Strategic leadership behaviours that develop organisational resilience in NHS Trusts in England: A multiple-case study

The provision of quality health care and standards of leadership in the National Health Service in England have been of concern for many years. To address falling standards and institutional failures external regulation of the service was introduced. However, despite the scrutiny of regulators, concerns regarding organisational culture, quality and leadership in the NHS prevail.Research in organisations that have improved their performance as evidenced by the health care quality regulator, Care Quality Commission, has mainly focussed on the organisational changes that have occurred. However, little has been studied as to whether organisational objectives go beyond delivering quality improvement and there is a lack of examination of the strategic leadership behaviour that underpins organisational performance improvement and resilience. Furthermore, there is little research into how the focus of organisational change may alter following a second inspection that demonstrates quality improvement, as evidenced by the Care Quality Commission. Thus it is unclear whether improvement is the result of corporate strategy that intends to deliver long-term, sustainable improvement, short to mid-term improvement to satisfy the regulator, or a mixture of both. This research set out to explore these issues.A multiple-case study design of two non-typical NHS Foundation Trusts were researched to identify the strategic leadership behaviours that enabled organisational performance improvement and underpinned the development of sustained organisational resilience. The research questions were explored through the multiple methods of interviews, secondary documents, non-participant observations and NHS Staff Survey data. Thematic analysis of interview data and analysis of documents were complemented by analysis of summary aggregated percentages of staff survey data. The research offers new insights into leadership behaviour that goes beyond a focus on quality improvement and presents a new theoretical framework regarding the development of organisational resilience. Five strategic leadership behaviours underpinned the development of sustained organisational resilience: responsible leadership, a values-led culture, being people-focussed, applying rigorous governance and a commitment to organisational learning. A new paradigm of leadership in the NHS is proposed, that of responsible leadership. This will benefit the health and social care sectors as they move into a model of integrated care.