Clinical directors have a critical role in coordinating the work of a PCN and providing leadership as part of this new structure. Equipping them with the skills to lead and develop PCNs is crucial to realising the ambitions of improving health outcomes for communities.
The formation of PCNs marked a fundamental shift to large scale general practice and networked provision of services, requiring an unprecedented level of collaboration between practices (Fisher et al, 2019).
SCW delivered a leadership development programme for PCN Clinical Directors and their future successors. It was designed to equip them with the skills and knowledge to lead successfully within an environment of complex organisational systems.
Participants reported that through this learning process, they developed a greater understanding of complex and dynamic systems, understood how to best engage with system partners and developed their own leadership capability. Indeed, all confirmed they would recommend the programme to others.
The pace of change in, and the demand on the health and care system is unprecedented. As Integrated Care Systems (ICSs) are formed, system leadership, grounded in systems thinking, has never been more important.
Recognising the changing needs, the Leicester, Leicestershire and Rutland ICS wanted to support the development of the 25 Primary Care Networks (PCNs) within the ICS. In particular, to support the personal development of the 25 Clinical Directors (and their Deputies).
The PCNs differed in organisational maturity so the programme needed to accommodate this variation. A framework was developed so that the individual needs and objectives of each of the clinical directors and PCNs could be supported.
Systems thinking has become critical to success. Organisations need to focus on their systems, and the need for adaptability, inclusivity and resilience like never before. The development of stronger partnerships in local places between the NHS, local government and others requires collaboration.
Real collaboration and partnership leadership stems from -
- an environment that supports situational leadership approaches
- a culture that encourages the diversity of thinking and approaches and values the contribution of each team member
- a collective awareness of human dynamic systems
SCW’s leadership development programme, therefore, focused on helping leaders and teams to develop skills for both the human elements and behaviours, and the organisational approaches needed, for effective system working. The programme was designed to foster a culture of learning and continuous improvement. Workshops used an experiential learning approach driven by the wealth of evidence (Cox, 2010; Kolb, 1984) that identifies this method as the most effective in delivering long term behavioural change.
- The programme
Four cohorts of Clinical Directors and their deputies received 6 workshops, covering topics including:
- systems thinking,
- understanding ‘self’ and leadership (using diagnostic tools to gain personal insight),
- managing conflict within a system,
- leading change,
- establishing good governance systems.
The topics of the programme were designed to address areas that were proposed by the local Clinical Directors. This was integrated with requirements identified by the ICS, and findings from previous PCN developments undertaken by SCW.
The Leadership Development Programme was delivered over 9 months, starting in September 2020. Each of the 4 cohorts attended workshops every 6-8 weeks.
Whilst the original intention was to deliver face to face workshops, the format was adapted to virtual learning as a result of the impact of the Covid-19 pandemic. Workshops were kept to a maximum of 2.5 hours. Short facilitator-led videos describing the key topics discussed and encouraging self-reflection supported the workshops.
- Clinical Directors rated their own skills and knowledge at the start of the programme and then again at the end. Significant improvements in ratings for the three key target learning areas were identified:
- +24% leadership skills
- +43% understanding of complex and dynamic systems
- +18% engaging with other system partners
- 100% of those surveyed confirmed they would recommend the leadership development programme to others
- Feedback from participants indicated they are:
- listening more
- seeking to include and understand their teams in order to better engage them
- taking more time to reflect and to consider their role as a leader in representing the needs of their PCN
- The practicalities of running a virtual PCN Leadership Programme during the pandemic emphasised the impact that increasing demand and workforce challenges were having on Primary Care. This served to further highlight the scarce commodity of time. Participants, however did tell us that the protected time of the programme provided them with the space to consider their own roles as leaders. And to develop attributes that have driven sustained PCN responses during the crisis.
'It has helped me reassess [leadership] with the big picture in mind' PCN Clinical Director
'I have undertaken leadership development courses in the past; however these sessions have helped me to identify how I can use the skills. It has been worth investing the time for me.' PCN Clinical Director
'I now will lead in a style relevant to the situation and people I am dealing with.' PCN Clinical Director