Going Round in Circulars
Take Away Line
Failings in healthcare delivery, as pointed out by the CQC’s report on care for elders on hospital wards last week may have an ultimate origin elsewhere. And Monitor’s governance report, also published last week, indicates significant weaknesses at the top of NHS trusts. Is there a connection here? Experience in other sectors suggests that to fix the wards, you have first to fix the boardrooms. As never before the focus needs to be on leadership!
Two reports in the same week
Two startling reports were published on the UK health sector last week. Everyone will remember the key findings of the Care Quality Commission’s ‘Dignity and Nutrition’ report, which pointed out the lamentable state of care for elderly patients on our wards. Inconsistent and frequently uncaring, the report pointed to systemic failure for the two-thirds of patients in hospital care who are over 65. As the Mental Health Foundation said, commenting on the report’s findings: ‘It is shocking that some basic human rights related to dignity and nutrition are not met in many hospitals. This is unacceptable.’ Press commentary on the report focussed on an uncaring culture, on ward management, on overwork and on nurse and care worker training.
But could leadership be the key factor?
In another report, also published last week, this time by the healthcare regulator, Monitor, the focus indeed turned to leadership. Monitor’s findings on governance were based on examination of returns each NHS foundation trust board must submit each quarter. Monitor examines performance against these reports to identify where problems might arise. It finds that 42% of NHS trust boards are failing to meet adequate standards of governance.
So, the big question is leadership
It’s hard to avoid the question: could there be a connection between these two sets of separate findings? Unfortunately the data in each report doesn’t permit further examination on this point. But more than just common sense suggests that it may be wise to do so. Work in other sectors shows the way.
Leadership is a lead indicator. If you have good leaders today, doing the right things, working well and setting a good tone, you’re likely to have a high performing organisation tomorrow or at least at some time later. Conversely, the effects of weak leadership may not be felt immediately. It takes time for the effects of missed opportunities, of inappropriate risks taken, of customers being poorly served and of weakened staff morale to be seen on the bottom line or bottom lines.
This is true of both executive and non-executive leadership. In a series of retrospective studies the then regulator of the social housing sector, the Housing Corporation, examined housing associations that had attracted undue regulatory attention for problems that had no apparent connection with leadership. The resulting publications, each under the generic title of Learning from Problem Cases, show that in every case – in every case, mark you! – there were weaknesses in governance that had not previously been detected.
And one of the major commissions on governance in the corporate sector which eventually resulted in the UK Corporate Governance Code, the Hampel Committee concluded, back in 1998: ‘Business prosperity cannot be commanded…There’s no hard evidence to link success to good governance, although we believe good governance enhances the prospect.’
Finding out more
So, if good governance and good leadership more generally promote success, and failings in leadership are ultimately behind organisational failings, could this also be the case in our health trusts? What work been done on this? What are its findings? If there is read-across, focus on the quality of leaders could potentially make a profound difference to the experience our elders have on our wards.
Debating points
1. Has the connection between NHS trust leadership and organisational performance been made?
2. If it has been made, how can the focus turn much more to the quality of leadership to move things forward?
3. How effective are existing leadership development programmes?
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