As part of its transition to becoming an effective clinical leadership voice within an emerging Integrated Care System (ICS), Leicester, Leicestershire and Rutland’s Clinical Executive Forum recognised a need for support. Arden & GEM’s leadership and OD experts worked collaboratively with the group and the ICS to design and deliver a tailored development programme which included a series of interactive workshops and a ‘coaching in the moment’ approach.
Clinical leaders now have a clear picture of what good system-wide executive clinical leadership looks like and an agreed vision, engagement framework and governance arrangement to achieve this.
The importance of strong clinical leadership within a mature, successful ICS was recognised by the national guidance and design framework published by NHS England in 2021. In alignment with this thinking, Leicester, Leicestershire and Rutland (LLR) ICS had already established a Clinical Executive Forum, running in shadow form, to fully involve clinical leaders as key decision makers. This would include system-wide responsibility for setting and implementing strategy, driving clinical culture, monitoring clinical risk and approving clinical pathways.
In order to strengthen clinical leadership and decision-making involvement, forum development support was needed to:
- Establish a shared vision, purpose and aims
- Provide a common understanding of what good system-wide clinical leadership looks like
- Increase team cohesiveness across organisational boundaries
- Better understand the group’s dynamics
- Explore ways of working and decision-making mechanisms.
To achieve the agreed objectives, leadership and OD experts from Arden & GEM co-designed a development programme with LLR focusing on two key elements:
- a series of interactive development workshops for forum members and
- direct observation of Clinical Executive Forum meetings utilising a ‘coaching in the moment’ approach.
Tailored design process
To ensure that the programme was relevant to the specific needs of LLR ICS, a collaborative design approach was taken which included:
- A desktop review of key ICS and Clinical Executive Forum documents and governance arrangements
- Semi-structured exploratory interviews with forum members and system leaders to understand the group’s challenges and opportunities as well as expectations for the group in relation to the ICSs vision, values and behaviours
- An online ‘Insights Discovery’ evaluation which produced a highly detailed personalised report on each forum member’s personality and work style.
Building on the findings of the design process and drawing upon our experience of national context, leadership best practice and working with NHS executives, a series of focused development workshops was coordinated and delivered. The overarching themes of core purpose, building relationships and ways of working were used to guide exercises and discussions within the sessions while experienced facilitators used proven approaches to establish psychological safety and positive interactions within a virtual environment.
Coaching in the moment
Running in parallel to the workshop series, a coaching in the moment approach was also used during Clinical Executive Forum meetings to explore undirected data more deeply and draw the attention of both individuals and the team to issues they may be unaware of or avoiding. This exploration focused on agreed topics such as conflicts of interest, team dynamics, constructive challenge, appreciative enquiry and why discussions can become siloed or overly operational.
Coaching helped to identify steps or actions that could be explored further during the development workshops while also testing that this resulted in changes in future meetings as part of a constant cycle of improvement.
Delivery of the dual programme took place over a six month period to enable reflection and action between sessions.
By adopting a collaborative, co-design approach with both key members of the forum and other system stakeholders, Arden & GEM’s leadership, OD and coaching experts were able to deliver a tailored leadership development programme for the Clinical Executive Forum. System stakeholders were also invited to take part in delivery to help broaden forum perspectives and build relationships.
The programme met and exceeded the initial objectives, and has resulted in a Clinical Executive that embodies the values, behaviours and culture of the ICS, with:
- A shared vision, purpose and aims which the group used within OD exercises to navigate the complexity of its operational environment
- An engagement and communications framework to socialise and champion the purpose of the Clinical Executive across the whole system
- A shared understanding of what good system-wide executive clinical leadership looks like
- Strengthened team cohesiveness among a group formed virtually under the context of system-wide change and the COVID-19 pandemic
- A shared focus on collective rather than individual achievement of objectives aligned to wider system aims
- A greater understanding of group dynamics and connections
- New quality governance arrangements for the ICS built through exploring the group’s ways of working and mechanisms for decision making, including its relationship with the LLR Integrated Care Board and System Quality Group (SQG).
"It was crucial for us that in aiming to develop a high-functioning clinical forum within our system architecture, we were clear on purpose and had developed a collective understanding of our strategic intent. We were keen to give due consideration to the different organisational, personal and professional viewpoints which could influence our current and future decision making.
Having external facilitation and live coaching during our meetings allowed us to instantly reflect on group dynamics as well as allowing us to develop stronger relationships and a better understanding of the perspectives of other members of the group. Clinical Executive is now well positioned within the Integrated Care System with a clear purpose and role."
Dr Nilesh J. Sanganee, Chief Medical Officer for NHS LLR Integrated Care Board
Following the successful delivery of the programme, Arden & GEM continues to work with the ICS as the lead partner in developing and implementing a system-wide inclusive culture and leadership strategy.