The purpose of this paper is to explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in health care organisations.
Using empirical data from two studies of the implementation of The Productive Ward: Releasing Time to Care™ in English hospitals, the paper explores leadership in relation to local implementation. Data were attained from in-depth interviews with senior managers, middle managers and frontline staff (n=79) in 13 NHS hospital case study sites. Framework Approach was used to explore staff views and to identify themes about leadership.
Four overall themes were identified: different leadership roles at multiple levels of the organisation, experiences of “good and bad” leadership styles, frontline staff having a sense of permission to lead change, leader's actions to spread learning and sustain improvements.
This paper offers useful perspectives in understanding informal, emergent, developmental or shared “new” leadership because it emphasises that health care structures, systems and processes influence and shape interactions between the people who work within them. The framework of leadership processes developed could guide implementing organisations to achieve leadership at multiple levels, use appropriate leadership roles, styles and behaviours at different levels and stages of implementation, value and provide support for meaningful staff empowerment, and enable leader's boundary spanning activities to spread learning and sustain improvements.
The studies which inform this work were commissioned and supported by Helen Bevan and Lynn Callard and Kristy Parnell at the National Health Service Institute for Innovation and Improvement (NHS Institute) in England. Diane Ketley provided helpful comments and suggestions on an earlier version of this paper. Professor Peter Griffiths, University of Southampton contributed to the design and conduct of the studies. The views expressed here are those of the authors, not of the NHS Institute. The authors thank all those who participated in the studies whether by participating in interviews, facilitating access to organisations or providing other information. Thank you to the two anonymous reviewers of this paper who provided helpful suggestions and comments.
Morrow, E., Robert, G. and Maben, J. (2014), "Exploring the nature and impact of leadership on the local implementation of The Productive Ward Releasing Time to Care™", Journal of Health Organization and Management, Vol. 28 No. 2, pp. 154-176. https://doi.org/10.1108/JHOM-01-2013-0001
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