The NHS Institute has been working with the Academy of Medical Royal Colleges since 2006 through the Enhancing Engagement in Medical Leadership project to develop a Medical Leadership Competency Framework (MLCF). The MLCF describes the leadership and management competences doctors need to become involved in the planning, delivery and transformation of health services. It has been approved by all of the key medical regulatory, professional and educational bodies.

While the context and scenarios described in the MLCF are relevant to doctors, the generic leadership competences are likely to be applicable to all clinicians in their practitioner roles.

The NHS Institute was commissioned in February 2010 to test the applicability of the leadership competences of the MLCF for other clinical professions.

The Action

In February 2010 the NHS Institute engaged Paul Long as Project Director to design and deliver a project, to work with the clinical professions to build leadership awareness and capability across the health service. The project was to assess the readiness of 21 regulated clinical professions to embed leadership competences in undergraduate education, postgraduate training and continuing professional development.

The specific objectives of the Clinical Leadership Competency Framework (CLCF) project were to:

• create a document, derived from the MLCF, which describes the generic leadership and management competences clinicians need, and use this in discussions with individual clinical professions;

• test the applicability of these leadership competences for each of the individual clinical professions;

• develop an understanding of the processes by which each clinical profession’s curricula and training standards are developed and approved;

• understand to what extent leadership competences were already included in curricula and training, and their state of readiness for adopting and agreeing a clinical leadership competency framework.

The Results

The findings showed that recognition that leadership was important, and the need to further develop leadership capability within the clinical professions, was unquestioned. Practitioners embraced the concept of the leadership frameworks because they afforded a common and consistent approach to development based on their shared professional values and beliefs. This was nested within the domains and standards rather than organisational structures which were ever changing.

The findings also revealed widespread support for a common approach to leadership development across the professional, regulatory and education sectors and the NHS.

The findings of the CLCF project were published in International Journal of Clinical Leadership Long, P W et al. (2011) The CLCF: developing leadership capacity and capability in the clinical professions. International Journal of Clinical Leadership. Vol. 17 No. 2

The CLCF was developed through consultation with a wide cross section of staff, patients, professional bodies and academics, and with the input of all the clinical professional bodies and has the support of the chief professions officers, the professions advisory boards, the peak education bodies and the Department of Health. This was the first time there had been a common and consistent approach to leadership that spanned the profession, regulatory and education sectors.

The British Psychological Society (BPS), the Royal College of Nursing and the Royal Pharmaceutical Society have published their own leadership frameworks based on the CLCF.

The Feedback

“Great meeting. I always get fired up and feel motivated after a meeting with you!” Keith Ison email to Paul Long.

“Chief credit for getting pharmacy out of the blocks must go to Paul Long, Project director, the CLCF Project, NHSI, along with colleagues…the resulting framework document…a genuine joint effort, endorsed by the NHS and the Health Minister, with pharmacy on every page”, Rob Darracott, Chief Executive. Pharmacy Voice Oct 2011

‘The CLCF would represent a fundamental shift in the way we train and educate clinicians.’

Dr Mark Goldman, July 2010

‘Prepared for the meeting expecting to get a small piece of the jigsaw (probably a bit of sky) and find you bringing along the whole box complete with the picture on the front. What a useful meeting. I have been drafting a communication to the AHPF setting out the importance of this initiative and suggesting early and prolonged engagement.”

Email from Paul Hitchcock, Director Allied Health Professions Federation 14/4/10

Chair of the Chartered Society of Physiotherapists (CSP) stated this as a “fantastic opportunity.”

Read the final report (pdf)

The Action

In 2003 Paul conceived and designed a programme to:

• teach consultant doctors the basics of leadership, teamwork and systems

• familiarise consultant doctors with Clinical Practice Improvement tools and resources

• integrate quality improvement activities with RACP Education Strategy

• provide opportunities for consultant doctors to improve appropriate competencies.

To deliver this objective, the Better Practice program was developed which comprised of education and training, supported with tools, resources and easily accessible information. Specifically the intervention included:

• Clinical Leaders Workshops

• Better Practice area on RACP website

• Better Practice web-letter broadcast monthly

• initiating Better Practice manual

• guidance and advice for conducting a project

• facilitated video & teleconferences.

The objective of the programme was to:

• improve participant knowledge of clinical practice improvement (CPI) and evidence based practice (EBP)

• increase the frequency of practice based audits and CPI projects being conducted by participants

• deliver a course covering leadership, team-work, understanding a systems perspective, risk management, clinical governance, root cause analysis, quality improvement, project design, measurement and review, designing effective interventions, working with consumers, evaluation and sustaining better practice.

 The Results

During 2003/2004 Paul and a colleague delivered 20 workshops around Australia and New Zealand. The Better Practice programme was the first active educational intervention delivered by the RACP. It represented a new way of doing business for the College in the delivery of CPD to fellows and to its specialty societies; demonstrated that the College could act as a provider of education and training through direct delivery via partnerships and collaboration; and build up the capacity of the RACP through innovative use of new and existing resources.

Independent evaluation of the workshops showed an overall satisfaction rate of over 80% for the respondents. Post-workshop surveys indicated that 92% of respondents have acquired significant content knowledge to which they were introduced during the workshops.

Pilot evaluation of the Better Practice website conducted over one month period indicated:

• a total of 2300 sessions. Ranging from browsing/reading 1-3 pages (30 secs – 5 mins) to reviewing 10-20 pages (over 20-30 mins)

• over 1500 pdf downloads

• over half participants stated they would be likely to change a form of their clinical practice as a result of reading the manual.

The Feedback

“I recently attended the CPI course held in Sydney and I write to thank all those involved. The day was excellent, well organised, well run and very interesting. We have already discussed ways of changing local systems currently in place.” (rural specialist, 2004)

Read more on this project (pdf)

The Action

In mid 2010 while working on the Clinical Leadership Competency Framework project, the NHS Institute asked Paul to merge this work with the refresh of the NHS Leadership Qualities Framework.

Along with colleague Sue Mortlock, Paul played a lead role in pulling together the two work-streams, the development of the Leadership Framework design and content, consultation with a wide cross section of stakeholders, staff, patients, professional bodies and academics, and the clinical professional bodies, the chief professions officers, the professions advisory boards, the peak education bodies and the Department of Health.

The main focus of Paul’s work was with the relevant bodies representing the clinical professions, the regulators, and the higher education sector to ensure their standards and guidance align and describe leadership.

The Results

The Secretary of State launched the Leadership Framework (LF) in June 2011, along with a wide range of supporting products and resources.

This was the first time that there has been a single agreed standard that provides a common understanding of leadership and a consistent approach to leadership development that spanned all clinical professions, the educational and regulatory sectors and aligns with those in the NHS.

Given that the framework, tools and resources had only been available since June 2011 the extent of embedding, high level of awareness and excellent examples of adoption were impressive.

There is evidence of the LF being used by all levels of the system and it was being implemented or planned for use in many organisations.

For example, within the first month, there were 35,007 visits to the website and 10,230 downloads of the Self Assessment Tool PDFs.

The Feedback

‘It represents a real achievement for the NHS – moving from a series of confusing and potentially conflicting guidelines that change from provider to provider to a leadership framework that combines under one shared expression of what leadership means in the NHS’

Secretary of State for Health Andrew Lansley speaking at the launch of the NHS Leadership Framework June 2011

“The launch has been a huge success. The delay in publishing the documents was worth the wait, the project team were prepared for every angle, they had the answer for every question, they had the whole package – there is something for everyone.” Guest at launch of LF June 2011

“The new Framework describes clearly the task of leadership across all disciplines and at all levels within the NHS. It strikes the right balance and feels fit for the future. I liked the focus on style and behaviour in the 360° feedback – this is useful for personal development and exactly the right emphasis for successful leadership in the coming years.”

Dr Mark Newbold, Chief Executive, Heart of England NHS Foundation Trust

“The new Leadership Framework has an instant additional appeal with its increased broad spread of applications from the most senior of leaders to a junior administrator, whether working directly in patient care or in organisations that support them. Whilst providing a clear shared definition across the NHS of what good leadership is and the need to deliver it also allows for organisations to mould it to their own particular needs whilst not attacking the integrity of the work. This is what we will be doing at the NHS Confederation.”

Karen Charman, Interim Operating Officer, NHS Confederation

“Spring 2011 was perfect timing for us to be able to use the LF in our refreshed Talent Management [TM] system. We are now future-proofed on the leadership behaviours and are able to support the LF by introducing it to our emerging leader populations. The LF, in turn, is able to support our TM by providing a valuable framework for feedback. We were proud to be recognised as an “early adopter” by Andrew Lansley at the launch of the LF in London on 29 June, 2011.”

Hesketh Emden, Head of Talent Management, NHS London

The Chief Executive of South East Coast SHA said, “I have had a good look at the LF, including ‘deep-diving’ into the general and clinical case studies for the various domains and levels. I must say that I think it’s an excellent piece of work, coherent and aligned. My congratulations to those concerned.”

Read the progress report (pdf)

It had been a long held goal of the HC to have a single point where there is a comprehensive view of each trust or independent organisation with which the HC deals; and that allows for the capture in one place of the findings from the HC’s assessment processes; serious concerns however discovered, and less serious concerns, which will prompt action if a “cluster” of concerns is revealed.

The Action

Paul Long was commissioned to pull together the various work streams across the HC to make this an operational reality. This included:

• introducing a methodology for grading concerns

• rolling-out an organisational risk profile which ties together all of the internal work-streams into one overall summary

• embedding a programme for cultural and organisational change

• introducing a quality assurance process via regional and national risk panels

• holding twelve risk summits with external partners between November 2008 – January 2009.

The Results

After only 6 – 7 months an independent evaluation found that the new system was welcomed by staff who had encountered it at all levels and across different directorates of the HC. The aims of the system were generally well understood and accepted and there is a view that the HC has ‘come a long way’ in its approach to concerns and risk.

The new ways of working have proved very effective in promoting communication within different parts of the organisation. There was improved scrutiny, transparency and accountability to risk identification and escalation action – leading to common understanding of levels of risk across the health economy and the action required.

The Feedback

“When I commissioned you to undertake this work I only had a high level idea of what I wanted. You made it happen. You have a real talent for it.”

Head of Operations, Healthcare Commission

“I’ve just completed 12 [assessments]. I lived off the pocket guidance. I’m doing [assessments] for other people. Using this I know I can justify the decision. Not just making it up.” Assessor

“It’s good to get people thinking in a similar way. More detail about risk – focuses attention where it’s actually needed.” Central Manager

Read the article on this project (pdf)

The Action

In June 2007 Paul was commissioned to lead on the development and implementation of the Information & Knowledge Management strategy, including associated organisational change processes.

The Results

Between June 2007 – March 2008 Paul worked with the operational lead and accountable manager to develop and publish the approved IKM strategy then lead the cultural and organisational change processes required to successfully deliver it. This included:-

• successfully integrating 4 separate teams into 1 business unit

• profiling capacity and development of product and services

• developing and implementing a marketing and communication strategy

Overall there was an increase in teamwork and productivity of staff in the IKM team.

The Feedback

“I’m now beginning to understand why we’ve been moved into the TAIKM team….Paul Long did that” Ellie, records officer

“You have a lovely way of gently nudging us towards implementation.”

Frances Carey, Head of Targets, Aggregation and Information & Knowledge Management

The Action

In July 1996, Paul Long was one of a team of four chosen to establish an international aid and business consultancy, based in Sydney and operating in the Asia Pacific region. Paul was intimately involved in all aspects of setting up the company. This included undertaking detailed market analysis (including risk assessment) to target appropriate countries and markets; establishing and growing our database of international consultants; profile our capability and product development including break even analysis;  establishing strategic alliances in-country to strengthen the company’s capacity to win business.

The Results

Within 3 years the company was successfully delivering donor funded aid projects in the Pacific and an Oncology Centre in Malaysia. Paul’s work involved:

• shifting large percentage of the cost of marketing activities in developing countries to a cost neutral position

• legitimising the company’s role in managing international relations with Area Health Services (NSW Department of Health), the principal pool of technical resources

• product development and break even analysis for education and training services

• developing a profitable and innovative mechanism for the commercialisation of Australia’s biotechnology and health research sector.

The Feedback

‘I am not usually one to make such gestures but I wanted to acknowledge your contribution and record my thanks for your efforts when we set up the company. I do not think your efforts should be under estimated’.

Hand written note from the company’s Managing Director.

The CSSP developed as a model which integrated the methodologies of clinical practice improvement (CPI) and evidence-based medicine (EBM) to enable clinicians to embed best practice routinely in clinical care. The CSSP model includes the management of clinical practice using clinical and consumer pathways, outcome and performance indicators, clinical measurement and review in a continuous improvement cycle using the best available extant evidence.

The Action

In 1999 Paul was appointed the National Director of the CSSP for the RACP, with the brief of delivering a significant change management program testing whether clinicians can improve the quality of care by managing clinical practice in a continuous quality improvement cycle and applying the best available evidence. The CSSP was the largest and most complex project of its kind undertaken at that time in Australia.

The Results

The improvements in systems of care achieved by the CSSP in a relatively short time were vast, widely acknowledged in Australia and internationally. Aspects of the CSSP projects continued beyond the 2-year funding phase in each of the participating hospitals. In two instances, important project components were taken up by state governments and the RACP has actively promoted uptake of the CSS model in other settings, leading to the extension of Program from 17 sites in three states to 63 sites across four states.

The project generated a unique web-based tool that provided a practical introduction to the CSS model and drew heavily on the experiences of clinicians involved in the CSSP.

The Feedback

The independent evaluation of the CSSP by KPMG Consulting noted the important contribution made by the National Program Director to the successful outcome of the project.

In 2004 the results of the CSSP were published in the Medical Journal of Australia. (see article links below)

“During his time at the RACP Paul made a significant contribution to advancing evidence-based clinical practice improvement in Australia and New Zealand. He played a leading role in changing physician attitudes and behaviour and gaining their buy-in to the quality, innovation and improvement agenda. He has a unique talent for turning ideas into reality and maximising opportunity for the benefit of the College and individual Fellows”.

Craig Glenroy Patterson, Chief Executive, RACP.

Read more about this project:

The final report of the CSSP (pdf)

Medical Journal of Australia articles (pdfs):

Towards a safer culture

The Clinical Support Systems Program

The Clinical Support Systems Program: supporting system-wide improvement

Lessons from the Clinical Support Systems Program: facilitating better practice through leadership and team building

Turning an idea into reality to improve patient care: the development of the Clinical Support Systems Program