Leadership Framework

Leadership Academy Leadership Framework A Summary © 2011 NHS Leadership Academy. All rights reserved. The Leadership Framework is published on behalf of the NHS Leadership Academy by NHS Institute for Innovation and Improvement, Coventry House, University of Warwick Campus, Coventry, CV4 7AL. Publisher: NHS Institute for Innovation and Improvement, Coventry House, University of Warwick Campus, Coventry, CV4 7AL.

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In developing the Leadership Framework detailed research and consultation with a wide cross section of staff and stakeholders has been undertaken, including those with a patient perspective and those involved in healthcare outside the NHS such as professional bodies, academics, regulators and policy makers. Those consulted embraced the concept of the Leadership Framework because it affords a common and consistent approach to professional and leadership development, based on shared values and beliefs which are consistent with the principles and values of the NHS Constitution1.

The Leadership Framework is based on the concept that leadership is not restricted to people who hold designated leadership roles and where there is a shared responsibility for the success of the organisation, services or care being delivered. Acts of leadership can come from anyone in the organisation and as a model it emphasises the responsibility of all staff in demonstrating appropriate behaviours, in seeking to contribute to the leadership process and to develop and empower the leadership capacity of colleagues2.

This document provides a summary of the seven domains of the Leadership Framework. A full and web based version can be found at www. leadershipacademy. nhs. uk/If Design and structure of the Leadership Framework Delivering services to patients, service users, carers and the public is at the heart of the Leadership Framework. The needs of the people who use services have always been central to healthcare and all staff work hard to improve services for them. However, if we are going to transform services, acting on what really matters to patients and the public is essential and nvolves the active participation of patients, carers, community representatives, community groups and the public in how services are planned, delivered and evaluated3. The Leadership Framework is comprised of seven domains. Within each domain there are four categories called elements and each of these elements is further divided into four descriptors. These statements describe the leadership behaviours, which are underpinned by the relevant knowledge, skills and attributes all staff should be able to demonstrate.

To improve the quality and safety of health and care services, it is essential that staff are competent in each of the five core leadership domains shown at right: demonstrating personal qualities, working with others, managing services, improving services, and setting direction. The two other domains of the Leadership Framework, creating the vision and delivering the strategy, focus more on the role and contribution of individual leaders and particularly those in senior positional roles. 1 Department of Health (2010) The NHS Constitution: the NHS belongs to us all.

The NHS Constitution can be accessed via http://www. nhs. uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overview. aspx NHS Institute for Innovation and Improvement and Academy of Medical Royal Colleges (2009) Shared Leadership: Underpinning of the MLCF Patient and Public Engagement, Department of Health (2009) Putting Patients at the Heart of Care: The Vision for Patient and Public Engagement in Health and Social Care. www. dh. gov. uk/ppe 2 3 Leadership Framework: A Summary 3 The word ‘patient’ is used throughout the Leadership Framework to enerically cover patients, service users, and all those who receive healthcare. Similarly, the word ‘other’ is used to describe all colleagues from any discipline and organisation, as well as patients, service users, carers and the public. The leadership context The application and opportunity to demonstrate leadership will differ and the context in which competence can be achieved will become more complex and demanding with career progression. We have therefore used four stages to describe this and to help staff understand their progression and development as a leader.

They are: Stage 1 Own practice/immediate team – is about building personal relationships with patients and colleagues, often working as part of a multi-disciplinary team. Staff need to recognise problems and work with others to solve them. The impact of the decisions staff take at this level will be limited in terms of risk. Stage 2 Whole service/across teams – is about building relationships within and across teams, recognising problems and solving them. At this level, staff will need to be more conscious of the risks that their decisions may pose for self and others for a successful outcome.

Stage 3 Across services/wider organisation – is about working across teams and departments within the wider organisation. Staff will challenge the appropriateness of solutions to complex problems. The potential risk associated with their decisions will have a wider impact on the service. Stage 4 Whole organisation/healthcare system – is about building broader partnerships across and outside traditional organisational boundaries that are sustainable and replicable. At this level leaders will be dealing with multi-faceted problems and coming up with innovative solutions to those problems.

They may lead at a national/international level and would be required to participate in whole systems thinking, finding new ways of working and leading transformational change. Their decisions may have significant impact on the reputation of the NHS and outcomes and would be critical to the future of the NHS. 4 Leadership Framework: A Summary Application of the Leadership Framework and supporting tools The Leadership Framework is designed to enable staff to understand their progression as a leader and to support fostering and developing talent.

There are many ways it can be applied, for example: • To raise awareness that effective leadership is needed across the whole organisation • To underpin a talent management strategy • As part of an existing leadership development programme • To inform the design and commissioning of training and development programmes • To develop individual leadership skills • As part of team development • To enhance existing appraisal systems • To inform an organisation’s recruitment and retention processes.

To assist users the full and web based version have a suite of indicators across a variety of work place situations which illustrate the type of activity staff could be demonstrating relevant to each element and stage as well as examples of behaviours if they are not. Supporting tools A self assessment and 360° feedback tool support the Leadership Framework; in addition an online development module signposts development opportunities for each of the seven domains.

The 360° is a powerful tool to help individuals identify where their leadership strengths and development needs lie. The process includes getting confidential feedback from line managers, peers and direct reports. As a result, it gives an individual an insight into other people’s perceptions of their leadership abilities and behaviour. To assist with integrating the competences into postgraduate curricula and learning experiences, there is the LeAD e-learning resource which is available on the National Learning Management System and through e-Learning for Healthcare (www. -lfh. org. uk/LeAD). The Clinical Leadership Competency Framework and the Medical Leadership Competency Framework are also available to specifically provide staff with clinically based examples in practice and learning and development scenarios across the five core domains shared with the Leadership Framework. A summary version of the Leadership Framework follows, which includes the domains, elements and descriptors. Work-place indicators that demonstrate he practical application of the framework at the four stages are included as tables in the back of the document. The examples in practice are not included, however these are available in the full document as well as on the website (www. leadershipacademy. nhs. uk/If). Leadership Framework: A Summary 5 1. Demonstrating Personal Qualities Effective leadership requires individuals to draw upon their values, strengths and abilities to deliver high standards of service.

To do so, they must demonstrate effectiveness in: • Developing self awareness by being aware of their own values, principles, and assumptions, and by being able to learn from experiences • Managing yourself by organising and managing themselves while taking account of the needs and priorities of others • Continuing personal development by learning through participating in continuing professional development and from experience and feedback • Acting with integrity by behaving in an open, honest and ethical manner. 1. 1 Developing self awareness 1.

Recognise and articulate their own value and principles, understanding how these may differ from those of other individuals and groups 2. Identify their own strengths and limitations, the impact of their behaviour on others, and the effect of stress on their own behaviour 3. Identify their own emotions and prejudices and understand how these can affect their judgement and behaviour 4. Obtain, analyse and act on feedback from a variety of sources 1. 2 Managing yourself 1. Manage the impact of their emotions on their behaviour with consideration of the impact on others 2.

Are reliable in meeting their responsibilities and commitments to consistently high standards 3. Ensure that their plans and actions are flexible, and take account of the needs and work patterns of others 4. Plan their workload and activities to fulfil work requirements and commitments, without compromising their own health 1. 3 Continuing personal development 1. Actively seek opportunities and challenge for personal learning and development 2. Acknowledge mistakes and treat them as learning opportunities 3. Participate in continuing professional development activities 4.

Change their behaviour in the light of feedback and reflection 1. 4 Acting with integrity 1. Uphold personal and professional ethics and values, taking into account the values of the organisation and respecting the culture, beliefs and abilities of individuals 2. Communicate effectively with individuals, appreciating their social, cultural, religious and ethnic backgrounds and their age, gender and abilities 3. Value, respect and promote equality and diversity 4. Take appropriate action if ethics and values are compromised 6 Leadership Framework: A Summary 2. Working with Others

Effective leadership requires individuals to work with others in teams and networks to deliver and improve services. To do so, they must demonstrate effectiveness in: • Developing networks by working in partnership with patients, carers, service users and their representatives, and colleagues within and across systems to deliver and improve services • Building and maintaining relationships by listening, supporting others, gaining trust and showing understanding • Encouraging contribution by creating an environment where others have the opportunity to contribute • Working within teams to deliver and improve services. . 1 Developing networks 1. Identify opportunities where working with patients and colleagues in the clinical setting can bring added benefits 2. Create opportunities to bring individuals and groups together to achieve goals 3. Promote the sharing of information and resources 4. Actively seek the views of others 2. 2 Building and maintaining relationships 1. Listen to others and recognise different perspectives 2. Empathise and take into account the needs and feelings of others 3.

Communicate effectively with individuals and groups, and act as a positive role model 4. Gain and maintain the trust and support of colleagues 2. 3 Encouraging contribution 1. Provide encouragement, and the opportunity for people to engage in decision-making and to challenge constructively 2. Respect, value and acknowledge the roles, contributions and expertise of others 3. Employ strategies to manage conflict of interests and differences of opinion 4. Keep the focus of contribution on delivering and improving services to patients 2. Working within teams 1. Have a clear sense of their role, responsibilities and purpose within the team 2. Adopt a team approach, acknowledging and appreciating efforts, contributions and compromises 3. Recognise the common purpose of the team and respect team decisions 4. Are willing to lead a team, involving the right people at the right time Leadership Framework: A Summary 7 3. Managing Services Effective leadership requires individuals to focus on the success of the organisation(s) in which they work.

To do so, they must be effective in: • Planning by actively contributing to plans to achieve service goals • Managing resources by knowing what resources are available and using their influence to ensure that resources are used efficiently and safely, and reflect the diversity of needs • Managing people by providing direction, reviewing performance, motivating others, and promoting equality and diversity • Managing performance by holding themselves and others accountable for service outcomes. . 1 Planning 1. Support plans for clinical services that are part of the strategy for the wider healthcare system 2. Gather feedback from patients, service users and colleagues to help develop plans 3. Contribute their expertise to planning processes 4. Appraise options in terms of benefits and risks 3. 2 Managing resources 1. Accurately identify the appropriate type and level of resources required to deliver safe and effective services 2.

Ensure services are delivered within allocated resources 3. Minimise waste 4. Take action when resources are not being used efficiently and effectively 3. 3 Managing people 1. Provide guidance and direction for others using the skills of team members effectively 2. Review the performance of the team members to ensure that planned services outcomes are met 3. Support team members to develop their roles and responsibilities 4. Support others to provide good patient care and better services 3. Managing performance 1. Analyse information from a range of sources about performance 2. Take action to improve performance 3. Take responsibility for tackling difficult issues 4. Build learning from experience into future plans 8 Leadership Framework: A Summary 4. Improving Services Effective leadership requires individuals to make a real difference to people’s health by delivering high quality services and by developing improvements to services.

To do so, they must demonstrate effective in: • Ensuring patient safety by assessing and managing risk to patients associated with service developments, balancing economic consideration with the need for patient safety • Critically evaluating by being able to think analytically, conceptually and to identify where services can be improved, working individually or as part of a team • Encouraging improvement and innovation by creating a climate of continuous service improvement • Facilitating transformation by actively contributing to change processes that lead to improving healthcare. 4. 1 Ensuring patient safety 1.

Identify and quantify the risk to patients using information from a range of sources 2. Use evidence, both positive and negative, to identify options 3. Use systematic ways of assessing and minimising risk 4. Monitor the effects and outcomes of change 4. 2 Critically evaluating 1. Obtain and act on patient, carer and user feedback and experiences 2. Assess and analyse processes using up-to-date improvement methodologies 3. Identify healthcare improvements and create solutions through collaborative working 4. Appraise options, and plan and take action to implement and evaluate improvements 4. 3 Encouraging improvement and innovation 1.

Question the status quo 2. Act as a positive role model for innovation 3. Encourage dialogue and debate with a wide range of people 4. Develop creative solutions to transform services and care 4. 4 Facilitating transformation 1. Model the change expected 2. Articulate the need for change and its impact on people and services 3. Promote changes leading to systems redesign 6. Motivate and focus a group to accomplish change Leadership Framework: A Summary 9 5. Setting Direction Effective leadership requires individuals to contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values.

To do so, they must demonstrate effective in: • Identifying the contexts for change by being aware of the range of factors to be taken into account • Applying knowledge and evidence by gathering information to produce an evidence-based challenge to systems and processes in order to identify opportunities for service improvements • Making decisions using their values, and the evidence, to make good decisions • Evaluating impact by measuring and evaluating outcomes, taking corrective action where necessary and by being held to account for their decisions. . 1 Identifying the contexts for change 1. Demonstrate awareness of the political, social, technical, economic, organisational and professional environment 2. Understand and interpret relevant legislation and accountability frameworks 3. Anticipate and prepare for the future by scanning for ideas, best practice and emerging trends that will have an impact on health outcomes 4. Develop and communicate aspirations 5. 2 Applying knowledge and evidence 1. Use appropriate methods to gather data and information 2.

Carry out analysis against an evidence-based criteria set 3. Use information to challenge existing practices and processes 4. Influence others to use knowledge and evidence to achieve best practice 5. 3 Making decisions 1. Participate in and contribute to organisational decision-making processes 2. Act in a manner consistent with the values and priorities of their organisation and profession 3. Educate and inform key people who influence and make decisions 4.

Contribute a clinical perspective to team, department, system and organisational decisions 5. 4 Evaluating impact 1. Test and evaluate new service options 2. Standardise and promote new approaches 3. Overcome barriers to implementation 4. Formally and informally disseminate good practice 10 Leadership Framework: A Summary 6. Creating the Vision Effective leadership involves creating a compelling vision for the future, and communicating this within and across organisations.

This requires individuals to demonstrate effectiveness in: • Developing the vision of the organisation, looking to the future to determine the direction for the organisation • Influencing the vision of the wider healthcare system by working with partners across organisations • Communicating the vision and motivating others to work towards achieving it • Embodying the vision by behaving in ways which are consistent with the vision and values of the organisation. 6. 1 Developing the vision for the organisation 1.

Actively engage with colleagues and key influencers, including patients and public, about the future of the organisation 2. Broadly scan and analyse the full range of factors that will impact upon the organisation, to create likely scenarios for its future 3. Create a vision which is bold, innovative and reflects the core values of the NHS 4. Continuously ensures that the organisation’s vision is compatible with future developments within the wider healthcare system. 6. 2 Influencing the vision of the wider healthcare system 1.

Seek opportunities to engage in debate about the future of health and care related services 2. Work in partnership with others in the healthcare system to develop a shared vision 3. Negotiate compromises in the interests of better patient services 4. Influence key decision-makers who determine future government policy that impacts on the NHS and its services. 6. 3 Communicating the vision 1. Communicate their ideas and enthusiasm about the future of the organisation and its services confidently and in a way which engages and inspires others 2.

Express the vision clearly, unambiguously and vigorously 3. Ensure that stakeholders within and beyond the immediate organisation are aware of the vision and any likely impact it may have on them 4. Take time to build critical support for the vision and ensure it is shared and owned by those who will be communicating it. 6. 4 Embodying the vision 1. Act as a role model, behaving in a manner which reflects the values and principles inherent in the vision 2. Demonstrate confidence, self belief, tenacity and integrity in pursuing the vision 3.

Challenge behaviours which are not consistent with the vision 4. Identify symbols, rituals and routines within the organisation which are not consistent with the vision, and replace them with ones that are. Leadership Framework: A Summary 11 7. Delivering the Strategy Effective leadership involves delivering the strategy by developing and agreeing strategic plans that place patient care at the heart of the service, and ensuring that these are translated into achievable operational plans.

This requires individuals to demonstrate effectiveness in: • Framing the strategy by identifying strategic options for the organisation and drawing upon a wide range of information, knowledge and experience • Developing the strategy by engaging with colleagues and key stakeholders • Implementing the strategy by organising, managing and assuming the risks of the organisation • Embedding the strategy by ensuring that strategic plans are achieved and sustained. 7. 1 Framing the strategy 1. Take account of the culture, history and long term underlying issues for the organisation 2.

Use sound organisational theory to inform the development of strategy 3. Identify best practice which can be applied to the organisation 4. Identify strategic options which will deliver the organisation’s vision 7. 2 Developing the strategy 1. Engage with key individuals and groups to formulate strategic plans to meet the vision 2. Strive to understand others’ agendas, motivations and drivers in order to develop strategy which is sustainable 3. Create strategic plans which are challenging yet realistic and achievable 4. Identify and mitigate uncertainties and risks associated with strategic choices 7. Implementing the strategy 1. Ensure that strategic plans are translated into workable operational plans, identifying risks, critical success factors and evaluation measures 2. Identify and strengthen organisational capabilities required to deliver the strategy 3. Establish clear accountability for the delivery of all elements of the strategy, hold people to account and expect to be held to account themselves 4. Respond quickly and decisively to developments which require a change in strategy 7. 4 Embedding the strategy 1.

Support and inspire others responsible for delivering strategic and operational plans, helping them to overcome obstacles and challenges, and to remain focused 2. Create a consultative organisational culture to support delivery of the strategy and to drive strategic change within the wider healthcare system 3. Establish a climate of transparency and trust where results are discussed openly 4. Monitor and evaluate strategic outcomes, making adjustments to ensure sustainability of the strategy 12 Leadership Framework: A Summary The following tables combine the indicators of behaviours at different leadership stages from each domain section.

Please refer to the full domain pages for the element descriptors. 1. DEMONSTRATING PERSONAL QUALITIES Effective leadership requires individuals to draw upon their values, strengths and abilities to deliver high standards of service. To do so, they must demonstrate effectiveness in demonstrating self awareness, managing themselves, continuing their personal development and acting with integrity. 2 Whole Service/Across Teams 3 Across Services/Wider Organisation Element Appreciates the impact they have on others and the impact others have on them. Routinely seeks feedback and adapts their behaviour appropriately.

Reflects on their interactions with a wide and diverse range of individuals and groups from within and beyond their immediate service/organisation. Challenges and refreshes own values, beliefs, leadership styles and approaches. Overtly role models the giving and receiving of feedback. Successfully manages a range of personal and organisational demands and pressures. Demonstrates tenacity and resilience. Overcomes setbacks where goals cannot be achieved and quickly refocuses. Is visible and accessible to others. Acts as an exemplar for others in managing their continuous personal development.

Facilitates the development of a learning culture. 1 Own Practice/Immediate Team 4 Whole Organisation/Wider Healthcare System Uses sophisticated tools and sources to continuously learn about their leadership impact in the wider health and care community and improve their effectiveness as a senior leader. Understands how pressures associated with carrying out a high profile role impact on them and their performance. Remains focused on strategic goals when faced with competing and, at times, conflicting demands arising from differing priorities.

Identifies where they need to personally get involved to achieve the most benefit for the organisation and wider healthcare system. Develops through systematically scanning the external environment and exploring leading edge thinking and best practice. Applies learning to build and refresh the service. Treats challenge as a positive force for improvement. 1. 1 Developing Self Awareness Reflects on how factors such as own values, prejudices and emotions influence their judgement, behaviour and self belief. Uses feedback from appraisals and other sources to consider personal impact and change behaviour.

Understands personal sources of stress. 1. 2 Managing Yourself Plans and manages own time effectively and fulfils work requirements and commitments to a high standard, without compromising own health and wellbeing. Remains calm and focused under pressure. Ensures that own work plans and priorities fit with the needs of others involved in delivering services. Demonstrates flexibility and sensitivity to service requirements and remains assertive in pursuing service goals. Leadership Framework: A Summary Puts self forward for challenging assignments and projects which will develop strengths and address development areas.

Acts as a role model for others in demonstrating integrity and inclusiveness in all aspects of their work. Challenges where organisational values are compromised. 1. 3 Continuing Personal Development Takes responsibility for own personal development and seeks opportunities for learning. Strives to put learning into practice. 1. 4 Acting with Integrity Behaves in an open, honest and inclusive manner, upholding personal and organisational ethics and values. Shows respect for the needs of others and promotes equality and diversity.

Creates an open, honest and inclusive culture in accordance with clear principles and values. Ensures equity of access to services and creates an environment where people from all backgrounds can excel. Assures standards of integrity are maintained across the service and communicates the importance of always adopting an ethical and inclusive approach. Generic behaviours observed if individual is not yet demonstrating this domain: • Demonstrates behaviours that are counter to core values of openness, inclusiveness, honesty and equality • Lacks confidence in own abilities to deliver results Does not understand own emotions or recognise the impact of own behaviour on others • Approaches tasks in a disorganised way and plans are not realistic • Unable to discuss own strengths and development needs and spends little time on development 13 14 2 Whole Service/Across Teams 3 Across Services/Wider Organisation 4 Whole Organisation/Wider Healthcare System Works across boundaries creating networks which facilitate high levels of collaboration within and across organisations and sectors.

Builds and maintains sustainable strategic alliances across the system and other sectors. Has high impact when interacting with others at all levels. Uses networks to bring individuals and groups together to share information and resources and to achieve goals. Identifies and builds effective networks with a range of influential stakeholders internal and external to the organisation. Builds and maintains relationships with a range of individuals involved in delivering the service. Manages sensitivities between individuals and groups.

Creates a supportive environment which encourages others to express diverse opinions and engage in decisionmaking. Constructively challenges suggestions and reconciles conflicting views. Helps lead others towards common goals, providing clear objectives and offering appropriate support. Shows awareness of team dynamics and acts to promote effective team working. Appreciates the efforts of others. Integrates the contributions of a diverse range of stakeholders, being open and honest about the extent to which contributions can be acted upon.

Builds and nurtures trusting relationships at all levels within and across services and organisational boundaries. Creates systems which encourage contribution throughout the organisation. Invites contribution from different sectors to bring about improvements. Takes on recognised positional leadership roles within the organisation. Builds high performing inclusive teams that contribute to productive and efficient health and care services. Promotes autonomy and empowerment and maintains a sense of optimism and confidence. Contributes to and leads senior teams.

Enables others to take on leadership responsibilities, building high level leadership capability and capacity from a diverse range of backgrounds. • Does not encourage others to contribute ideas • Does not adopt a collaborative approach 2. WORKING WITH OTHERS Effective leadership requires individuals to work with others in teams and networks to deliver and improve services. This requires them to demonstrate effectiveness in developing networks, building and maintaining relationships, encouraging contribution, and working within teams. Element 1 Own Practice/Immediate Team . 1 Developing Networks Identifies where working and cooperating with others can result in better services. Endeavours to work collaboratively. 2. 2 Building and Maintaining Relationships Communicates with and listens to others, recognising different perspectives. Empathises and takes into account the needs and feelings of others. Gains and maintains trust and support. 2. 3 Encouraging Contribution Seeks and acknowledges the views and input of others. Shows respect for the contributions and challenges of others. Leadership Framework: A Summary 2. 4 Working within Teams

Understands roles, responsibilities and purpose within the team. Adopts a collaborative approach and respects team decisions. Generic behaviours observed if individual is not yet demonstrating this domain: • Fails to network with others and/or allows relationships to deteriorate • Fails to win the support and respect of others 3. MANAGING SERVICES Effective leadership requires individuals to focus on the success of the organisation(s) in which they work. This requires them to be effective in planning, managing resources, managing people and managing performance. Whole Service/Across Teams 3 Across Services/Wider Organisation 4 Whole Organisation/Wider Healthcare System Anticipates the impact of health trends and develops strategic plans that will have a significant impact on the organisation and wider healthcare system. Ensures strategic objectives are translated into operational plans. Strategically manages resources across the organisation and wider healthcare system. Element Works collaboratively to develop business cases and service plans that support organisational objectives, appraising them in terms of benefits and risks.

Leads service design and planning processes. Communicates and keeps others informed of strategic and operational plans, progress and outcomes. 1 Own Practice/Immediate Team 3. 1 Planning Contributes ideas to service plans, incorporating feedback from others including a diverse range of patients, service users and colleagues. 3. 2 Managing Resources Understands what resources are available and organises the appropriate type and level of resources required to deliver safe and efficient services. Identifies resource requirements associated with delivering services.

Manages resources and takes action to ensure their effective and efficient use. Forecasts resource requirements associated with delivering complex services efficiently and effectively. Manages resources taking into account the impact of national and local policies and constraints. Motivates and coaches individuals and teams to strengthen their performance and assist them with developing their own capabilities and skills. Aligns individual development needs with service goals. Leadership Framework: A Summary Provides others with clear purpose and direction.

Helps others in developing their roles and responsibilities. Works with others to set and monitor performance standards, addressing areas where performance objectives are not achieved. • Does not effectively manage and develop people • Fails to identify and address performance issues 3. 3 Managing People Supports others in delivering high quality services and excellence in health and care. Inspires and supports leaders to mobilise diverse teams that are committed to and aligned with organisational values and goals. Engages with and influences senior leaders and key stakeholders to deliver joined up services. . 4 Managing Performance Uses information and data about performance to identify improvements which will strengthen services. Establishes rigorous performance measures. Holds self, individuals and teams to account for achieving performance standards. Challenges when service expectations are not being met and takes corrective action. Promotes an inclusive culture that enables people to perform to their best, ensuring that appropriate performance management systems are in place and that performance data is systematically evaluated and fed into future plans.

Generic behaviours observed if individual is not yet demonstrating this domain: • Disorganised or unstructured approach to planning • Wastes resources or fails to monitor them effectively 15 16 2 Whole Service/Across Teams 3 Across Services/Wider Organisation 4 Whole Organisation/Wider Healthcare System Creates a culture that prioritises the health, safety and security of patients and service users. Delivers assurance that patient safety underpins policies, processes and systems. Reviews practice to improve standards of patient safety and minimise risk.

Monitors the impact of service change on patient safety. Develops and maintains audit and risk management systems which will drive service improvement and patient safety. Engages with others to critically evaluate services and create ideas for improvements. Synthesises complex information to identify potential improvements to services. Identifies potential barriers to service improvement. Benchmarks the wider organisation against examples of best practice in healthcare and other sectors. Evaluates options for improving services in line with future advances.

Acts as a positive role model for innovation. Encourages dialogue and debate in the development of new ideas with a wide range of people. Challenges colleagues’ thinking to find better and more effective ways of delivering services and quality. Accesses creativity and innovation from relevant individuals and groups. Drives a culture of innovation and improvement. Integrates radical and innovative approaches into strategic plans to make the NHS world class in the provision of healthcare services. Focuses self and others on achieving changes to systems and processes which will lead to improved services.

Energises others to drive change that will improve health and care services. Actively manages the change process, drawing on models of effective change management. Recognises and addresses the impact of change on people and services. Inspires others to take bold action and make important advances in how services are delivered. Removes organisational obstacles to change and creates new structures and processes to facilitate transformation. • Maintains the status quo and sticks with traditional outdated ways of doing things • Fails to implement change or implements change for change’s sake 4.

IMPROVING SERVICES Effective leadership requires individuals to make a real difference to people’s health by delivering high quality services and by developing improvements to services. This requires them to demonstrate effectiveness in ensuring patient safety, critically evaluating, encouraging improvement and innovation and facilitating transformation. Element 1 Own Practice/Immediate Team 4. 1 Ensuring Patient Safety Puts the safety of patients and service users at the heart of their thinking in delivering and improving services. Takes action to report or rectify shortfalls in patient safety. . 2 Critically Evaluating Uses feedback from patients, carers and service users to contribute to healthcare improvements. Leadership Framework: A Summary 4. 3 Encouraging Improvement and Innovation Questions established practices which do not add value. Puts forward creative suggestions to improve the quality of service provided. 4. 4 Facilitating Transformation Articulates the need for changes to processes and systems, acknowledging the impact on people and services. Generic behaviours observed if individual is not yet demonstrating this domain: Overlooks the need to put patients at the forefront of their thinking • Does not question/evaluate current processes and practices 5. SETTING DIRECTION Effective leadership requires individuals to contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values. This requires them to demonstrate effectiveness in identifying the contexts for change, applying knowledge and evidence, making decisions, and evaluating impact. 2 Whole Service/Across Teams 3 Across Services/Wider Organisation 4 Whole Organisation/Wider Healthcare System Synthesises knowledge from a broad range of sources.

Identifies future challenges and imperatives that will create the need for change and move the organisation and the wider healthcare system in new directions. Influences the context for change in the best interests of services and service users. Uses knowledge, evidence and experience of national and international developments in health and social care to influence the future development of health and care services. Ensures that corporate decision-making is rigorous and takes account of the full range of factors impinging on the future direction of the organisation and the wider healthcare system.

Can operate without all the facts. Takes unpopular decisions when in the best interests of health and care in the long term. Identifies gains which can be applied elsewhere in the organisation and incorporates these into operational/ business plans. Disseminates learning from changes which have been introduced. Synthesises learning arising from changes which have been introduced and incorporates these into strategic plans. Shares learning with the wider health and care community. Element Identifies the external and internal drivers of change and communicates the rationale for change to others.

Actively seeks to learn about external factors which will impact on services. Interprets the meaning of these for services and incorporates them into service plans and actions. 1 Own Practice/Immediate Team 5. 1 Identifying the Contexts for Change Understands the range of factors which determine why changes are made. 5. 2 Applying Knowledge and Evidence Gathers data and information about aspects of the service, analyses evidence and uses this knowledge to suggest changes that will improve services in the future. Involves key people and groups in making decisions.

Actively engages in formal and informal decision-making processes about the future of services. Obtains and analyses information about services and pathways to inform future direction. Supports and encourages others to use knowledge and evidence to inform decisions about the future of services. Understands the complex interdependencies across a range of services. Applies knowledge to set future direction. Leadership Framework: A Summary Evaluates and embeds approaches and working methods which have proved to be effective into the working practices of teams and individuals. 5. 3 Making Decisions

Consults with others and contributes to decisions about the future direction/vision of their service. Remains accountable for making timely decisions in complex situations. Modifies decisions and flexes direction when faced with new information or changing circumstances. 5. 4 Evaluating Impact Assesses the effects of change on service delivery and patient outcomes. Makes recommendations for future improvements. Generic behaviours observed if individual is not yet demonstrating this domain: • Makes poor decisions about the future • Fails to evaluate the impact of previous decisions and actions Unaware of political, social, technical, economic, organisational factors that impact on the future of the service/organisation • Does not use an evidence-base for decision-making 17 18 ELEMENT DESCRIPTORS (see also page 11) 4 Whole Organisation/Wider Healthcare System Actively engages key stakeholders in creating a bold, innovative, shared vision which reflects the future needs and aspirations of the population and the future direction of healthcare. Thinks broadly and aligns the vision to the NHS core values and the values of the wider healthcare system.

Actively participates in and leads on debates about the future of health, wellbeing and related services. Manages political interests, balancing tensions between organisational aspirations and the wider environment. Shapes and influences local, regional and national health priorities and agendas. Clearly communicates the vision in a way that engages and empowers others. Uses enthusiasm and energy to inspire others and encourage joint ownership of the vision. Anticipates and constructively addresses challenge. Consistently displays passion for the vision and demonstrates personal commitment to it through their day-to-day actions.

Uses personal credibility to act as a convincing advocate for the vision. • Misses opportunities to communicate and share understanding of the vision with others • Lacks enthusiasm and commitment for driving the vision 6. CREATING THE VISION Those in senior positional leadership roles create a compelling vision for the future, and communicate this within and across organisations. This requires them to demonstrate effectiveness in developing the vision for the organisation, influencing the vision of the wider healthcare system, communicating the vision and embodying the vision.

Element 6. 1 Developing the Vision for the Organisation • Actively engage with colleagues and key influencers, including patients and public, about the future of the organisation • Broadly scan and analyse the full range of factors that will impact upon the organisation, to create likely scenarios for its future • Create a vision which is bold, innovative and reflects the core values of the NHS • Continuously ensures that the organisation’s vision is compatible with future developments within the wider healthcare system . 2 Influencing Vision in the Wider Healthcare System • Seek opportunities to engage in debate about the future of health and care related services • Work in partnership with others in the healthcare system to develop a shared vision • Negotiate compromises in the interests of better patient services • Influence key decision-makers who determine future government policy that impacts on the NHS and its services Leadership Framework: A Summary 6. 3 Communicating the Vision Communicate their ideas and enthusiasm about the future of the organisation and its services confidently and in a way which engages and inspires others • Express the vision clearly, unambiguously and vigorously • Ensure that stakeholders within and beyond the immediate organisation are aware of the vision and any likely impact it may have on them • Take time to build critical support for the vision and ensure it is shared and owned by those who will be communicating it 6. 4 Embodying the Vision Act as a role model, behaving in a manner which reflects the values and principles inherent in the vision • Demonstrate confidence, self belief, tenacity and integrity in pursuing the vision • Challenge behaviours which are not consistent with the vision • Identify symbols, rituals and routines within the organisation which are not consistent with the vision, and replace them with ones that are Generic behaviours observed if individual is not yet demonstrating this domain: Does not involve others in creating and defining the vision • Does not align their vision with the wider health and care agenda 7. DELIVERING THE STRATEGY Those in senior positional leadership roles deliver the strategic vision by developing and agreeing strategic plans that place patient care at the heart of the service, and ensuring that these are translated into achievable operational plans. This requires them to demonstrate effectiveness in framing the strategy, developing the strategy, implementing the strategy, and embedding the strategy. Element

ELEMENT DESCRIPTORS (see also page 12) 4 Whole Organisation/Wider Healthcare System Critically reviews relevant thinking, ideas and best practice and applies whole systems thinking in order to conceptualise a strategy in line with the vision. 7. 1 Framing the Strategy • Take account of the culture, history and long term underlying issues for the organisation • Use sound organisational theory to inform the development of strategy • Identify best practice which can be applied to the organisation • Identify strategic options which will deliver the organisation’s vision . 2 Developing the Strategy • Engage with key individuals and groups to formulate strategic plans to meet the vision • Strive to understand others’ agendas, motivations and drivers in order to develop strategy which is sustainable • Create strategic plans which are challenging yet realistic and achievable • Identify and mitigate uncertainties and risks associated with strategic choices Integrates the views of a broad range of stakeholders to develop a coherent, joined up and sustainable strategy.

Assesses organisational readiness for change. Manages the risks, political sensitivities and environmental uncertainties involved. Leadership Framework: A Summary 7. 3 Implementing the Strategy • Ensure that strategic plans are translated into workable operational plans, identifying risks, critical success factors and evaluation measures • Identify and strengthen organisational capabilities required to deliver the strategy • Establish clear accountability for the delivery of all elements f the strategy, hold people to account and expect to be held to account themselves • Respond quickly and decisively to developments which require a change in strategy Responds constructively to challenge. Puts systems, structures, processes, resources and plans in place to deliver the strategy. Establishes accountabilities and holds people in local, regional, and national structures to account for jointly delivering strategic and operational plans. Demonstrates flexibility when changes required. 7. 4 Embedding the Strategy Support and inspire others responsible for delivering strategic and operational plans, helping them to overcome obstacles and challenges, and to remain focused • Create a consultative organisational culture to support delivery of the strategy and to drive strategic change within the wider healthcare system • Establish a climate of transparency and trust where results are discussed openly • Monitor and evaluate strategic outcomes, making adjustments to ensure sustainability of the strategy Enables and supports the conditions and culture needed to sustain changes integral to the successful delivery of the strategy.

Keeps momentum alive by reinforcing key messages, monitoring progress and recognising where the strategy has been embraced by others. Evaluates outcomes and uses learnings to adapt strategic and operational plans. Generic behaviours observed if individual is not yet demonstrating this domain: • Absolves oneself of responsibility for holding others to account • Fails to enable an organisational culture that embraces the strategy • Does not align the strategy with local, national and/or wider health care system requirements • Works to develop the strategy in isolation without input or feedback from others 19

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