12 How can leadership in NHS hospitals be improved to ensure better quality of care for patients?

Introduction The inspiration for this literature review came from the Francis report (2013) on the failings of the Mid Staffordshire NHS trust in delivering high quality of care to patients. The hospital's non-clinical managers, doctors and nurses with leadership positions, all prioritised the 4-hour waiting-time target over safe and good quality practice (Allen and Dennis, 2010). Consequently, one of the main recommendations from this inquiry was to improve the leadership within the Trust. It argued that leadership is essential; delivery of healthcare must be patient centred; and that the responsibility of leadership must be shared across all levels within a hospital, from its board members all the way down to the frontline staff working on wards (Kings Fund Commission, 2013). Improving leadership was encouraged for hospitals across the country and the Mid Staffordshire Trust scandal became a spotlight for demonstrating just how important leadership is for delivering a high quality service. Aims and objectives of the research project or activity During the initial scoping of literature on leadership in health, it is noticeable that there is abundant research indicating that leadership is important to healthcare delivery, but limited research was available on how this leadership can be improved to better the quality of care delivered to patients. This literature review therefore aimed to find strategies that can be implemented in hospitals to improve current leadership of doctors and nurses working in NHS hospitals. The research question that guided this review was posed as: 'How can leadership be improved in NHS hospitals to ensure better quality of care for patients?'. Themes to categorise the results were identified using the World Health Organisation's framework for leadership development in health (2009). Method or approach The search was performed in the Medline, CINAHL and EMBASE databases for the time period of 2013–2021. Themes to categorise the results were identified using the World Health Organisation's framework for leadership development in health (WHO, 2009). The framework provided four key factors that are required to improve leadership in health systems: (1) adequate number of managers, (2) appropriate competencies, (3) functional support systems and (4) enabling a working environment. Papers had to be peer-reviewed articles published after 2013, which yielded a total of 564 possible documents for review. Inclusion criteria: (1) Records must be relevant to UK NHS hospitals; (2) Population target must be doctors and nurses; (3) Intervention must look at how leadership is developed; and (4) Outcomes must measure quality of care. Findings 564 articles were initially found. After using the inclusion criteria and screening the articles, 11 articles were finally included in the literature review to answer the research question. 6 studies concluded that we need to have more doctors and nurses in leadership roles and appropriate competencies such as effective communication and teamwork must be developed to improve leadership potential and skill (Mckee et al, 2013) (Dewar, 2014) (Miani et al, 2013). 2 papers proposed that hospitals require functional support systems. 8 papers called for an enabling working environment such as having incentives in place for staff to develop leadership (Phillips, 2013). The Francis report (2013) found that fear over whistleblowing was seen as issue that prevented many staff from raising concerns over the quality of care provided to patients in the in the Mid Staffordshire scandal. Failure of clinical leaders to set examples on high quality practise and a lack of trust in them by other colleagues meant that the quality of care given to patients diminished. When minor incidents and wrongdoings happen constantly, overtime they become the new norm and that reduces the standard of care provided to patients (Mastracci, 2016). Key messages Effective clinical leadership has been linked to a better overall health system performance (Daly et al., 2014), and in particular it relates to providing a high quality of care which is why this topic is so important (Sfantou et al., 2017). Future doctors and nurses should consider developing their leadership skills and ability. NHS organisations should also encourage their staff to develop such skills and allow more doctors and nurses to become clinical leaders, to overall better the quality of care provided to patients. The methodology I used was systematic and one of the key strengths of this literature review as it kept a focus on NHS England Trusts, which other systematic reviews don't do. However, the lack of research in this field must encourage us to pursue more quantitative based studies on leadership in the NHS and how it can help us better patient outcomes.