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New style of NHS leadership could deliver better patient care and financial performance says The King’s Fund review

A year-long review carried out by The King's Fund argues that a new style of leadership in the NHS could deliver lower mortality, better patient experience and outcomes, and financial savings.

The review builds on last year’s
The future of leadership and management in the NHS: No more heroes report, which criticised political attacks on the role of NHS managers. It argues that the NHS should move away from the predominant ‘pace-setting’ style of leadership based on meeting targets and makes a compelling business case for a new model of leadership based on stronger engagement between staff, clinicians and patients.  

Drawing on eight commissioned papers and numerous submissions, the review highlights the links between organisational performance and leaders who engage staff, patients and others in improving care. For example, evidence suggests a strong correlation between levels of staff engagement and hospital mortality rates. It shows that by increasing staff engagement to the level of the top 20 per cent of hospitals, the average acute trust could reduce patient mortality by 2.4 per cent. It also found that this could save an estimated £150,000 annually per trust by reducing staff absenteeism alone, indicating the potential to make substantial savings across the NHS as a whole.

The review found strong evidence linking effective engagement by doctors with improved organisational performance and better patient outcomes. Organisations with medical engagement generally have higher quality patient care, improved productivity (including significantly lower mortality rates) and better financial performance.  The review also highlights the importance of NHS leaders engaging across organisational boundaries to deliver integrated care and calls for a stronger emphasis on increased patient engagement to improve patient outcomes.

The review argues that leadership for engagement needs to be embraced at all levels of the NHS, from the front line to the NHS Commissioning Board. This requires the new Leadership Academy to promote a diversity of leadership approaches and for NHS boards to set the tone for staff and for team leaders to create a climate that emphasises patient care and enables staff to perform to the best of their abilities.

Chris Ham, Chief Executive at The King’s Fund said:

‘The NHS is facing unprecedented financial and organisational challenges. The need to improve service quality, while finding £20 billion in productivity improvements by 2015 and implement the NHS reforms, means that effective NHS leadership has never been more important. Our review reveals a compelling business case for leadership based on stronger engagement between staff, clinicians and patients. Instead of making swingeing cuts to the number of NHS managers, our research suggests that a new style of leadership could significantly improve financial and service performance.

‘The reformed NHS must leave behind the command and control culture that has dominated health policy in the last decade and develop leaders who can engage others to deliver further improvements in performance and patient care.’

Read the full report, Leadership and engagement for improvement in the NHS, and the supporting papers

Notes to editors

For copies of the reports, interviews and further information, please contact Saskia Kendall at The King’s Fund press office on 020 7307 2603 or by email on

The statistics comparing staff engagement and both patient mortality and staff absenteeism above can be found in the West, Michael; Dawson, Jeremy (2012) Employee engagement and NHS performance, a paper commissioned by The King’s Fund for the leadership review. Using the NHS annual national staff survey data, the researchers measured how engaged staff were. By comparing this to other NHS data sets, they found a strong correlation between staff engagement and better outcomes, including mortality and absenteeism.  The statistics outlined above are equivalent to the following statement made in the West/Dawson paper: ‘An increase of one standard deviation in engagement would be equivalent to a saving of around £150,000 in salary costs alone for an average acute trust.’Leadership and engagement for improvement in the NHS: Together we can is to be published at the annual leadership summit at The King’s Fund on Wednesday 23 May. At the event, Chris Ham and Nicola Harley, Director of Leadership, will be speaking along with Malcolm Grant (the new Chair of the NHS Commissioning Board) and a live stream speech from David Nicholson (Chief Executive of the NHS Commissioning Board). For details of the event please contact Saskia Kendall.

eight commissioned pieces, available to download, are:

  • Alimo-Metcalfe, Beverley (2012) Engaging boards: The relationship between governance and leadership, and improving the quality and safety of patient care
  • Bagnall, Pippa (2011) Facilitators and barriers to leadership and quality improvement
  • Bohmer, Richard (2012) The instrumental value of medical leadership
  • Clark, John (2012) Medical engagement:  Too important to be left to chance
  • Coulter, Angela (2012) Leadership for patient engagement
  • Lemer, Claire; Allwood, Dominique; Foley, Tom (2012) Improving NHS productivity:  The secondary care doctor’s perspective
  • Welbourn, David; Warwick, Rob; Carnall, Colin; Fathers Dean (2012) Leadership of whole systems
  • West, Michael; Dawson, Jeremy (2012) Employee engagement and NHS performance

The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, we help shape policy, transform services and bring about behaviour change. Our work includes research, analysis, leadership development and service improvement. We also offer a wide range of resources to help everyone working in health to share knowledge, learning and ideas.

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