NHSG LEADERSHIP STRATEGY
1. Background
NHS Grampian is committed to bringing about a whole-system approach to health and
healthcare, and to the changes required to make that happen. To do this in an effective and
sustained way we need to be explicit about the leadership principles and values that underpin
our vision and strategy. The vision for the system is as follows:
NHS Grampian believes that people in Grampian deserve the best health possible. To make
our contribution to this, we need to realise our vision of an integrated, connected,
collaborative and corporate health system, working together to ensure that we:



Develop health services to maximise opportunities for health gain
Sponsor and support the promotion of health
Influence and work effectively with our partners to improve the wider determinants of
health
We need leaders to provide a strong sense of purpose and direction, consistently and
effectively leading others in that direction.
2. The leadership we need
Our core function is to improve both health and health services for the people of Grampian,
against a complex environment of:
 growing expectations of patients, public and staff
 changes in other organisations with whom we need to work
 changing patterns of disease and the availability of new technology
 political drivers and expectations
 economic constraints
Effective management and leadership are essential if we are to achieve our vision.
The proposal for an integrated NHS Grampian is designed to put in place organisational
arrangements which will help our efforts to improve both health and health services.
However, these arrangements must be driven by leadership and ways of behaving which will
enable every member of staff to cope with, and manage, the changing environment outlined
above.
The leadership style which we, as an organisation, need to develop is one which:
 supports and encourages a culture of empowerment
 builds effective relationships inside and outside NHS Grampian
 creates effective teams within and across departments
 recognises staff as individuals with different needs, perspectives and aspirations
 invites, and accepts, challenge in order to reach the best solutions
The strategy outlined in this document is relevant to all leaders in the system. This includes
those who are:
 currently in a formal leadership role
 required to demonstrate leadership in your day-to-day work due to your role eg ward
sister, lead nurse, GP, consultant, administrators etc
 thinking of your career in the future and have aspirations for a leadership role
 currently attending a leadership development programme
 staff-side representatives
Indeed, it is relevant to all members of staff, since it describes what we should all expect from
those in positions of leadership and the behaviours they need to display
3 Organisational ‘drivers for change’
There is increasing evidence that change must be led through clear, consistent and robust
leadership. Grampian’s change agenda continues to grow both in size and complexity.
Pay Modernisation – in the form of the new GP Contract, Consultant Contract and Agenda for
Change – has the potential to ‘lever’ change. Taking advantage of this opportunity does
however require skill and experience on the part of leaders in the system.
Meanwhile, national policy continues to shift towards joint-working with public sector partners.
This also requires a complex mix of skills and behaviours if we are to achieve the desired
outcomes for our communities.
Our agenda to become an increasingly integrated system is entirely consistent with
Scotland’s Health White Paper Partnership for Care. This calls for leadership to be
supportive, facilitating and empowering, and to work with patients and staff to create a
modernised health service fit for the 21st century.
To achieve successful outcomes in all these agendas, we must be clear about what needs to
change, and how we will make it happen. This strategy plays a crucial role in that process.
4. Organisational ‘dilemmas’
We are aware, through the extensive work of the short life strategy development group
(membership detailed in appendix 1), that there are a number of ‘dilemmas’ or paradoxes
within the system. Identifying these will help us understand where we currently are in
developing leadership in the organisation. Inevitably these paradoxes create tensions in our
environment but they are the reality of our organisational life. It is through the honest
acknowledgement of these that we can challenge behaviour and ultimately work towards
changing it.
We list these dilemmas as appendix 2. As a system we need to work through these issues.
Identifying them explicitly is the first step towards developing the systems, processes and
behaviours which will help us address them.
5.Principles of good leadership
As a system we must be explicit about the core principles which underpin our leadership
strategy. Our overarching principle is that leadership is about how we build relationships
based on respect, fairness and equity. In other words, how we treat each other.
Leaders need to:
 Energise, enable and empower the people they work with
 Continuously and consistently value and develop people
 Think more strategically, while paying sufficient attention to operational issues
 Look at the whole service, as well as its separate parts
 Learn to be effective in situations where there is no line management authority
 Not use uncertainty as a reason to delay action
 Continue to minimise risk in clinical practice, but be prepared to take managed risks when
required
 Consult, involve and listen to people
 Be honest, open and transparent in making decisions, maintaining confidentiality when
necessary
 Be able to recognise and communicate priorities clearly and consistently to their teams
 Realise that, though results are important, so too is the route by which we achieve them
 Be clear about accountability, but be open and learn from mistakes
 Work more effectively across organisational boundaries
6. Elements of a leadership strategy
The mechanisms to create, develop and sustain leadership skills are a combination of
individual development and organisational process. (See appendix 3)
6.1 Concentrating on core business
The foundation of any sustainable leadership strategy is to be clear about the purpose of
the organisation. Clearly, the NHS is about improving health, and providing care free at
the point of delivery. Our purpose is described in our vision statement above.
Being clear about our core functions allows us to focus on what really matters, ie services
which deliver health improvement and high quality patient care. The development of
support functions, e.g. HR, IT, Finance etc will always be governed by our organisational
purpose.
6.2 Leaders with the right skills
As part of the preparation for the Grampian Leadership Development Programme which
began in 2002, we identified the leadership competencies and behaviours which we need
to deliver our core functions.
These are attached in full as Appendix 4, and are consistent with those already
developed for NHSScotland.
In summary, there are seven themes as follows:
i.
Service focus
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ii.
Leadership
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iii.
building and maintaining effective relationships both within NHS Grampian
and with other organisations
Team/group working

vii.
leading and managing change effectively, paying particular attention to the
impact of change on staff
Relationships

vi.
the ability to anticipate and focus on the longer-term and wider agendas, as
well as ‘delivering the day job’
Leading change

v.
including providing a strong sense of purpose and direction, and leading and
involving others in moving in that direction
Strategic and operational focus

iv.
working towards agreed national, local and professional priorities, as well as
emphasising integration, service improvement, multidisciplinary services, and
patient and public involvement
creating effective teams, and continually motivating and leading them
Supporting and developing others

coaching and supporting others, to help them develop and reach their full
potential
Appendix 5 is the result of recent work with OD Partnership Network to explore the
environment within which NHS leaders are now required to work. From this work we see
that the environment is diverse, and there are very different types of ‘terrain’, making it
very unlikely that many managers can be equally competent in all areas.
For some managers the emphasis will be on brokering across organisations, for others
acting as a ‘politician’ may be more important, while for others ensuring delivery of
services is of prime importance. The leadership strategy for NHS Grampian must
recognise this wide arena in which managers operate, and be pragmatic in our
expectations. With equal competence in all areas unlikely, we must identify the critical
areas of competence for different positions, and manage the risks of lower competence in
other areas.
6.3 Developing good leaders
a) Robust Service Planning & Delivery Processes
Underpinning any successful organisation are sound planning and implementation
processes and standards which everyone in the organisation is expected to follow.
These set the standards by which we conduct our business and relationships, and
include:
1. being clear about the organisation’s direction, intention and purpose
2. translating that into key strategies and organisational objectives
3. subsequently creating operational plans and targets for implementation i.e.
service plans
4. creating clear measures of performance
5. measuring our progress at regular intervals, to ensure we are making progress
towards our vision
6. being committed to effective two-way communication
7. critical questioning of the consequences of decisions and actions
8. being clear about responsibility and accountability, both individually and
collectively
9. simple organisational structures that help people understand the system rather
than confuse them
10. sound processes for making decisions and managing conflict
11. excellent meeting and organisational skills
12. comprehensive, dependable and honest reporting systems
13. processes which involve patients and public in development of services
14. adherence to the Staff Governance Standards
b) Active role modelling
The greatest influence on the leadership tone set by a manger is the leadership tone
they experience from their bosses. Consequently all leaders in the organisation are
role models, whether they intend it or not. This provides opportunities to achieve
consistency of action and words, and avoid mixed messages. What we say we value
in the organisation must be evident in the behaviour of its leaders.
All leaders have a duty to use their position as role models responsibly, since this will
reinforce other aspects of their development, such as training and performance
review.
c) Developing leaders for the future
One of the most visible signs of our commitment to excellent leadership is how we
manage succession within the organisation. Doing this successfully depends on:
1. understanding what determines success in any given role
2. understanding an individual’s strengths, weaknesses, development needs,
experiences, successes, interests and visible behaviours
3. understanding the longer term needs of the organisation particularly in relation to
strategic workforce development
4. a fair, open, objective and equal process, focused on development
5. a commitment to be consistent in how we use the process
The key to succession management in our system will be visible commitment and
support for the Personal Development Planning process. We must make sure that
people have the skills to participate in, and manage, the process effectively, so that
they fully understand individual strengths and aspirations. There is more about this in
the NHS Grampian Learning and Development Strategy, which should be read in
conjunction with this document.
d) Appointment processes
The appointment of managers at all levels should be consistent with the agreed
leadership competencies, and reflect the areas of emphasis for the particular post.
The competency framework for posts at all levels should explicitly reflect the
competencies, or - for junior posts – reflect the framework at the very least.
At senior levels (where the risk posed by poor leadership is highest) selection
procedures should confirm that the candidate already has leadership competence, or
has the potential to develop it. This means that a traditional interview is insufficient.
e) Reviewing performance
Performance review, like role modelling, is one of the most powerful development
tools. The mechanism for performance review in NHS Grampian is clearly defined.
However, its impact is determined by the extent to which it is used, and the
effectiveness of the ‘performance reviewer’.
Along with objectives, the leadership competencies are the backdrop for performance
review. The overall aim of the process is to help the individual achieve their
objectives, and gain the competence and behaviour necessary for leadership.
Personal development plans are an important outcome of the review. If thorough and
sufficiently personalised, they indicate the development activities which would be
helpful to that individual. The quality of the relationship between the manager and the
individual is also critical for the success of the review process.
f)
Learning and Development
If we are clear about the organisation’s direction and goals, and consequently clear
about what we value in people, we can then be quite explicit about what people need
to develop. The aim of individual, team and organisational learning is not to push
people through a sausage machine, but rather to identify their individual gaps and
develop skills and competencies which support the organisation’s direction. To do this
effectively we must be very clear about what those skills, competencies, experience
and behaviours are. This will help us to check that all development programmes
support the organisation’s development agenda.
Our portfolio of approaches must be comprehensive to support the many and varied
personal learning styles, and may include the following:
 Traditional learning programs through teaching
 Internal, external and cross-organisational programmes
 Learning sets
 e-learning
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organisational raids
secondments
shadowing
supported development
Substantially more detail on this specific topic can be found in a separate document
entitled the Learning and Development Strategic Plan which has recently been
developed and should be read in conjunction with this document.
g) Rewards and recognition
‘Reward management’ is about how people are rewarded both financially and - just
as importantly - non-financially, in accordance with their value to the organisation.
Within the National Framework we do not have much flexibility in terms of pure
financial reward. However this gives us the opportunity to be creative with nonfinancial rewards and incentives. In terms of reward management, what we are most
concerned with in this strategy are:
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methods of enhancing quality of working life
ways to motivate people by financial and non-financial rewards, eg through the
work itself, and opportunities to develop skills and career
schemes to provide financial and non-financial rewards and incentives to people
according to individual, team or organisational performance
recognition schemes which reward achievement and behaviour, aligned with
organisational performance
When the reward strategy is aligned with the organisation's direction and goals it:
1. helps to attract, retain and motivate high-quality people
2. plays a significant part in communicating the organisation’s values, performance,
standards and expectations
3. encourages behaviour which contributes to achieving the organisation’s
objectives
4. underpins organisational change programmes which are concerned with culture,
process and structure
5. helps make real the key values of the organisation, such as quality improvement,
patient care, teamwork, innovation, flexibility and speed of response
6. provides value for money
To shift the culture towards a model which supports whole system planning and
delivery it is essential that we align our reward and recognition processes, so that we
gain the greatest value across the system. To do this we must be explicit about what
we do value (and consequently reward) such as managed risk-taking, innovation,
success, flexibility, adaptability and delivery. Identifying this list will help us evaluate
whether our development programmes are properly focused on delivering successful
outcomes for the whole organisation.
We must explore, wherever possible, broader options to make our investment in staff
pay deliver greater value, which could include:
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contingent pay (based on performance, competence, contribution or skill, team
performance or organisational performance)
variable pay (which is not consolidated in base i.e. is paid for that year only and is
not pensionable, but can immediately reinforce achievement)
forward-looking incentives and backward-looking rewards
exploring private sector funding and/or sponsorship
exploring European funding sources
h) Managing people
Based on feedback from the Staff Governance Survey and the Partnership Forum and
recognising the need to manage a significant change agenda, the People Management
Project was established. Implementation of this project is essential to building staff
support and commitment to change. The competencies relate to leadership competencies
and the Staff Governance Standard.
The People Management Project has been established to agree the competencies
required by staff who manage and lead teams of people. As part of its role in developing
its staff, NHS Grampian is committed to these competencies, as an integral part of
recruiting, developing and appraising managers.
These competencies are the knowledge, skills and behaviours that ‘people managers’
need to enable their own staff to deliver the best services, and achieve their personal
potential.
The effective integration of NHS Grampian’s services requires managers to lead,
communicate and support staff effectively through the change. Similarly, Pay
Modernisation calls for skills in assessing development needs, coaching staff, and
providing feedback on performance.
The continuing development and redesign of clinical and support services requires staff
who are skilled, flexible and motivated, all of which can be enhanced by effective ‘people
management’.
7. Initial, medium and long term actions (in no particular order)

Determine the mechanism for ongoing development and management of the
leadership strategy.

Bring together everyone involved in training and development activities (ie the
‘trainers’ ) in a regular learning-set type activity to ensure that they understand,
can, and will, promote the vision of leadership as outlined in the strategy. As well
as providing leadership, this will also give us feedback from those attending
courses and delivering frontline services.

Systematically look at all our training programmes to see how they can actively
promote the strategy (as opposed to simply being consistent with it) and identify if
there are any gaps in what we provide.
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Ensure that all new development programmes, at any level, are linked to both the
wider organisation and the leadership strategy, and that they actively promote the
strategy.

Continue to develop competency based selection processes which reinforce the
leadership strategy

Review all aspects of performance management processes that are under our (as
opposed to Scottish Executive) control :


Consider supplementing the formal process with a less formal (but
compulsory) peer review process which enables people to assess their
own performance in a setting which is not linked to PRP. Agenda for
Change will determine much of this. (The consultant appraisal process
would be a good model for this).
Find ways to ensure that links can be made between individual and
organisational performance.


Develop skills among those doing performance management (especially
clinical managers who have little experience and few benchmarks in this
area)
Develop an overview mechanism for performance management.

Develop monetary and non-monetary reward and recognition processes,
encourage good practice.

Use the Grampian Management Team to review progress on the leadership
strategy, linking it to progress in improving health and services

Ensure key management groups are signed up to, have ownership of, and have
an in-depth understanding of the leadership strategy, and in particular understand
their role and how they will assess their impact as a group as well as individuals.
to
8. Funding/resourcing
To resource this strategy we need to prioritise it, and see the work to support it (as outlined in
the action list) as critical to our success and not as an optional extra.
There may be occasions where central or external funding is available and we should develop
bids for such funding as appropriate.
Similarly, we may wish to submit internal proposals for funding, but only after considering
whether or not internal prioritisation could have more impact.
9. Evaluation and ongoing development
For any strategy to be successful it must be ‘owned’ by those who work in the system, and it
must have clear and objective performance measures, so that we know whether or not it is
making a difference.
We believe that this strategy, along with other key organisational strategies, must, as a first
step, be owned by the Grampian Management Team, and we would strongly recommend that
its success is performance managed through that group.
Mechanisms we can use include the processes which already measure organisational
effectiveness, individual effectiveness, and the effectiveness of leadership development
activities. A number of tools currently exist which could be used, including:
 Staff surveys
 PAF (Performance Assessment Framework)
 360 review
 Feedback from the Grampian Area Partnership Forum
In addition, the leadership principles set out in this document could be used by various
management group to assess the impact of this strategy.
Appendix 1
Grampian Leadership Strategy Development Group
Jim Royan (Chair)
Ken McLay
Stephen Lynch
Elizabeth Robertson
Elinor Smith
Alisdair Chisholm
Colin McKenzie
Anne Inglis
Sharon Macdonald
Elaine Mottram
Jennifer Mack
Appendix 2
ORGANISATIONAL DILEMMAS
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We want leaders who make tough decisions, but when we get one we accuse them of not
listening to, and involving, people.
We want excellent leadership, but we are not prepared to properly invest in developing it.
We demand excellence from our leaders, yet we do not define what constitutes
excellence.
We want good role models, but we are not prepared to take the pain in identifying them
and letting go of the poor models.
We talk about being performance-focused, but we do not have the skills to effectively
manage poor performance.
We say that it is critical to encourage and develop long-term thinking and strategy, but we
remain short term, and focused on crises.
Our vision is built upon a whole-system integrated model, yet our thinking remains in
compartments.
We say we value open and honest behaviour, but it seems that some people can do well
in the organisation without being open and honest.
We say we value certain types of behaviour, but we don't, as an organisation, tackle
bad/bullying behaviour.
We have policies but it seems there are ways round the policies for senior people.
We want to provide quality services, but meeting waiting list targets and other deadlines
seems to override quality.
We talk about managing risks, but our culture is to avoid risk rather than manage them.
We say we will treat staff with equity, but it appears that there are different rules for
different groups.
We set up management arrangements, then develop parallel processes.
We spend a lot of time working out who is responsible for what, but much less time and
effort on developing the ability to take that responsibility.
We create systems (eg performance management), but then don't check to see whether
the systems actually deliver what they were set up to deliver (eg improved performance?)
We say we want to improve the effectiveness of our services and then expect people to
deliver that change on top of performing their day job of delivering services even though
many people’s day jobs have them working crazy hours to start with
We encourage tackling inefficient service design but allow the overall organisational
structure of change approval to be bureaucratic, cumbersome and generally prevent and
discourage fast , responsive, obvious changes
We encourage breaking down of professional barriers but allow professional shroud
waving to stop common sense improvements
Appendix 3
APPROACH TO LEADERSHIP DEVELOPMENT
People Management
para. 6.3.h
Reward and recognition
mechanisms
para. 6.3.g
Clarity about
the direction
and strategy
and the core
work for
NHSG.
Leadership Strategy
- overall aim is to create
the skills and experience
in the leaders in the
organisation such that
NHSG improves its ability
to deliver improved health
and health services for the
people of Grampian
Learning and
Development
Mechanisms to
create, develop
& sustain the
skills
para. 6.3.f
Performance review
processes
para.6.3.e
(6.1)
Appointments
processes
Robust
processes
para.6.3.a
para.6.3.d
Active role
modelling
para.6.3.b
79b
Successio
n planning
para.6.3.c
Appendix 4
The NHS Grampian Leadership Competencies and behaviours are:
Service Focus
1. Keeps up-to date about NHS/Professional priorities
2. Works in partnership with patients/service users and other stakeholders
3. Works across boundaries to promote an integrated service
4. Makes use of computer-generated reports to assess service performance
5. Establishes ways to improve Service planning/delivery
6. Involves Patients/service users/staff side in key service reviews
7. Works to focus multi-disciplinary services around the patient/service user needs
Leadership
1. Win peoples’ attention when communicating
2. Provides a strong sense of purpose and direction
3. Deals constructively with challenges
4. Behaves as a positive role model that inspires others
5. Involves others in key decisions
6. Considers good ideas and explores them
7. Leads others confidently
Strategic and Operational Focus
1. Is able to anticipate the local implications for the NHS priorities
2. Keeps a clear focus on what needs to be delivered
3. Translates vision into something easy to understand
4. Is concerned to address both the local needs and the wider agenda
5. Keeps in touch with key issues
6. Takes positive action to influence the internal and external political agendas
7. Monitors progress against plans
Leading Change
1. Tackles difficult issues sensitively
2. Gains support for the change agenda
3. Follows through and delivers what is promised
4. Remains optimistic when faces with ambiguity and uncertainty
5. Offers constructive change options
6. Assesses how major decisions will impact on people and Services
7. Seeks a balance between change and stability
Relationships
1. Actively listens and values contributions
2. Good people skills – puts others at their ease
3. Keeps calm under pressure
4. Is honest, open and approachable
5. Acts to recover from own acknowledged mistakes
6. Influences through networks of contacts
7. Able to work with all levels and types of people
Team/Group Working
1. Praises and gives the team/group the credit for its achievements
2. Keeps the team/group well informed
3. Trusts the team/group members to get on with their tasks
4. Works with the team/group to achieve goals
5. Manages conflict and disagreement within the team/group
6. Inspires and motivates the team/group
7. Supports multi-disciplinary working teams/groups
Supporting and Developing Others
1. Coaches others to improve
2. Supports and challenges performance issues constructively
3. Helps people to develop their skills to their full potential
4. Shows an interest in others people’s work
5. Encourages more effective ways of doing things at work
6. Review and gives feedback on progress
7. Delegates effectively
These leadership competencies and behaviours will be linked to NHS
Grampian’s Recruitment Strategy and the Appraisal Process.
Appendix 5
Some critical terrain for the development of management &
leadership
The prevailing principles

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

Generic competencies underpinning national leadership programmes
Plus access to numerous courses for dev’t of skills & knowledge
Plus encouragement of good practice in performance appraisal & personal dev’t planning
Code of conduct for managers
YET…..

Diversification of management
challenges


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


Leadership for health gain
Managing clinical services
Facilities management
Introducing new technologies
Scheduling/queuing management
Etc
The manager as deliverer
A more
provision
pluralist
pattern
of

More diversity in NHS
provision/settings
 Private sector management of
elective ‘factories’

Better customised community care
 Patient choice
 Patients as active partners in their
own care
The manager as nomad or not?
Increasing need to work across boundaries


With other professions; teams; agencies etc
On chronic disease management; community care;
workforce dev’t etc etc
The manager as broker
Social & democratic
accountability
–
expectations
of
responsiveness
greatly
increased
The
manager
as
‘politician’
AND



SO
adaptability is the
key….. at every stage of a
career
BUT
how to create the
opportunities?
there are some real threats:
Rhetoric & reality don’t match
Heroic management still rules
Diversity undervalued
The
Darwinian
manager
Need to develop next
generation
of
managers
AND
Need for experienced
managers to thrive…
& survive