An integrated leadership approach needed to improve care

Sitting cat with sitting lion shadow on the wall

A new report, published by the King’s Fund, identifies the behaviours, effectiveness, competencies and key personal characteristics required of an effective leader, whether they work at local or national level.

Effective leaders in health services emphasise continually that safe, high quality, compassionate care is the top priority.

Personal traits include empathy, fairness, respect, compassion, empowering, and engaging. It looks at the requirements in five different areas of leadership:

  1. Individual leadership in health services
  2. Team leadership, ensuring that all members understand the part they play and have the skills to do their job effectively with other team members
  3. Leadership of organisations, for example, when organisations are led by a board, must be consistent in all areas
  4. The influence of national level leaders on the cultures of NHS organisations
  5. The effectiveness of leader and leadership development programmes
Magnifying glass over the word evidence

The evidence summarised in this report is important for commissioners because it defines the leadership skills required

Evidence base

The evidence summarised in this report is important for commissioners, because it defines the leadership skills required for the successful delivery of quality health and social care services, both locally and nationally. The analysis of the evidence has been divided into four sections:

  1. Leadership theory and research in general
  2. Leadership theory and research in health care
  3. Leadership, culture and climate in health care
  4. Leader and leadership development

Finding and synthesising the evidence for leadership in health care is very difficult because there are different leadership styles and variations in service delivery and priorities around the world. The reference list at the end of the document is an invaluable resource for further reading on this subject area.

White balls in the shape of an arrow with a gold ball at the top

Services must be planned and managed effectively, and aligned with objectives

Leadership task

Commissioners and providers must provide strong and consistent leadership to their employees, ensuring that the need to deliver continuous levels of quality improvement is embedded in the culture of their organisations. The authors suggest that within their organisations, the main task for leaders is to ensure:

  • Direction – if staff understand what the organisation is trying to achieve, they will commit to, and take pride in their individual, professional responsibilities
  • Alignment – leaders need to make sure that the services their organisation provides are planned and managed effectively, so that they integrate with other providers, and service delivery can be seamless, improving the patient experience
  • Commitment – this links back to ‘direction’, because people will support their organisation if they believe in its values and strategy

High quality care

The section on leadership for cultures of high quality care is particularly interesting as it draws on previous research which says that “regulatory systems, increasing competition and setting targets” are not sufficient to bring about the change in practice required to improve care while making cost savings.

Five key cultural elements

In addition to the leadership task described above, the authors describe the five key cultural elements needed to ensure high quality compassionate care and these are:

  1. Inspiring visions followed by leadership action
  2. Clear, aligned objectives
  3. Excellent staff management and engagement
  4. Embedding learning, innovation and quality improvement in all practice
  5. Effective teams

This report will help all organisations delivering health and social care services to the general public to nurture a culture that focuses on continually improving high quality, safe and compassionate care. Not only does it focus on the elements of leadership, including styles and competencies, but also looks at the various ways to improve leadership skills.

Compass with arrow pointing to the word quality

There are five key cultural elements needed to ensure high quality compassionate care


This is such an important report for commissioners and providers to read, as it provides a clear insight into how to improve quality through effective leadership.

However, while it covers leadership in general, people in other sectors, such as the third sector or local authorities, who are important partners for the health service, may not be aware of the report and may have their own thoughts on leadership styles and competencies.

Commissioners should share this report with all their partners, so that those who are not familiar with leadership in health care can understand what commissioners and the NHS are trying to achieve, and the importance of improving quality in health care. Greater understanding will make it easier to work together, and identify a vision and a set of clear objectives that all parties can commit to.


West M, Armit K, Eckert R, West T, Lee A. (2015) Leadership and leadership development in health care: The evidence base.  The King’s Fund, London (pdf)

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Caroline De Brún

Caroline De Brún

Caroline has been a medical librarian in a variety of NHS and academic roles since 1999, working in academic, primary and secondary care settings, service improvement, knowledge management, and on several high profile national projects. She has a PhD in Computing and currently develops resources to support evidence-based cost and quality, including QIPP @lert, a blog highlighting key reports from health care and other sectors related to service improvement and QIPP (Quality, Innovation, Productivity, Prevention). She also delivers training and resources to support evidence identification and appraisal for cost, quality, service improvement, and leadership. She is co-author of the Searching Skills Toolkit, which aims to support health professionals' searching for best quality clinical and non-clinical evidence. Her research interests are health management, commissioning, public health, consumer health information literacy, and knowledge management. She currently works as a Knowledge and Evidence Specialist for Public Health England, and works on the Commissioning Elf in her spare time.

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