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6. Leadership to facilitate change

In this section, we’ll consider how leadership can help, encourage and facilitate change, assisting the implementation of non face-to-face (Nf2f) clinics.

Good and effective leadership from individuals – and across the system – is an essential part of facilitating and leading change. This is important when setting up Nf2f clinics.

This section focuses on the key domains where we require leaders to facilitate change, using change models and frameworks to support them.

This section doesn’t cover the attributes of a leader. The Healthcare Leadership Model, by the NHS Leadership Academy, provides guidance.

Why consider leadership in the implementation and adoption of Nf2f clinics?

Leadership plays an important role in how we handle innovation.

The 2018 Kings Fund paper – Adoption and spread of innovation in the NHS – found that leadership within a system can determine how we develop new ways of working, as well as the success of these innovative approaches.

This independent report, commissioned by six Academic Health Science Networks (AHSNs), found the attitude of leaders – and the working environment within organisations – are key to the success of an innovation being adopted and spread across an organisation.

The report stated that leaders who support staff in pursuing new ways of working provide an environment that helps the workforce to develop innovative solutions to the challenges they’re facing. Conversely, staff told to focus on their “day job” felt unable to pursue these innovative ways of working. 

Depending on their attitude, a leader might be seen as either an enabler or a barrier to the speed and spread of innovation. The report goes on to suggest:

There is still a need to convince at least some leaders that innovation is a solution to the NHS’s challenges, rather than an unaffordable luxury, and of the role they should play in supporting it.

Where is leadership required to support the implementation of Nf2f clinics?

Both clinical and organisational leadership will play an important role during the planning, implementation, delivery and evaluation of Nf2f clinics.

Nf2f models have traditionally been clinically-led solutions and project formulated in response to challenges within health and care settings. However, there’s now a system-wide drive to address the current unsustainable and outdated model of outpatient services. To support the implementation of Nf2f clinics and facilitate the change process, we must consider both clinical leadership and system leadership.

Clinical leadership

Clinical leadership can be defined as:

…The concept of clinical healthcare staff undertaking the roles of leadership: setting, inspiring and promoting values and vision, and using their clinical experience and skills to ensure the needs of the patient are the central focus to the organisation’s aims and delivery.

Jonas et al (2011)

Consequently, clinical leaders are integral to transforming services and improving quality for patients. This is a key enabler for the implementation of Nf2f approaches, given that clinical experience and skills often lead to identifying the need for alternative ways of working.

System leadership

A way of understanding system leadership has been described by NW Leadership academy as:

“Working beyond organisational boundaries on challenges of mutual concern that cannot be solved by any one person or institution. The system is no longer focused on operating as sole organisations and calls for a collaborative approach across a variety of new boundaries.

…System leadership emphasises particular leadership qualities required to effectively work across boundaries with diverse groups of people, patients, citizens and staff. It involves leaders working in a system and, at the same time, acting as change agents within that system to improve its overall performance, focused on improving the health of the local population.

NHS policy and strategy are now aligning to encourage new innovative models of care to replace traditional face-to-face outpatient appointments. 

There’s a range of Nf2f clinic implementation options available, based on both specialty and need. However, all models require the need to engage and influence others effectively, while working across organisational boundaries.

Here’s an example: access to primary care data within a secondary care setting is integral to the success of the chronic kidney disease (CKD) Nf2f model. This highlights the importance of system leadership and collaboration to support the implementation of these models, including agreements for information sharing and governance.

A Kings Fund report entitled The practice of system leadership: Being comfortable with chaos recommends the following strategies to overcome barriers and achieve system change:

  • Start with a coalition of the willing.
  • Involve patients, service users and carers.
  • Strike the right balance between constancy of purpose and flexibility by facilitating conversations about what needs to change – and how.
  • Pursue stability of leadership.

You’ll find further information and case studies on the Kings Fund dedicated resource on system leadership.   

Task

Looking back at your previous stakeholder mapping, consider who the key players are in both clinical and system leadership roles.


Why manage change?

Change theory is the study of what makes change happen, and what factors contribute to the success or failure of a change. From a practical perspective, these factors can then be addressed and/or mitigated against.

Great change needs strong foundations.

(NHS change model)

The introduction of Nf2f models is an example of change and transformation in the way that outpatient services are delivered. Making change happen and changing the way that these services are delivered can be challenging and difficult.

Using change management models and tools provides a framework to facilitate sustainable and successful change, hopefully increasing its likelihood. They can be useful throughout the change process, starting with developing a shared purpose.

What models are available to support leading change?

Among the many models available, NHS England has developed the Change Model Guide. This resource brings together a range of tools and tips designed to support change in the health and care system. The guide is made up of eight components.

  • Our shared purpose – the starting point
  • Spread and adoption
  • Improvement tools
  • Project and performance management
  • Measurement
  • System drivers
  • Motivate and mobilise
  • Leadership by all

When you review these eight components, you’ll recognise similarities with the sections of this Nf2f clinic resource. You can use both resources to complement each other as you work towards setting up an Nf2f model. 

The following case study demonstrates the practical application of a change model when implementing an Nf2f clinic in East London.