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Well-Led: A Key Question

Not everyone can aspire to be a great leader but everyone can work towards being a better leader.

Culture and leadership are crucial for any organisation’s success and this is one of the KLOE (key lines of enquiry) which the Care Quality Commission will use to judge and evaluate on how well led a primary care provider is. And although a small number of people may seem to have been born knowing what to do and say to inspire and lead their teams to success, for most people this is a skill which requires a lot of work and practice as it won’t come naturally to them. For a healthcare business to be defined as successful there are pre-conditions which need to be in place: it does not happen by chance! Some of these pre-conditions include (but are not limited to):

  • a clear vision and strategy that is enacted in practice
  • a well thought-through governance framework
  • a developing leadership strategy
  • a culture that supports shared learning and innovation
  • team-based working
  • high levels of staff engagement
  • patient and carer engagement

Well-led practices provide outstanding levels of care for their patients and will make the work of general practice easier, creating in that sense a happier and balanced working environment for both clinical and admin staff.

On the other hand where there is poor leadership, there is more likely to be issues across the practice, for example in safety, effectiveness, responsiveness and how caring the service is.

In my view, I strongly believe that a great leader should be visible and approachable (inclusive, compassionate and effective leadership is key) and should be hungry for knowledge at all times, actively researching for new and improved ways to work and should also be a good listener as it is important to receive and analyse the feedback received from all levels within the organisation i.e. receptionists, cleaning staff, GP’s, other managers, IT staff, etc. Those in charge of a business are more likely to receive a far better insight from these people who have everyday hands on experience in their roles regarding the difficulties they may be facing or any improvement that could be made to simplify processes and at the same time, make these processes more effective.

In their inspections the CQC will most surely ask practices to present their values and mission statement – this is a very important piece of information as it highlights the organisation’s strategic objectives and on what the practice places value.

A recent update from the CQC detailing the next phase methodology for inspections indicated that clinical research markers are now part of inspections. This is the first time a major NHS regulator has formally recognised clinical research activity in the NHS as a key component of best patient care.

Clinical research is no longer just a ‘nice to do’ exercise in the NHS – it is now a key part of improving patient care!
Also, research is written into the NHS Constitution and this is now backed up through the CQC inspection process. The focus is on how well an NHS Trust/GP Practice as a whole supports research activity. This involves strategic and divisional leadership, and patient opportunity and access around research; there are three levels in the research process:

  • Research equity – how does the organisation support the research programme across the breadth of its services?
  • Research facilitation – how does the organisation proactively support the delivery of research from board/Partnership level to the clinical setting(s)?
  • Research awareness – how does the organisation make research opportunity known to patients, the public and healthcare professionals?

The 3 Levels were first summarised by one of the Patient Research Ambassadors involved in the project and this structure has been used since. This can be applied for both NHS Trusts and GP Practices as the principle is the same and evidence shows clinically research active Hospitals and GP’s have much better patient care outcomes!
It is therefore crucial that leaders in both primary and secondary care organisations support internal researchers initiating and managing clinical studies whilst incorporating a vision and strategy in which clinical research activity is seen as a key contributor to best practices and better patient care. From a business perspective, being actively involved in research might also result in additional income to your organisation as many studies are backed by financial incentives (allocated funding from either the NHS or private stakeholders).
And although the questions on research activity (associated with the well-led topic) which are part of the CQC’s overall assessment will not carry any specific penalties or rewards, they will be used by inspectors when reaching their overall judgement of the organisation. So if you aim to be part of an outstanding NHS organisation in the well-led chapter then you might want to start looking at implementing research activity as part of your organisation’s overall business plan and clinical strategy.

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