Examining commissioners' leadership behaviour

Abstract

Clinical commissioning groups (CCGs) now control around two-thirds of the NHS budget, influencing healthcare provider priorities and playing a key role in implementing the NHS plan. However, significant failures in healthcare have highlighted a dissonance between expressed values of leaders and everyday routine practices. This research explores the leadership behaviour of commissioners and the role it plays in determining quality and safety in healthcare. The research took a two phase approach: phase 1 used focused video ethnography to observe commissioners in a mock board room setting; phase 2 employed a quantative questionnaire to determine the leadership behaviours that subordinates would expect their commissioners to adopt. The findings of this research identified that the leadership style most prevalent within the commissioners was transactional in nature. The questionnaire to subordinates of commissioners identified that transformational leadership had the best outcome on staff performance if this was linked to positive leadership style. In addition, commissioners appear to lack consistency when analysing risks effectively and holding providers to account, citing issues such as ‘professional drift’ and concerns over further scrutiny, as validation for this approach. This confusion of leadership behaviours, allied with poor analyse of risk leaves commissioners prone to repeating previous healthcare failures.

Understanding good leadership in the context of English care home inspection reports

“…The distinction between transactional and transformational leadership originates with Burns (1978), who contrasted a leadership approach centred around the exchange of reward for compliance (a transaction) with an approach that was built upon a shared understanding of values, purpose or direction and which focuses on changing or transforming the organisation. This distinction, reinforced by work of scholars such as Bass (1997), continues to be discussed, for example, by the work of Bohan and Mitchell (2015) with English Clinical Commissioning Groups or Marková (2018) assessing leadership styles in Czech social care. A more recent development in this area is authentic leadership (Walumbwa et al , 2008; Gardner, 2011) which extends the ideas of a transformational style, focussing on an honest and ethical foundation to relationships between leaders and followers.…”