Introduction and background
I have worked within the NHS for the whole of my working life and have worked for my current employer, (XXXXXXXX) for the past 12 years. During this time frame and long before, there has been a consistent message coming from the Government, the Department of Health and many parts of the British media; Leadership within the NHS needs to change in order for the service to continue. As long ago as the 1983, the Griffiths report (Griffiths 1983) questioned the consensus style of management structures which had underpinned the NHS for the previous decade (DHSS 1972); and many would argue still exists to a great degree today.
Research completed more than 20 years ago by Stewart and Ranson (1988) remains relevant, they highlighted the very specific challenges faced by managers and leaders within the NHS as:
Politicised and political. Strategic decisions are invariably made whilst balancing a number of difficult and unclear political situations and processes.
Shifting accountability. Leaders are accountable in different ways, at different times to a number of different people.
Needing to constantly reflect, respond and change. The mechanisms for feedback on the service being provided is not always clear within the public domain and as such skills need to be developed to create an environment which allows time to pause, reflect and learn from situation before possibly changing strategies.
Effective leadership within such a complex backdrop is both challenging and vital.
XXXXXXXX is an extremely large NHS institution compromising of 3 large hospitals and two community services. The trust employs 12500 staff, has 1100 beds, has 1.6 million patient contacts each year and has a turn over totalling £1.1 Billion. An organisation chart for XXXXXXXX can be
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