Quality and safety in healthcare: does leadership behaviour of commissioners affect outcomes?

Clinical Commissioning Groups (CCG’s) now control two-thirds of the NHS budget for England, influencing healthcare provider priorities and playing a key role in implementing the NHS plan. However significant failures in healthcare has highlighted a dissonance between expressed values of leaders and everyday routine practices. This research aims to explore the leadership behaviour of Commissioners and the role it plays in determining Quality & Safety (Q&S) in healthcare. The research took a pragmatic mixed method approach using two phases: phase 1 used focused video ethnography to observe Commissioners (n=9) verbal and non-verbal communication in an open forum setting. The research method further develops the process to observe real time group dynamics and may aid decision making processes for leaders in healthcare. Phase 2 employed a quantitative questionnaire (n=48) to determine the leadership behaviours that subordinates would expect their Commissioners to adopt. The findings of this research identified that the leadership style most prevalent within the Commissioners was transactional in nature. The Commissioners felt joint ownership of the risks to patients from providers of healthcare services, with empathy and understanding of the pressure their colleagues were under. The most prevalent behaviour within the group determined outcomes of risk analysis. The questionnaire to subordinates of Commissioners identified that transformational leadership had the best outcome on staff performance if this was linked to positive leadership style. In addition Commissioners appeared to lack consistency when analysing risks effectively and therefore holding providers to account, citing issues such as “professional drift” and concerns over further scrutiny, as validation for this approach. This confusion of leadership behaviours, allied with poor analysis of risk leaves Commissioners prone to repeating previous healthcare failures