area to develop and that this was a crucial area of effective
leadership. “Leadership will still be about relationships and engagement with teams”. Respondents expressed
the need for future leaders to be more “in touch” with their staff.
9. Respondents felt that future leaders would need to embrace technology, such as social media in the future.
This was felt to be important as it could help ensure greater” transparency” and “openness” for staff, patient
and service users within the NHS in the future.
10. The issue of continuous support was expressed by many respondents as a paramount to developing effective
leadership.
Recommendations:
Need for leadership development which produces leaders who are “business focused” and “entrepreneurial
spirited” and politically aware. With skills, courage and ability to innovate as well as fulfil management goals
Training that builds resilience in managers and their awareness of how to use emotional intelligence in the
workplace
Clearly identified and measurable the core skills for leaders which include and reflect the need for important
team working
Intersectional development of leaders so they are aware and gain experience of the related organisational
structures and the challenges e.g. medical staff to understand the business, and the commensurate
opportunity for general managers to gain insight into clinical pressure
Leadership development and CPD working practices which support and enable greater collaboration
between organisations (NHS/local authority, public health, voluntary sector)
Leadership development across the professional spectrum from undergraduate/non-clinical to senior levels.
All leaders should be developed and “not just the chosen few”
Need to “enhance” nurse leadership so it truly leads practice and innovation of self and whole care team.
Not just focused on managing localised clinical practice
5Leadership Development Needs, Delphi Project Report, July 2013
Mentoring and coaching as vital component and should be an integrated part of leadership programmes and
CPD offer in order to ensure an effective outcomes
Leadership development of staff and to communicate this clearly and in an accessible way
6Leadership Development Needs, Delphi Project Report, July 2013
Chapter 2: Introduction:
The NHS has had a long history of implementing stronger management and leadership qualities. Reports such as
Cogwheel report in 1967 which called for greater involvement of clinicians to the Griffiths report in 1983 which
highlighted the importance of doctors as a central role within the management structure. There has been an
increasing focus on the involvement of GPs in management which was sought initially by the last labour government.
More recently Lord Darzi’s Next stage Review final report (Department of Health 2008) also placed a significant focus
on clinical leadership. The recent health reforms with along with The Health and Social Care Act 2012 also placed
clinicians at the centre of commissioning. Health Education England (HEE) which operates 13 local education and
training boards (LETBs) has been set up to provide education and training to those in health and social care.
Along with the recent Francis Report, which identified poor leadership as a critical factor in the failing’s patient care
found in Mid Staffs NHS Foundation, the focus on improving leadership training within the NHS has been a particular
focal point within the NHS. This is particularly significant given the radical changes that will occur within healthcare
over the next decade. Research Topakas A, Admasachew L, Dawson (2011) has highlighted the importance of
effective leadership and confirms the link between quality of leadership, staff engagement and outcomes. The focus
on leadership training within the NHS has become an increasingly important area within the NHS. The Frances report
also highlighted the importance of developing clinical leaders at all levels and therefore adopting a more inclusive
approach to leadership training. These reports and papers all have underlined the importance of “good” leadership
in order to deliver high quality health care within the NHS. Therefore, there is a clear need to identify leadership
needs and priorities in order to develop appropriate training programmes that will inevitably produce quality leaders
for the future.
Chapter 3: Project Context
The National Leadership Academy has been in operation since April 2012, its purpose is to develop outstanding
leadership in health improving the experiences and health outcomes of patients and service users. The Programme
Board, chaired by Sir David Nicholson, met for the first time at the end of September.
The local delivery arms of the NHS Leadership Academy (the Academy) are known as Local Delivery Partnerships
(LDPs). The Academy will be responsible for:
• The National framework for leadership development and talent management alignments
• Leadership of national programmes
• Advice, support and input on emerging policy
• Best practice guidance and support
• Research, horizon scanning, strategy development
Local Delivery Partnerships will be responsible for:
• Communicating local needs and intelligence to inform national strategy and priorities
• Identifying, sharing and spreading best practice
• Local support for the national delivery of the Talent Management Strategy and processes
• Support and delivery of the Academy funded programmes
• Delivering locally agreed priorities
A decision was made by the Board of Health Education West Midlands - HEWM (the LETB for the West Midlands) to
develop the West Midland LDP to be integrated as a Directorate of HEWM.
7Leadership Development Needs, Delphi Project Report, July 2013
Governance of the Leadership Directorate will be through the HEWM Board, which brings together 5 local education
and training councils (LETCs) in the West Midlands region. To secure wider stakeholder engagement in shaping and
developing the West Midlands approach to leadership and talent management a West Midlands Leadership Forum
will act as the key reference group, with each LETC being represented on this Forum.
To ensure that the Leadership Directorate vision, operating principles and investment priorities reflect a fully
engaged, locally led and evidence informed approach, Forum members agreed that an initial scoping should be
carried out using a rigorous consensus approach (Delphi or modified Delphi study).
Project aim
The Delphi framework will distil consensus amongst key stakeholders across the West Midlands in relation to
regional priorities for leadership development in the West Midlands at a region-wide and LETC level.
Project objectives
1. Identify consensus on leadership needs and priorities across the West Midlands
2. Provide comparative data on priorities identified across key professional and organisational groups
3. Identify generic or ‘big ticket’ items that have the potential to be addressed region-wide
4. Identify any local or LETC-specific needs
5. Provide a qualitative analysis of stakeholder views in relation to how the and Leadership Directorate can best
support them locally
Chapter 4: Project outline and process
The Delphi framework was originally identified by West Midlands Strategic Health Authority (WMSHA) as their
method of choice for identifying leadership development needs for the newly proposed Health Education West
Midlands, Leadership Directorate. WMSHA believed that utilising the Delphi approach would be the most
appropriate method to distil consensus amongst key stakeholders across the West Midlands in relation to regional
priorities for leadership development in the West Midlands at a region-wide and LETC level. In addition, the WMSHA
had begun to collate information via a paper based questionnaire from some of their stakeholders and requested
that any Delphi study incorporate the responses already supplied. The Centre for Health and Social Care
Improvement at the University of Wolverhampton devised and completed a modified Delphi study in response to
the requirements of the WMSHA.
In this study a two round online Delphi survey was used. The Delphi technique uses a systematic structural approach
in order to facilitate communication around a group of experts to provide a consensus. The data identifies
information where there is a gap or a problem about a specific topic (Hasson, Keeney & Mckenna 2000). The online
process of distribution and the decision to implement a two round process was devised in response to the time
constraints and to optimise ease of access to respondents at a tie of organisational change.
In a Delphi technique a questionnaire is distributed to a group of experts anonymously in order to identify areas of
consensus amongst the expert group. Consensus “is defined as an agreement in the judgment or opinion reached by
the group as a whole” (Princeton University 2006). Experts agree that gaining 100 per cent consensus is unlikely and
the few studies that have been identified on this issue have been “arbitrary and ranged widely from 51-80%”(Keeney
S, Hasson F, McKenna H 2006). This study will aim to achieve a majority of over 50% agreement within 2 rounds. The
first round consisted of questions directly imported from the paper based questionnaire provided by the WMSHA as
this had already been used for some stakeholders, which they wanted to include in the Delphi. In the second round
the respondents were resent the questions from round one with some modifications and indications of views from
8Leadership Development Needs, Delphi Project Report, July 2013
round one. The aim was is to optimise the reliability of responses at the first stage and get further views on the
validity of issues raised in that round.
4.1: Participants Round One
The invitation to participate in the survey was sent to 222 professional and organisational groups in the WMSHA
area. The email addresses were provided by the WMSHA leadership directorate to the researchers from their
existing stakeholder lists. All suggested respondents were contacted by WMSHA via email in advance to alert them
to the purpose of the Delphi and to introduce the researchers. Following receipt of the names to be contacted and
their email addresses the researchers devised the round one questionnaire and these were sent via SurveyMonkey
Software to the identified contacts. Respondents were asked to respond to 10 questions about their views on
leadership and development. Within a week 55 respondents replied. A further reminder was sent out to all those
that had not responded (191) to the first survey. The total response rate rose after the reminders to 73. In line with
the Delphi process, round 1 data was collated and feedback to the respondents in order for them to complete the
survey again in light of the feedback from round 1.
The survey contained a mixture of multiple choice and short answer questions. The findings are presented below by
question per round with graphical representation used for the multiple choice responses. A full list of the questions
included in both round can be found in Appendix 1.
9Leadership Development Needs, Delphi Project Report, July 2013
Chapter 5: Findings Round One
Respondents: 73 respondents responded in round 1. The following section will now present the feedback from the
1st round of the Delphi survey.
Chart 1: Length of time worked in current post
The majority of the respondents in round 1 had worked in their current role for at least a year. The initial view
suggests that there is a relatively higher number of inexperienced staff, however there should be some caution
placed here as the changeover from one organisational structure to another had already begun at the time of the
Delphi, this means that ‘new roles’ cannot be automatically equated with inexperience.
10Leadership Development Needs, Delphi Project Report, July 2013
Chart 2: Current position in the workplace
The vast majority of staff responding to the round 1 survey worked in service priority areas and commissioning. This
was not surprising as leadership development and prioritising of service issues are traditionally a key part of the role
at this level within the NHS. No responses were received by the end of the first round from either voluntary services
or Public Health directors. The change over occurring within Public Health (from health to local authority - LA
control) as well as the cuts in voluntary and charitable funding occurring at the time of the survey may have
impacted on this. Possible changes in personnel responsible for health leadership (in LA and Health) as well as the
closure of some voluntary agencies due to funding constraints are among some of the possible issues affecting the
responses. With the move to a more collegiate approach to leadership from the frontline to the boardroom
following the Francis report, this was an important consideration in discussions with the new directorate when
reviewing possible additional stakeholders to be included in round 2.
Q3. Who are the leaders that they think should be developed?
The majority of the respondents indicated that leaders at all levels should be given the opportunity for leadership
development and not “just the chosen few”. The group that the respondents felt should be most eligible for
leadership development were clinical leaders and directors followed by senior management and middle
management. Generally respondents highlighted that any staff member who leads or manages a team should have
the opportunity to have leadership development. Middle management included ward sisters, ward management,
and team managers.
Senior management was the next group of people that respondents identified as need for leadership development.
One respondent related that they felt senior managers would then be able to implement and inform the information
11Leadership Development Needs, Delphi Project Report, July 2013
that they had acquired to their staff. Thus the information would gradually be filtered down through the whole
organisation. Development in senior management was particularly important for some respondents if the intention
was to implement a “different leadership of culture across the new NHS system”.
Respondents also commented that they felt clinical leaders particularly needed development given their new clinical
roles, for example GPs and consultants on governing boards. This was felt to be particularly significant for those who
were developing new roles for example in commissioning.
Q4. What do you think needs to be different about the way leadership development is delivered?
Many respondents indicated that they felt that there should be a variety of approaches to leadership development
and not just leadership courses. There was a clear emphasis that leadership development needed to be personalised
for different groups/levels. This was felt to be important due to different groups having individual needs.
The respondents’ responses were varied and focused on different aspects on the how leadership development
should be delivered. There were three areas that the respondents focused on these were,
The structure of the leadership programme,
The programme content and
Who should be the best candidates to develop for future leadership?
Programme structure
Some recurring comments were around the structure of the leadership course. For example some respondents
expressed that respondents should be given adequate time to be informed about the courses along with providing
enough notice about the delivery of dates. Others stressed the importance of “succession planning” and having the
knowledge that the course was not just a “one off”. While other respondents commented on the length of course
highlighting that ideally courses should not be over a long period but in “short intensive blocks”. Some also felt that
it would be more productive for programmes to be delivered in small group sessions with “bite size topics” ensuring
that there was enough time to discuss issues raised. GPs particularly highlighted that it was often difficult to find the
time to attend a course and indicated that half days instead of whole days would be more practical given their time
restraints. Other groups expressed the importance of ensuring that there was sufficient time allocated for new skills
to be “learned and demonstrated”. The general feedback from respondents therefore indicated the importance of
allocating sufficient time for the course. It was also felt that more intensive and shorter sessions would be more
beneficial for the participants.
Programme content
A large majority of respondents focused on the content of the leadership course. Some respondents expressed the
benefits of using “experience” as part of the course for both course leaders and attendees, while others related the
courses that they had previously attended were “excellent” due to the wealth of experience that the staff delivering
the programme had. This was reinforced by other respondents who related that “experience based learning” was a
priority, and felt that learning should generally be more interactive. “Action based learning” was one method that
was quoted by a few respondents emphasizing that it encouraged greater discussion and reflectivity. As one
respondent summarised the importance of “learning rather than theory and didactic lectures” was key. Others felt
that action based learning was particularly useful method for networking and sharing information. As one
respondent described;
“Action learning set are an invaluable way for leaders to reflect, change and develop...”
The theme on reflexivity was expressed by many respondents as they highlighted the importance of a balance
between directly delivered learning and self/reflective learning. Some felt that a challenging programme of
activities, which included “thought provoking” issues and involved a critique of change process which generally
encouraged candidates out of their comfort zones, would be fundamental. Moreover by exposing candidates to
12Leadership Development Needs, Delphi Project Report, July 2013
other experiences and people’s point of view would ensure a more reflective approach. However there was a
general sense that current leaders needed to be challenged in their continuing development and many highlighted
the benefits of utilising different approaches for differing grades of staff.
Others were keen on presenting “real issues and problems” that could be discussed and reflected with peers.
However while some felt that more locally focused leadership programmes would be useful such as a LETC type
footprint, others felt there was a need for more external programmes to be commissioned to the Trust which would
in turn develop further networking between organisations.
Some respondents felt the need for some type of standardisation; for example an agreement of “common care
content and standards with flexibility” that would enable additional programmes to be added onto the core
depending on organisation and individual need. Again others reinforced this by explaining that the programmes
should be delivered by each Trust “meeting their objectives and demands……Trusts know what they want or need
and do not want prescribed courses.”
Who should be leaders?
There was a degree of consensus that leadership should involve a range of people and a sharing of expertise and
knowledge not simply focused on skills and abilities currently among care workers in the NHS. Respondents’
highlighted that this mixed approach to leadership development was crucial in order to ensure continual learning
and sharing from each other and other associated organisations. “Visit and learn from other organisations” was one
suggestion from a respondent. While others expressed the significance of understanding the “broader political
agenda” through visiting and working in commissioned organisations along with voluntary and social care sectors.
This was felt to be important, in order to create general sense of “shared learning to build shared understanding of
patient focus”.
Another area that was highlighted was the need to have a more business focused approach so that “real results”
could be seen as a result of investment. As one respondent commented,
“Too few people in the NHS have a finance background (or indeed comprehension or passion)”
It was expressed by some that finance should not be left to the accountants and that there should be a greater focus
on “simple business tools” within programmes. Others thought that the programmes should also include a
comprehensive course on the legal framework (including information governance, patient choice and rights,
contracting etc.). Other areas that respondents felt needed to be developed were the development of emotionally
intelligent leaders in order to support the changing NHS. This also included greater emphasis on mentorship,
coaching, and relationship management. Others areas identified were around measurable and visible behaviour
change and competence improvement rather than qualification or credits.
Q5. What do you believe needs to be different about the way leadership development is COMMISSIONED and
why?
The respondents had a wide range of ideas as to how leadership development should be commissioned. Some felt
that leadership development needed to be commissioned more effectively by;
“Investing in a pool of in-house associates/coaches/trainers that are employed by the NHS”,
As it was felt there would be a better investment in order to develop skills and competences within the organisation
rather than utilising external organisations to “dip in and out for key products”. While others specifically expressed
that they felt that leadership development should only be commissioned “when attached to developmental role or
when identified as part of a management process.”
Generally it was expressed that a well thought out accredited course should be commission along with ensuring a
backfill from each organisation. Another respondent highlighted that they felt a more structured approach was
13Leadership Development Needs, Delphi Project Report, July 2013
important and therefore felt that leadership development should be commissioned “in conjunction with a university
and established more as a recognisable master’s degree”.
In theory it was felt that this would therefore ensure greater commitment from the respondents. This was reiterated
by respondents who felt that leaders should start from undergraduate students though to directors. There was also
a general need for programmes to be more service specific taking into account the vision and aims of the
organisation. Respondents felt that programmes needed to ensure it could motivate leaders to;
“move the future agenda for the NHS forward with courage to make hard decisions.”
Again many expressed the need for a “consistent approach” to leadership development that was relevant across
services. As one respondent summarised;
“It needs to be simple, common sense and deliverable at a local level.”
Others noted the need for leadership to be commissioned in a way that would;
“Clearly address the business needs and drivers within the locality.”
Respondents felt that it was important to consider the local values and culture. Many respondents felt a need for
greater local input and more “visibility in localities”. With one respondent stating that local areas needed to develop
talent pools “to better understand potential fit to organisations”. One respondent felt that it would be more
beneficial to give the Trust their own budgets in order to invest in their own leadership strategies as they expressed
that commissioning external consultants was not necessary the “right approach”. Others related the need for greater
cohesion with local programmes at Trust level with;
“Trusts with different skills sets/ programmes delivering elements at other national/ regional programme.”
There also seemed to be a general consensus that there needed to be more programmes that were commissioned at
a regional/national level. It was felt that this would help encourage greater integration across services with a more
consistent approach to patient care and delivery. Respondents indicated that there had been too many programmes
commissioned at a provider’s level, which had often led to “inconsistent approaches”. They therefore concluded that
“collating and summarising regional needs” would ensure a more efficient use of resources and in time develop a
regional leadership talent pool which would have the benefits of supporting the development of leadership training.
Other also restated the importance of developing an effective evaluation process which could be part of the
commissioning process in order to identify the benefits of investment.
Q6. How to measure and track the impact of anything that we might commission to ensure it meets our need and
contributes to making an impact on improving patient experience and outcomes on an individual level/
organisational and provider level?
Respondents felt organisations needed to have a more “strategic vision” which had a clear message of the vision and
objectives of the organisation and that these concepts should be continuously reinforced. Many respondents
highlighted the need to ”identify”, “define” and “understand” the initial outcomes as the starting point. This was
important in order to establish how to measure the outcomes in the first place. There was a general emphasis on
obtaining clarity from the organisation, such as, the general goals and outcomes that were expected. Respondents
felt that it would be useful for those undertaking or sponsoring courses to have a “clear plan of what the learner can
achieve following the training”, while in the long term having a clear picture of the “vision” and “goals” and
expectations of providers, sponsors and learners. The respondents also felt that there was a need to monitor staff
14Leadership Development Needs, Delphi Project Report, July 2013
and patient experience and compare over time to “other service areas where training not taking place. As one
respondent suggested;
“Key deliverables identified at onset of programme… measures could then be measured and shared through an
evidence based evaluation strategy.”
Many therefore felt that an initial assessment of “individual and organisations intended programme outcomes”
would be valuable. Many respondents also expressed a need therefore to evaluation the benefit/ effectiveness and
value of the programme.
An evaluation of the expectations of the programmes in the first place was recognised as important. Some
respondents focused on the organisation while other on the managers’ expectations of the programme. Evaluations
or feedback from the respondents as to how they felt the programme had impact upon their performance or had
helped enhanced their skills were recognised as crucial. Other expressed the need for a more longitude approach in
order to assess the real benefits of those accessing leadership interventions. One respondent felt that it was
important to commission a programme that would “hit” as many people as possible and that would ultimately
“incorporate most organisational needs.” Many expressed the importance of ensuring that the programme reflected
the organisations goals and while also developing individual needs.
A large percentage of respondents indicated that there needed for an evaluation/feedback following the programme
(i.e. if they would recommend the course to others). One respondent related that there should be no need to create
a particular method for measurement as there were “thousands of metrics already” to choose from. A variety of
measurements were suggested for example; feedback from patients, NRI, impact assessments such as an evaluation
of impact on the patients at different stages, 360 feedback, incident reports, development of KPI that included
patient outcome measures, friends and family test “(despite its acknowledged flaws)”, staff and patient survey
results, patient stories, measurement of level of engagement of activity pre and post programme, observation of
care, delivery of QiPP, CQuin targets reduction in SUI which were recommended by the respondents.
A general focus on return of investment was also highlighted by some respondents. Some suggested using the
Kirkpatrick model or the Jack Philips model of ROI (Return on Investment). The Paul Kearns was suggested as the
ideal ROI model by one respondent. Furthermore some felt that if these goals were not achieved then they should
be held accountable and made to explain “why”. One respondent also felt that service users/ carers should be
involved in developing the ROI/ROE framework. As they felt that it was important for the carers and users to have
greater input into the actual design and delivery of the programme. One respondent also suggested a need to
explore what the patients expected from quality leadership and whether the programme actually met these
expectations.
Others highlighted the importance of monitoring quantifiable metrics regarding health of the team (staff turnover,
absence, PDR compliance, staff survey outcomes, patient survey outcomes etc.). One respondent felt that if a
programme had been commissioned externally the provider should have to agree a “6 month evaluation to assess
the long term transference”. Others suggested that each candidate should have to complete “an individual learning
plan and a reflective journal” along with a mentor and supervisor to monitor progress or follow up by email in order
to identify any benefits of the programme.
Evaluating/monitoring how many respondents progressed within their career on to higher leadership roles internally
or external to the organisation was also suggested as a way to “profile individuals after a year to see progress”.
While some respondents suggested that need to monitor patients experience in order to identify the benefits of the
programme many acknowledged that this may prove difficult to collate that type of information. One suggestion was
15Leadership Development Needs, Delphi Project Report, July 2013
to monitor the number and type of complaints; however they did acknowledge that this would be a challenging
process given that most measures would be multifactorial.
Q7. How to achieve greater alignment to the development we provide and the expectation managers have…?
“We all have very different concepts of what makes a good leader and it’s all about finding the right mix that is suited
to the organisation and the individual.”
‘Leadership development is rather like marketing “half of what you spend is wasted, but who knows which half”’
The above quotes illustrate the respondents’ recognition of the difficulties in determining the right mix and focus for
leadership development that would be appropriate for changing NHS. There was general consensus on the need for
a greater dialogue between stakeholders across a range of levels in the service around expectations and benefits of
the programme with “agreed set of measurable outcomes”. Many felt that to have greater alignment between the
development provided and the expectations of line manager was to have greater communication. Respondents also
related the importance of involving senior managers in the development of the course. A large number of
respondents reported that they felt line managers and staff needed to be asked what they required, as one
respondent related;
“Stop guessing and do some detailed needs analysis by profiling managers”
Many respondents reinforced that managers need to be approached beforehand to provide the appropriate
information. Other suggestions made were around utilising the feedback from managers about previous courses to
structure future courses, this included seeking the “expectations of the programme at nomination/application
stage.” As one respondent stated;
“Engagement matched to the line manager needs through the use of pre-learning diagnostics, 360 feedback tools
and learner led objectives linked to service improvement strategy.”
Once the objectives and key deliverables have been set from the onset of the programmes they felt that it should be
review on a longitudinal basis following the programme i.e. at 6, 12 and 24 months which could then be shared
through an “evidence-based evaluation strategy”.
This links into the importance of ensuring clearer communication is made by the organisation in order to inform the
line manager as to what they should expect from the course which would in turn prepare the line manager for the
return of their colleagues.
Again many emphasised the importance of clearer, measurable or demonstrable outcomes so that managers could
have realistic expectations. In general the importance of more comprehensive information being communicated to
staff at all levels was recognised as vital. As on respondent asserted;
“Establishment of clearer objectives with clear ROI/ROE framework and evaluation mechanism will enable a clearer
understanding of the benefits of the programme.”
Another respondent also suggested comparing the NHS with other leading organisation to establish what the leaders
of the NHS will need to “look like what skills they should have” in the future would be valuable. They felt a gap
analysis would also help clarify what the leadership course will need to deliver and achieve, which would in turn help
identify the criteria for suitable candidates for the course, as they concluded;
“This is evidence-based commissioning for outcomes, in action”
16Leadership Development Needs, Delphi Project Report, July 2013
Others felt that it was important to set some key deliverables/outcomes for different management levels that Trusts
could then build into their local programmes. One respondent felt that Leadership development should be a part of
“performance objectives and included within appraisal.”
Expectations were recognised as crucial in order to of “understanding what leadership was about” and what
programmes could therefore deliver these “skills/competencies/behaviours attitudes.” It was also felt by some
respondents that courses needed to be modified if there was no alignment between the course and the feedback.
Other expressed that it might be beneficial to have an output from the program that was related to a project, which
had been previously negotiated with the line manager.
Q8. Main priorities for leadership development
“Leadership courses need to deliver and achieve”
- It was felt that more opportunities for organisations to share and to access information, experts’ toolkits etc.
As one respondent reinforced that smaller organisations tended not have as much opportunity to access
these resources and funding compared to the larger organisations. Clarity and consistency were also
frequently used words to describe what the respondents required from the organisation.
- There was a split between respondents feeling that there was a need for the programme to be more like a
qualification (more formally assessed or accredited) while others expressed that there should be more of a
focus on “self-awareness development and behavioural change rather than qualification”.
- Clearer organisation vision/objectives/values/cultures communicated were strongly emphasised by the
respondents. Along with listening to organisations to ensure appropriate local support and delivery.
- Many felt that it was important to produce leaders that would have the “vision, skills, knowledge ability and
communication techniques to lead large organisation through big changes.” Along with leaders who can
develop and “nurture” the future generations to become effective leaders.
- Many highlighted the priority to focus on all staff for example, front line (who can make a real difference),
senior managers (who can implement the cultural change required) and director level (to articulate the
strategy and support with implementation and monitoring). Along with developing team leaders “who can
take forward the challenges of increased demand on services and restricted resources.”
- Some respondents mentioned any priorities should be guided by the Francis recommendations and the
importance of how each individual can make changes in their areas. Others felt that talent management and
mapping were really critical.
- Others felt it would be beneficial to have a consistent approach to leadership across the region and that it
was necessary to ensure that enough places were provided on commissioned programmes to meet the
development needs of all staff - suggesting that if this was not possible Trusts should be provided with
adequate funding to develop capacity within their own organisation. Many also felt that leadership
development should be “in a structured manner across career frameworks”.
- Some respondents particularly prioritised regular staff training that can be easily accessed locally so that they
can have the opportunity to improve their current roles for future promotion.
- Others commented on the importance of working across boundaries and borders.
17Leadership Development Needs, Delphi Project Report, July 2013
- Coaching styles of management and its role in performance management was felt to be important, as one
respondent clarified, it would help in the delivery of QiPP and delivery for patients and also further
development of mentoring.
- Understanding finance, budgets and targets was another area prioritised.
- Some felt the need to focus on talent management and “scoping the talent pipeline across the West Midlands
to ensure that there is a decent pool of recognised staff with the potential to become leaders at all levels.”
- The importance of collaborative and integrated working was an area that many highlighted particularly in
complex and challenging environments. Building trust between organisations. “Learn to build a collaborative
common understanding”. Particularly developing the commissioner provider relationship.
- Many prioritised nursing leadership or clinical nursing commissioners requiring leadership.
- Local regional database of leadership development programmes “for information and awareness.”
- Others focused on developing managers, ensuring that they had enough time “to care and value their staff”.
- One respondent highlighted that while results/productivity were important against business drivers/
objectives this should not be at the “expense of compassion and care for service users, carers and staff”. Thus
ensuring the right values and balance within organisations were incorporated.
Round 1 Summary:
o One of the main themes that the respondents identified was the need for greater “clarity and clearer
objectives” from the organisation. Comments were made such as “Clearer vision of the programme and its
benefits”. This was felt to be particularly important due to the current and uncertain changes occurring
within the NHS.
o Accessibility was another area of concern as many expressed a need for greater access to programmes for
all cohorts and not just the “chosen few”. There was also a need for greater accessibility for all organisations
– utilising clinical networks.
o Practical issues about the programme design and delivery were also raised, for example programmes
needed to incorporate enough time to “demonstrate appropriate skills”. Realistic time frames and periods
were also highlighted as essential by the respondents.
o Integrated approach to leadership – respondents highlighted a need for NHS organisations to continually
work closer together, for example sharing information about what works and what doesn’t across
organisations.
o A need for measurable objectives was identified by many respondents in order to assess the benefits of the
programme. Many felt the need to evaluate and obtain feedback from both the trainee and the sponsor.
While expressed that patient feedback was also vital.
o Coaching and mentoring were two areas that were highlighted as needing greater inclusion.
18Leadership Development Needs, Delphi Project Report, July 2013
Chapter 6: Findings from Round Two:
Overview:
Round two was initiated a month following completion of round one. Additional names were provided by the new
HEWM leadership to be included here in response to role changes and personnel changes following the new
directorate launch in April 2013. Furthermore the new directorate staff also highlighted possible contacts in public
health and voluntary sector agencies in response to the lack of responses from these sectors identified in round one.
The findings presented here indicate comparisons with round one data where relevant as well as pure round 2
findings in line with Delphi methodology.
Prior to commencing round 2, a meeting was held between the researchers and the new Leadership directorate to
ascertain the nature of the Delphi survey conducted so far and its possible role in future development. As a
consequence the new directorate requested the inclusion of some more descriptive profiling of respondents in
round 2 and a broader fielding of the survey to staff who had recently taken up their roles. Therefore the first few
charts in the findings below reflect the more detailed demographics of the respondents to rather than their direct
responses to questions about leadership (Charts 3-7).
Charts 8 to 13 reflect the responses collated from round 1 and these are identified as statements. These charts
contain abbreviated statements and the full statements can be found in Appendix 2 on page 48.
The invitation to participate in the survey was sent to 339 professional and organisational groups in the West
Midlands region. Within a week 47 respondents replied. A further reminder was sent out to all those that had not
responded (292) to the first survey. The total response rate rose after the reminders to 97.
Respondents:
The largest group out of the 97 respondents were from the nursing sector followed by the administrative sector.
Other groups that responded were from finance (2), management (10), education (2), HR (3) and a nursery nurse (1).
In round 2 the number of years that the respondents had worked in their current post ranged from under 12 months
to over 20 years. In both rounds the largest number of respondents that replied had been in the post between 1-5
years. However in round 1 the second largest group that replied had been in post less than 12 months whereas the
next largest group in round 2 had been in post over 20 years.
The majority of the respondents in round 2 were from senior management (47.1%) followed by middle management
(17.4%). The majority of these respondents were from a provider background such as a hospital (79.3%). With the
majority from Birmingham (30.3%) followed by Shropshire (19.1%) and Staffordshire (18.0%)
Following round one the question of role was modified to include a question identifying the professional background
of respondents as well as a linked question to ascertain the amount of time in that role. This was felt to be a more
useful indicator than the simple identification of ‘role type’ used in the round 1 question, thus providing more insight
into the nature and spread of professionals contributing to the evaluation. These findings are illustrated in charts 3
and 4 below.
19Leadership Development Needs, Delphi Project Report, July 2013
Chart 3: Professional background of respondents
This illustrates that the highest percentage of staff responding were Nurses (over 25%) by professional background,
closely followed by administrative staff and a range of ‘other staff’. AHP comprised less than 16% of the sample in
round 2 with medical staff making up just over 6% of the sample. The smallest group self-classified as ‘other clinical
managerial’. While the new directorate is in its first stage of adjustment it is unknown whether this reflects the
percentage division of professional groups. This would be something to monitor in future evaluations if a reflection
of the Trust professional profile is imperative to future monitoring.
20Leadership Development Needs, Delphi Project Report, July 2013
Chart 4: Length of time in post
Chart 5 below illustrates responses to the question of level of functioning within current roles in the Trust. This was
an important indicator to monitor whether in line with points raised in round 1, responses were being sought from a
range of frontline leaders/managers as well as those at a more senior or strategic level.
21Leadership Development Needs, Delphi Project Report, July 2013
Chart 5: Professional operating level
This chart demonstrates that the majority of respondents are operating at a senior management level. It is not
possible to determine whether ‘senior manager’ reflects the current job title or the individuals’ appraisal of their
roles. However, all respondents self-assigned their own judgment as to the level of their relative position within the
organisation and so this provides a useful reflection on personal and professional appraisal of relative position and
therefore at the very least bears some relation to perceived responsibility to leadership and contributions to
leadership within the Trust. It does illustrate that despite a broader inclusion of names of staff and roles in round
two in an attempt to capture more ‘front line’ and voluntary service providers, this was not successful. A result
which is further borne out in Chart 6 which illustrates the nature of the organisation in which respondents were
employed at the time of the survey. In round two there was still a lack of responses in the same areas as round one.
This may well be something which could be addressed more directly through any focus groups, direct interviews or
consensus events which follow this Delphi.
22Leadership Development Needs, Delphi Project Report, July 2013
Chart 6: Nature of employing organisation
Chart 7: Geographical location within the West Midlands region.
23Leadership Development Needs, Delphi Project Report, July 2013
Chart 7 illustrates a relatively good spread of responses from across the West Midlands region. Responses were
received from the major conurbations as well as the rural parts of the region. This gives a relatively clear assurance
that the issues raised are reflective of the West Midlands region as a whole and not simply a single locality
viewpoint.
The remaining charts and findings in this section relate directly to the questions posed previously in round one
concerning leadership and leadership training for staff. The illustrated charts reflect the absolute numbers collated.
Furthermore following text contextualises these numbers with the appropriate response rates which are shown both
as absolute and percentage values.
Information and references to responses received in round one were, in some cases, made explicit to respondents in
certain questions in order to either provide insight into previous findings, gain further insight or check reliability of
responses or concerns raised in round one.
For many of these questions, respondents used their own words to capture their thoughts. The qualitative nature of
the data collated was valuable in giving a sense of the issues of importance; however, this meant that in round 2
there was less of an easily quantifiable nature to the data analysis as the comments added gave further insight which
would not be reflected in the statistical count alone. Therefore for this section many of the charts are followed by an
analysis summary related to that specific question which gives a flavour of the issues raised and example quotes to
illustrate some of the dominant (and outlying) thoughts of respondents.
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