What do we need from our CEOs to lead us through these challenging times, and how can Aqua and NHS Quest support them?

CEOs aren’t reflecting as much as they used to

Great leaders understand their responsibility as direction setters and role models is even more vital at times of great organisational pressure.

It is therefore worrying that when asked, “how often do you stand back and assess how well you are doing your job, and do you look for ways you could work smarter and more effectively?”, 0% of CEOs answered “at least once a week”. This is down from 33% before the COVID-19 pandemic, with both results coming from Optima Life’s annual cross-sector survey.

Working with many CEOs for over 25 years, our experience is that the greater the operational pressure, the harder it is to prioritise your own development. However, reflection and resilience are key leadership traits and these cannot be acquired if you do not invest in your own development.

What’s the impact of this?

The survey results paint a picture of CEOs being so busy that they can’t think about how to change or improve their system and approach. However, this is vital in reducing organisational pressures and therefore becoming less busy.

At a time of significant workforce constraints, CEOs consumed in trying to manage these operational pressures by doing ‘more of the same’ is concerning. What’s more, the impact of this leadership style makes the lives of staff members even harder.

CEOs have a key role in demonstrating to their staff what is important, and investing in themselves is key to ensuring they have the energy to lead well.

The changing landscape

In the 2000s, most CEOs assessed themselves as being ‘pacesetters’, however the changing landscape in which ICBs have been established now requires an emphasis on collaboration.

So with this in mind, we have been considering what could and should be expected of CEOs helping the NHS and care system to move forward.

The 5 fundamental expectations of a great leader

We have identified 5 fundamental expectations from a huge range of literature on being a great leader, especially at times of high operational challenge:

1. Maintain a broad perspective by looking outwards to other systems and sectors for insights into success.
2. Set and maintain an effective balance of delivering short term imperatives, whilst laying the foundations for medium to longer term transformation
3. Maintain and demonstrate (not just declare) a set of core, compassionate values (including kindness, calmness, and fairness).
4. Balance the focus of your organisation between internal delivery and building external partnerships across your systems.
5. Express your voice and influence on key policy matters, whilst communicating clearly with your staff and partners (to bring clarity of role and expectation). Explain honestly to your local population and service users about how services are constrained and how they can help address the issues.

These are incredibly difficult for a leader to achieve, but they are the fundamental components of leadership that the system needs. So, to play our part, we are working with NHS Quest members to offer a programme of bespoke support to CEOs.

How can NHS Quest help?

Facilitated by an experienced CEO, the NHS Quest network sets its own learning agenda, utilising the experience and credibility Aqua has in convening, brokering and facilitating learning for improvement.

NHS Quest senior leaders are being offered time and space to:

• engage with health and care system leaders from around the world, such as New Zealand, Australia and Canada.
• engage with other sectors such as sport on high performance; retail on customer engagement; and automotive on reducing development costs.
• talk honestly about challenges in a safe space, sharing hopes and fears, insights into leadership style and success.
• consider organisational culture and how to empower our clinical and care professionals.
• work out how to influence upwards, creating the space to move forward on local priorities and demand management and prevention strategies.
• develop their communication skills and strategies.

Psychological safety is often talked about in the NHS but for CEOs, finding those spaces is often reliant on ad hoc relationships, private WhatsApp groups or closed peer-to-peer learning groups.

We see our offer to CEOs as being fundamental in providing this space.

Join NHS Quest

We are currently offering an open invitation for Trust CEOs to join our NHS Quest network, and bring their leadership to this exciting new programme.

Please contact Jackie Bene, Aqua Specialist Advisor or Elizabeth Bradbury, Aqua Director for further details.

By Sue Holden and Mike Farrar

About the authors

Sue Holden

Sue has worked in the NHS since 1983, after initially starting her career as a librarian. Sue trained as a nurse, then midwife and worked clinically for over 15 years before developing her interest in organisational development and learning. Sue worked as an Executive Director in a Teaching Trust before moving to become the Lead Improvement Director for NHSI in 2015. For five years Sue worked with Trusts in Quality and Financial Special Measures and in 2019, she became the National Director for Intensive Support.

In June 2022, Sue joined Aqua as its new Chief Executive Officer. Sue believes it is more ‘how’ we go about supporting organisations than ‘what’ we do as a key part is enabling organisations to learn how to improve and sustain improvement.

Mike Farrar

Mike is an independent Management Consultant, specialising in health and care, sports and higher education. He has 13 years of CEO experience in the NHS and is currently the Chair of ukactive, a not-for-profit industry association, promoting the interests of commercial fitness gyms and community leisure centres, with more than 3500 organisations in membership.

In 2005, Mike was awarded the CBE for services to the NHS and is an Honorary Fellow of the Royal College of General Practitioners, the Royal College of Physicians, and of the University of Central Lancashire.