A College strategy for professional development in leadership and management

1 / Purpose of paper

Council members are invited to:-

1)Comment on the relevant areas for the College to take forward

2)Agree key areas for future activity

2 / Background
  • Competency in leadership and management is fundamental to the work of a psychiatrist and underpins all aspects of psychiatric practice;
  • Leadership in mental healthcare involves leadership practices and organizational intervention in addition to personal behavioral style or competences;
  • Leadership and management competencies are clearly defined in the NHS Leadership Framework;
  • Leadership development should focus on organizations and systems as well as individuals and should be informed by the organizational context in which individuals work;
  • Leaders in mental healthcare should demonstrate:-
  • A commitment to promoting high quality care;
  • A willingness to collaborate;
  • An ability to adopt a wider perspective;
  • An interest in team and organizational rather than individual success;
  • A desire to strengthen their capabilities through continuing learning, training, and reflection.
  • Psychiatrists are uniquely positioned to provide leadership within mental healthcare teams, services and organisations.

3 / Strategic Plans

We propose:-

Establishing networks

  1. The formation of a National Leadership Network
  2. A national leadership network to facilitate high quality networking between psychiatrists holding formal leadership and management positions
  1. The formation of Regional Leadership Networks
  2. Regional leadership networks to provide members, of all specialities and levels, with opportunities for:
  3. Networking
  4. Accessing peer support (including mentoring and coaching)
  5. Sharing best practice regionally and, via the College, nationally
  6. Networks to be led and co-ordinated and sit within current divisional and national structures
  1. The creation of the role of Leadership Champion
  2. Named individuals might function as “leadership champions” within the regional leadership networks and offer members:-
  3. A point of contact and coordination around leadership development
  4. Signposting to leadership and management information
  5. Signposting to local and national leadership development opportunities, programs and events
  6. Introductions to allied individuals and organisations
  7. Leadership champions might be formally registered with the College and work closely with counterparts in primary and secondary care and leaders in postgraduate and undergraduate psychiatric training
  1. Meshing with external work streams
  2. The RoyalCollegewill develop close links with key national allied organisations in particular:
  3. The Faculty of Medical Leadership and Management
  4. User and carer groups
  5. Provider organisations

Establishing networks is vital to ensure that the College remains a flexible and responsive organisation that can reflect mental healthcare priorities and arrangements.

Continuing Professional Development initiatives

  1. The provision of leadership and management resources
  2. The College to provide its members with high quality leadership and management resources in the form of:-
  3. An online repository of leadership and management case studies which would:-
  4. Illustrate leadership and management best practice in mental healthcare and in each arena of practice (academic, research, clinical)
  5. Supplement the clinical examples offered in the NHS Leadership Framework
  6. Celebrate success
  7. Support for revalidation
  8. Model job descriptions for formal positional leadership and management roles
  1. The provision of leadership and management training
  2. The College to provide high quality face to face training in leadership and management topics
  3. Groups with specific learning needs around leadership include:-
  4. Psychiatrists making the transition to consultant grade
  5. Psychiatrists in formal leadership and management positions
  6. Those providing supervision to psychiatrists in formal leadership and management positions
  7. Those involved in teaching leadership and management skills
  8. College members have specifically requested access to:-
  9. Tools and training around commissioning in mental health and financial and resource management skills
  10. A formally accredited leadership and management course for psychiatrists

Curricula and competency issues

  1. Embedding leadership and management competencies in psychiatric practice
  2. The College should encourage and enable its membership to identify and achieve the relevant leadership and management competencies as described in the NHS Leadership Framework and its supporting materials
  3. Leadership and management competencies for psychiatrists should be embedded in:-
  4. Training
  5. Competency Based Curricula for Core and Specialist Psychiatry Training
  6. Annual Review of Competence Progression
  7. Workplace Based Assessments
  8. Membership examinations
  9. Continuing Professional Development
  10. College delivered CPD activities
  11. Appraisal
  12. Revalidation
  13. The College web pages

Raising the profile of leadership

  1. The importance of leadership can be highlighted and the work of the College publicized via:-
  2. Presentations at College events including the International Congress
  3. Publications on line and in print
  4. Regional and local networks
  5. Electronic resources
  6. There may be value in conducting an internal consultation or survey on members’ perceived leadership needs and known resources
  7. The College offers opportunities to be a professional leader via roles at Faculty and national level (including leadership of initiatives, committees, acting as champions and providing expert resources)
  8. Rewarding leadership achievement with College awards
  • nts as consumers to Monitor;
  • Represent the interests of patients to the NHS in strategic commissioning;
  • Monitor the NHS and disseminate information nationally and locally;
  • Pursue and refer individual or collective patients complaints;
  • Contribute to the public debate about the NHS at a national level.

4 / The leadership landscape

The pace of change in the NHS is rapid and the Royal College leadership strategy will most likely evolve in tandem with current and emerging national political, healthcare and leadership strategies. Strategic Health Authorities will be abolished in April 2013 and the organisations listed below will be providing oversight, organisation and input in the emerging leadership development landscape.

The National Leadership Council (NLC) ( was set up to underpin and champion the priority attached to leadership in the NHS and aims to ensure that the NHS system supports and fosters effective leadership, and to challenge where it does not (NLC, 2011). The Council is responsible for ensuring that the NHS has a systematic way of identifying and developing the leaders of today and tomorrow. It works to support world-class leadership talent and leadership development and to ensure that this exists at every level of the NHS. The Council is a sub-committee of the NHS Management Board, is chaired by the NHS Chief Executive David Nicholson, and has identified five priority areas for NHS leadership with specific work streams set up to focus on each. These areas are: Clinical Leadership, Board Development, NHS Top Leaders, Inclusion and Emerging Leaders.

The Academy of Medical Royal Colleges ( comprises the Presidents of the Medical Royal Colleges and Faculties and this group meets regularly to promote, facilitate and where appropriate co-ordinate the work of the Medical Royal Colleges and their Faculties.

The Faculty of Medical Leadership and Management ( is a new UK-wide organisation that aims to promote the advancement of medical leadership, management and quality improvement at all stages of the medical career for the benefits of patients. Revalidation for doctors will be introduced during 2012 and the FMLM is developing support for participants and appraisers focussing on leadership elements of each doctor’s role including those of doctors with a substantial leadership and management commitment. The FMLM is developing standards for management and leadership and supports those involved in management and leadership education.

The NHS Institute for Innovation and Improvement ( a range of products and interventions to help build leadership capability and capacity across the NHS.

The Academy and the NHS Institute are collaborating on a UK-wide project called “Enhancing Engagement in Medical Leadership” which aims to promote medical leadership and help create organisational cultures where doctors seek to be more engaged in management and leadership of health services and non-medical leaders genuinely seek their involvement to improve services for patients.

The Academy and the NHS Institute have published “The NHS Leadership Framework” (NHS LF); this is an overarching framework describing leadership capabilities, competences and behaviours in the NHS. The NHS LF relates to all doctors in the NHS, is described in more detail in the following section.

Medical Education England ( provides independent expert advice on education and training and workforce planning for doctors, dentists, healthcare scientists and pharmacists.

5 / NHS Leadership Framework

5.1 – Overview of the NHS Leadership Framework

The NHS Leadership Framework (NHS LF; is an overarching framework describing leadership capabilities, competences and behaviours in the NHS. It is underpinned by a consistent set of guiding principles which reflect the values of NHS staff as captured in the NHS constitution and represents the foundation of behaviour for staff throughout the NHS.

The NHS LF relates to all staff in the NHS irrespective of their professional role, function or level and comprises 5 core dimensions. The 5 core dimensions relate to the 5 domains of the Medical Leadership Competency Framework and Clinical Leadership Competency Framework plus two more for senior leaders intersected by 5 levels to enable leaders to understand their progression/development from self to leading systems:-

  1. Demonstrating personal qualities: Effective leaders need to draw upon their values, strengths and abilities to deliver high standards of service. This requires them to be demonstrate effectiveness in Developing Self Awareness, Managing Themselves, Continuing Personal Development and Acting with Integrity.
  1. Working with others: Leaders work with others in teams and networks to deliver and improve services. This requires them to demonstrate effectiveness in Developing Networks, Building and Maintaining Relationships, Encouraging Contribution, and Working within Teams.
  1. Managing services: Effective leaders are focused on the success of the organisation(s) in which they work. This requires them to be effective in Planning, Managing Resources, Managing People and Managing Performance.
  1. Improving services: Effective leaders make a real difference to people’s health by delivering high quality services and by developing improvements to services. This requires them to demonstrate effectiveness in Ensuring Patient Safety, Critically Evaluating, Encouraging Improvement and Innovation and Facilitating Transformation.
  1. Setting direction: Effective leaders contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values. This requires them to demonstrate effectiveness in Identifying the Contexts for Change, Applying Knowledge and Evidence, Making Decisions, and Evaluating Impact.

There are two additional dimensions which may apply to all leaders but particularly apply to senior leaders.

  1. Creating the vision: Effective senior leaders create a compelling vision for the future, and communicate this within and across organisations. This requires them to demonstrate effectiveness in developing the vision for the organisation, Influencing the vision of the wider healthcare system, Communicating the vision and Embodying the vision.
  1. Delivering the strategy: Effective senior leaders deliver the strategic vision by developing and agreeing strategic plans and ensuring that these are translated into achievable operational plans. This requires them to demonstrate effectiveness in Framing the strategy, Developing the strategy, Implementing the strategy, and Embedding the strategy

Staff will exhibit a range of leadership behaviours across these 7 dimensions dependent on their context. Intersecting these dimensions are 5 levels of leadership. These are broadly progressive and are designed to illustrate the stages of development as a leader.

Level 1: Leading as a professional involves building personal relationships with a range of colleagues, often working as part of a multi-disciplinary team. L1 leaders need to be able to recognise problems and work with them to solve them. The impact of the decisions leaders take at this level will be limited in terms of risk of a successful outcome.

Level 2: Leading others involves building relationships across and within teams, recognising problems and solving them. At this level, leaders will need to be more conscious of the risks that their decisions may pose for self and others in terms of a successful outcome.

Level 3: Leading services involves networking across teams and departments. Leaders will challenge the appropriateness of solutions to complex problems. The potential risk associated with their decisions will have a wider impact on the Service.

Level 4: Leading organisations involves building broader partnerships across and outside traditional organisational boundaries. At this level leaders will be dealing with multi-faceted problems and coming up with innovative solutions to those problems. Their decisions may have significant impact on the NHS brand and outcomes.

Level 5: Leading systems is about sustainable, replicable relationships across the system (relationships that will be retained even if a leader leaves the organisation). L5 leaders may lead at a national/international level and would be required to participate in whole systems thinking, finding new innovative ways of working and leading transformational change. The impact of their decisions would be critical to the future success of the NHS.

5.2 - Supporting tools

There are a number of supporting tools ( to help support healthcare professionals in understanding and using the NHS LF, such as a free self assessment tool, a 360° tool, e-learning modules, and material written specifically for educators and trainers. Clinicians will also find additional material, such as additional examples for learning and development and scenarios, available throughout the website.

5.3 – Advantages of Competency Frameworks

Competency frameworks offer a clear benchmark for the specific behaviours, knowledge and understanding underpinning the outcome of effective leadership. They can be used as a basis for continuing professional development (CPD) by assessment against relevant standards and frameworks. The Third Sector Leadership Centre (2007) suggests that competency frameworks can be used by leaders:-

  • As a checklist for measuring individual performance;
  • To increase awareness of roles and responsibilities;
  • To identify professional development needs within their role;
  • As a foundation for career progression;
  • To accrue evidence that may lead to a nationally recognised qualification;
  • To identify group and / organisational developmental needs;
  • As a record of previously acquired competencies, skills and knowledge;
  • To enhance confidence to perform a role well.

5.4 – Disadvantages of Competency Frameworks

Competency frameworks are based on what strong performers have done in the past and thus may not be relevant in rapidly changing circumstances. It is unlikely all leaders within an organisation must possess the same set of competencies to be successful - or make the organisation successful. There is also a risk of embedding one particular group of attitudes and not seeking out the right skills and attitudes for new ways of working.

An extensive list of knowledge, skills and attributes may be overwhelming and appear unachievable and by listing individual competencies frameworks can imply to readers that leadership resides in a single individual, whereas notions of contemporary shared leadership argue for leadership as an embedded characteristic of organisations.

5.5 - Leadership competencies in mental healthcare

Leadership competencies for mental health do not differ from those in health; core leadership competencies are universal.However, the knowledge required of policies and programs are different for mental health than for health and vary according to the region and locality in which they are applied. There is also greater emphasis within mental health on:-

  • Team work
  • Interagency work
  • Collaboration with independent providers of healthcare and non-healthcare organisations (such as Social Services, the probation service, courts, housing, the Third Sector, user and carer forums and the media)
  • Reducing discrimination and stigma against people with mental health problems and learning disabilities
  • Encouraging true partnerships between carers, patients and professionals
  • Promoting best practice in mental health

The importance of clinical commissioning in mental healthcare is increasingly recognized and needs to be incorporated into training and continuing professional development activities alongside knowledge of the basics of evidence-based practice and quality improvement.

6 / What is leadership?

Leadership and management is a core strand of the emerging NHS and psychiatrists and allied professionals are expected to be competent at both. Leadership and management can be highly rewarding; considerable satisfaction can be derived from setting up and delivering a new service or model of care, working with underperforming colleagues and seeing them improve and generating improvements in clinical outcomes. The time when the sole function of a psychiatrist was to provide clinical care has passed; the NHS Leadership Framework (Academy of Medical Colleges, 2011) identifies leadership competencies that are expected of all doctors throughout their career - from medical school to retirement.

6.1 - A fourfold typology

There is no consensus in the leadership literature as to the basic meaning of leadership, whether it can be taught or its effects both measured and predicted (Grint, 2011) and the concepts of leadership and management overlap (Storey, 2004). However, the following four fold typology encompasses a significant proportion of leadership definitions (Grint, 2011):-

  1. Leadership as Person – who leaders are; their personality traits, skills and standards of personal effectiveness;
  1. Leadership as Process - how leaders get things done; defined by social interactions, attempts at influence, communication, empathy, empowerment and coaching;
  1. Leadership as Position - where leaders operate; defined by organisational leadership roles, position, authority and/or professional status;
  1. Leadership as Results - what leaders achieve;

The above typology is heuristic, pragmatic and non-hierarchical and empirical examples of leadership are likely to embody all four types. Defining leadership allows individuals to understand each other’s position and arguments and has vital implications for how organisations function and who is rewarded and sanctioned; there may not necessarily be a need to agree on a definition however it is important for individuals and organisations to know what the definitions are in order to identify which particular definition is being referred to.