Implementing change in the NHS: effects of clinical leadership on performance

The National. Health Service (NHS) is an intricate amalgam of disparate health care organisations. This research investigated critical success factors for implementing change in the complex environment of acute NHS hospitals in England. The research is of theoretical and practical importance because it includes every acute NHS hospital in England. In doing so it informs future efforts to improve how change and clinical leadership are progressed in NHS hospitals. As a consequence, the findings provide theoretical and practical support for NHS staff in developing leading and delivering successful change strategies for the ultimate benefit of NHS patients. Conflicting and dichotomous views have emerged on what makes change in the NHS happen. Current views reflect the importance of a range of different concepts including leadership, culture and environment. This research draws together theoretical, ideographic and nomothetic knowledge and tests this out in a real world setting. A biphasic emergent research strategy was adopted which incorporates both qualitative and quantitative methods founded upon a predominantly positivistic stance. The first stage used semi-structured interviews of front-line NHS staff to identify rich, descriptive data concerning the factors perceived to either help or hinder their efforts. Themes generated from this were combined with concepts derived ·from the literature to provide the foundation for the second stage of the research. Every acute NHS hospital in England was engaged in a major national change programme to improve the quality of care to Accident and Emergency patients. The second phase of the research involved designing and administering a large-scale survey questionnaire to front-line staff who were participating in this programme. Results confirm a positive relationship between (transformational) clinical leadership and organisational performance In an NHS context. Furthermore, a two factor model of transformational leadership in an NHS context was found in which successful leaders generate and manage a vision, and empower staff to make changes happen. In addition to these research findings the novel methodological approach taken represents a contribution, refining research instrumentation in this complex area. This empirical research makes both theoretical and practical contributions to the management of change. These contributions transcend healthcare and will be of interest to those concerned with the management of change in large complex organisations