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Modernisation Agency NHS Leadership Qualities Framework A Good Practice Guide

READER INFORMATION Policy Estates HR/Workforce Performance Management IM&T Planning Finance Clinical Partnership Working Document Purpose: Best Practice Guidance ROC Ref: Gateway Ref: 3757 Title NHS Leadership Qualities Framework A Good Practice Guide Author NHS Leadership Centre Publication Date September 2004 Target Audience PCT CEs, NHS Trusts CEs, SHA CEs, Care Trusts CEs, WDC CEs, Medical Directors, Directors of Nursing, Special HA CEs, Directors of HR, Allied Health Professionals, GPs, NHSFTs for information only. Circulation list Description A resource to help implement LQF in the workplace. The LQF sets the benchmark for outstanding leadership within the service, and is intended as an ongoing assessment and development tool. The Good Practice Guide brings together recommendations, case studies and step-by-step implementation advice from pilot sites already using the LQF. Relates to the LQF found at: www.nhsleadershipqualities.nhs.uk Cross Ref LQF document publication number 34675 1P 2K Feb 04 Superceded Docs N/A (Rectangle comment peter 21/12/2006 15:32:35 blank) Action required N/A Timing N/A Contact Details Anne-Marie Archard NHS Leadership Centre 5th Floor, 11 Belgrave Road London SQ1V 1RB 020 7592 1021 www.nhsleadershipqualities.nhs.uk (Text Box comment blank) (Text Box comment Sue Mortlock NHS Institute for Innovation and Improvement Coventry House University of Warwick Coventry CV4 7AL www.nhsleadershipqualities.nhs.uk ) (Rectangle comment peter 21/12/2006 15:34:30 blank) For recipient use

Contents Foreword 3 1 Introduction 4 1.1 What is the LQF and what is its purpose? 4 1.2 The NHS Leadership Qualities Framework 5 2 Preparing to use the LQF 7 2.1 Clarity of purpose 7 2.2 Ensuring fit 7 3 Practical Guidance on Planning 9 3.1 Who needs to be involved? 9 3.2 Do you need more confidence in understanding the LQF? 9 3.3 Who will participate? 10 3.4 Can you resource it? 11 3.5 What else is going on? 11 3.6 What are your success criteria? 12 3.7 Summary of planning process (checklist) 13 3.8 Evaluating the impact of your LQF project 15 4 Using the Framework for different purposes 20 4.1 Organisational development 20 4.2 Leadership development programmes and courses 22 4.3 Recruitment and selection processes 24 4.4 Role and career development 26 5 Using the LQF 360 tool 29 5.1 Personal development 29 5.2 Team development 34 6 Conclusion 36 7 How has good practice been identified? 37 Appendix 38

Foreword I am delighted to introduce you to the NHS Leadership Qualities Framework Practice Guide. The Good Practice Guide brings together recommendations from more than 35 pilot sites within the NHS who are already using the Leadership Qualities Framework (LQF) as part o f their strategy for organisational and individual leadership development. Recognising effective leadership as the catalyst for change in the NHS, the LQF sets the standard for outstanding leadership within the service. Benchmarking against 15 leadership qu alities, it is intended for use as an ongoing assessment and development tool to help staff lead more ef fectively in order to improve services. Importantly, it underpins the drive to make the NHS more patient-centred, and on e of the best health services in the world. For human resources professionals, managers, and others charged with the respons ibility of leading teams in the NHS, the Good Practice Guide is an invaluable handbook for successfully implementing the LQF within your organisation. Based on experiences from the LQF pilot sites, the Good Practice Guide is rich i n case studies, lessons learned and practical advice, making for easy adaptation to local situat ions. I encourage you to use the LQF and realise the true potential for leadership wit hin your organisation and within your individual members of staff. I am confident that th e Good Practice Guide will help you to do this. Penny Humphris Director NHS Leadership Centre A Good

1. Introduction This Good Practice Guide has been developed to help those with responsibility fo r leadership within the NHS to understand and make use of the Leadership Qualities Framework (LQF). It is based on the experiences of staff from the 37 health and social care organisatio ns involved in the NHS Leadership Centre s LQF Early Implementation Programme. The 37 participating s ites piloted the use of the LQF for personal and organisational leadership development, with the aim of supporting future applications of the Framework across the NHS. The aim of the Good Practic e Guide is to capture the learning from the pilot sites and provide guidance to others who may be considering using the LQF in their organisations. The Good Practice Guide begins with a brief overview of the LQF and its purpose. In section two you will be guided through a process of deciding whether the LQF is right for yo u and your organisation. Examples of LQF applications piloted by the Early Implementers are included to help you with your decision-making process. This is followed in section three by advi ce on planning your leadership development initiative, from first scoping to evaluation strateg ies. Sections four and five focus on implementation, using examples of good practice from the pilot sites. Section four looks at the use of the Framework for a wide variety of purposes; section f ive focuses on the use of the LQF 360 tool for personal and team development. There is a short concl uding section and an explanation of how good practice has been identified by the evaluation te am. 1.1 What is the LQF and what is its purpose? The LQF has been developed to reflect the NHS culture and to provide a common la nguage and approach that is relevant to all those working within a complex service. The mod el itself is succinct, intuitive and visual. It allows for flexibility and creativity in its application and enables a focus on self-awareness. It also captures the current context of an NHS that is undergoing major cultural change. The NHS context is very challenging; leaders in health and social care are grapp ling with a huge change agenda. Many of their organisations, such as PCTs, SHAs, Care Trusts and Foundation Trusts, are relatively new. They are tasked with working efficiently and effecti vely across complex health and social care systems, raising standards and redesigning services to im prove the quality of the patients experience. New relationships are being established with the public and service users in order to meet the growing expectation of patient choice. Within the service, roles are being

redesigned, new ways of working are developing and the process of redefinition i s being managed through the Agenda for Change . Reflecting on this complexity, the model pr ovides NHS staff with a means of analysing their leadership roles and responsibilities. The LQF comprises of 15 leadership behaviours. Often nicknamed the doughnut becaus e of its shape, it was researched and developed over a two year period by the Hay Group, in consultation with leaders within the service. The LQF was launched by Sir Nigel Crisp in Octo ber 2002. www.nhsleadershipqualities.nhs.uk

1.2 The NHS Leadership Qualities Framework The Leadership Qualities Framework A brief overview of the 15 qualities is given below. Cluster One: Personal Qualities 1. Self Belief The inner confidence that you will succeed and can overcome obsta cles to achieve the best outcomes for service improvement 2. Self Awareness Knowing your own strengths and limitations and understanding y our own emotions and the impact of your behaviour on others in diverse situations 3. Self Management Being able to manage your own emotions and be resilient in a range of complex and demanding situations 4. Drive for Improvement A deep motivation to improve performance in the health service and thereby to make a real difference to others health and quality of life 5. Personal Integrity A strongly held sense of commitment to openness, honesty, inclusiveness and high standards in undertaking the leadership role. www.nhsleadershipqualities.nhs.uk

Cluster Two: Setting Direction 1. Seizing the Future Being prepared to take action now and implement a vision f or the future development of services 2. Intellectual Flexibility The facility to embrace and cut through ambiguity an d complexity and to be open to creativity in leading and developing services 3. Broad Scanning Taking the time to gather information from a wide range of sou rces 4. Political Astuteness Showing commitment and ability to understand diverse gro ups and power bases within organisations and the wider community, and the dynamic betwee n them, so as to lead health services more effectively 5. Drive for Results A strong commitment to making service performance improveme nts and a determination to achieve positive service outcomes for users. Cluster Three: Delivering the Service 1. Leading Change Through People Communicating the vision and rationale for chan ge and modernisation, and engaging and facilitating others to work collaboratively to a chieve real change 2. Holding to Account The strength of resolve to hold others to account for agre ed targets and to be held accountable for delivering a high level of service 3. Empowering Others Striving to facilitate others contribution and to share lead ership, nurturing capability and long-term development of others 4. Effective and Strategic Influencing Being able and prepared to adopt a number of ways to gain support and influence diverse parties with the aim of securing health impro vements 5. Collaborative Working Being committed to working and engaging constructively with internal and external stakeholders. The aim of the LQF is to provide a single model of leadership relevant to NHS st aff working in a wide variety of clinical and non-clinical roles. As this Good Practice Guide wil l demonstrate, the LQF is a very flexible model. It can be used in a variety of ways to enhance lea dership skills and behaviours across the service and to foster a shared understanding of what leade rship means in modernising the NHS. For further information about the LQF and to download a copy of the Framework se e www.nhsleadershipqualities.nhs.uk www.nhsleadershipqualities.nhs.uk

What is happening within an organisation more generally will have a significant impact on the LQF initiative. For example, your organisation may be new, well established or i n the process of merging or restructuring. Other factors are also likely to help or hinder progre ss. Ask yourself the Is there a strong culture of support for leadership initiatives within the organ isation and a strong commitment from the top for your particular initiative/s? How many competing initiatives within the organisation will affect the impact of this initiative? What else is happening in relationship to leadership in particular? Are others a lready using other leadership frameworks or 360 tools, for example? What resources do you have available? If you are going to use the 360 tool there will be a need for administrative support and access to IT resources 7 What is happening within an organisation more generally will have a significant impact on the LQF initiative. For example, your organisation may be new, well established or i n the process of merging or restructuring. Other factors are also likely to help or hinder progre ss. Ask yourself the Is there a strong culture of support for leadership initiatives within the organ isation and a strong commitment from the top for your particular initiative/s? How many competing initiatives within the organisation will affect the impact of this initiative? What else is happening in relationship to leadership in particular? Are others a lready using other leadership frameworks or 360 tools, for example? What resources do you have available? If you are going to use the 360 tool there will be a need for administrative support and access to IT resources 7 2. Preparing to use the LQF 2.1 Clarity of Purpose If you are considering using the LQF, you will need to be clear about what exact ly you are trying to do and why and how the LQF will help with this. There are a variety of possibili ties, for example: To raise awareness that effective leadership is needed across the whole organisa tion As part of an existing leadership development programme To enhance individual leadership skills As part of team development To enhance your appraisal system As part of your organisation s recruitment and retention strategy To work with a specific group such as clinicians, nurses and management teams to enhance

leadership capacity. Clarifying your purpose will help you to decide where you are best to start by f ocusing on a small and specific professional group, on a process of diffusion across the organisati on, or somewhere in between. Examples of how organisations used the LQF to focus on different pur poses can be found in sections four and five of this guide. 2.2 Ensuring Fit following questions:

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What degree of influence and authority do you have over those you would like to involve? Who would it be helpful, even critical, to have on your side? Things that will help you to tailor the LQF to your organisation s needs include: Being clear about the purpose of the LQF and who will be using it within the org anisation Integrating the Framework within other initiatives and clarifying the role and v alue of the LQF in the context of other, existing leadership tools Recognising the potential for flexibility within the LQF tool and ensuring it fi ts organisational requirements If possible, starting with individuals or groups that are most likely to respond positively rather than forcing staff to be involved. Building on success is generally a more effec tive use of time than struggling against indifference or resistance Ensuring that the language used is appropriate for the context and groups involv ed, and that those involved understand the Framework and how it works. Whilst circumstances may not be perfect for the introduction of the LQF within y our organisation (for example, there may be competing initiatives and your resources might be lim ited) these factors need not necessarily discourage you. You may feel that some positive thi nking about leadership within your department could be just what is needed. Exploring the po tential of the LQF, or focusing on particular elements of the model, could re-energise staff an d deliver both personal and organisational development. An appreciation of the situation within which you find yourself is essential - it will help you to be realistic about what is possible and plan accordingly. Once you are sure that this is the right moment to introduce the LQF and that yo u have identified the helping and hindering factors within your organisation, department or profes sional group, you will need to think in more detail about how you prepare and plan your use of the LQF. www.nhsleadershipqualities.nhs.uk

3. Practical guidance on planning your use of the LQF In this section we ask you to consider a range of questions related to planning your LQF project. We take you through the whole planning process, from initial scoping, looking at who needs to be involved, to effective evaluation of your project s impact. Contributions and c ase studies from early implementers are included to illustrate some of their experiences and to d emonstrate the flexibility of the Framework. 3.1 Who needs to be involved in supporting, organising and managing the project? Who is the champion or senior leader within the organisation who will support and/ or steer the project? This might be crucial in engaging some staff groups. For example, a n enthusiastic and supportive Medical Director will probably be able to secure buy in from consul tant colleagues! Who will be the co-ordinators and facilitators? Do you have more than one person leading this proposal? Some of the organisations involved in the pilot programme relied on ju st one or two individuals and this caused difficulties as the demands of their leadership proj ect escalated. Can you identify a project administrator? As well as keeping the project on trac k, this is likely to improve the effectiveness of communication between participants and those man aging the project. Will you need external help? If externals are to be involved, try to be clear ab out the role they will be asked to fulfil; consultant, tutor, facilitator, coach, mentor and evalu ator are all possibilities. Good Practice The Chief Executive s leadership was important, especially the time he personally gave to the project. With Hindsight... The plans have slipped because the organisers went into new roles and haven t been replaced. 3.2 Do you need more confidence in understanding the LQF model and behaviours in order to use it effectively? Because the Framework is still relatively new, you may need time to develop a fu ll understanding of the qualities. This can be an opportunity for shared learning f or those who will be involved in the project. Some early implementers have formed learning se ts in order to

share ideas about the model and plans for its use. Others have suggested working with a mentor. How might you address this need in your own organisation? www.nhsleadershipqualities.nhs.uk

Where might you find more information? For example, you could identify site cont acts from the Early Implementation Project or contact the NHS Institute. Their website provides useful information at www.nhsleadershipqualities.nhs.uk. Good Practice I use the LQF doughnut with my team, helping them to understand what is meant by terms such as political astuteness. I ask them what they would look for under ea ch of the concepts, where they feel they are in relation to each and what they might e xpect or want to develop. It really helps us in our discussions. With Hindsight... Coaches and participants needed a higher degree of familiarity with the LQF model before using the 360 tool. Think locally about what you need to put in place to supplement the formal training, which may not be enough. 3.3 Who will participate? How will you select the participants? This will depend on your identified purpose and objectives. The Early Implementa tion Project has shown that the LQF can be used with a wide variety of staff from clinical an d non-clinical backgrounds. Some organisations have selected individuals with a common role (fo r example, matrons, directorate managers) whilst others have chosen to use the LQF with mor e diverse participants, working in a variety of leadership roles across the organisation. Should participation be voluntary or obligatory? Again, this is probably dependent on the purpose, but if participation is regard ed as required think carefully about how this will be put across. Are the participant numbers realistic? This may be particularly relevant if you are going to use the 360 tool or offer o ne-to-one coaching as part of the programme, both of which can have a significant impact o n workload and costs. Try to anticipate any potential issues by considering the following: participant s roles, their level of seniority, their professional and organisational background, and prior experi ence of development of this kind. www.nhsleadershipqualities.nhs.uk

Good Practice The LQF has really helped the Trust to develop its strategy for the development o f this group of nurse managers. With Hindsight... The participants come from different organisations, have different backgrounds an d priorities....it s been difficult. 3.4 Can you resource it? You may need to consider a range of resource demands: time, staff availability a nd expertise, finance, IT capacity, accommodation, and more. It is important to fully scope th e resource requirements of your project and to try to assess the time that will be needed f or implementation. (Also see section five on resourcing the 360 process). Good Practice We had the infrastructure in place to support the running of the programme and a project manager to keep it on track. That proved invaluable. With Hindsight... Some of the community based staff couldn t access the IT facilities. We seriously underestimated the time needed for 360 completion and feedback. 3.5 What else is going on? Timing can be crucial. In the organisations involved in piloting the LQF, other w ork demands emerged as the most significant factor impacting on the implementation process. Wherever possible, aim to align your LQF project with other work. It will never be feasib le to wait until you have time on your hands, but events can intervene. One organisation delayed the start because of the pressures of the imminent Commission for Health Improvement (CHI) inspection. However, in a different organisation a similar inspection provided a n impetus for using the Framework. The CHI inspection was really helpful in retrospect because they identified leadership as an area for development. Thinking about timing involves both deciding what should happen and when, and th inking about how to keep up the most beneficial pace. Try to balance keeping up enough pace to energise the process but avoiding overload on already busy people. www.nhsleadershipqualities.nhs.uk

3.6 What are your success criteria? The identification of appropriate success criteria and goals is a crucial part o f planning any development. However, it can be hard work to create good ones, especially in tho se areas of your work where simple, quantifiable measures are unavailable. This section aims to h elp you to follow best practice in setting success criteria for your project. Examples of criteria that people have identified in the context of using of the LQF include: 1 Developing the capability and capacity of senior management 2 Enhancing the quality and depth of information available to the appraisal proc ess 3 Promoting individual and team development 4 Encouraging close working across professional boundaries 5 Reducing patient mortality 6 Ensuring that 75% of leaders attend training The items on this list may look familiar and are reasonable aspirations, but onc e you ask the question, What evidence will we be able to gather to establish that we have achie ved this? It becomes clear that this is going to be much easier in some cases than others.

What is easiest to measure might not be the most relevant. Number six is the eas iest to measure but is relatively undemanding because it avoids any reference to the quality of the training or the hoped for outcomes. What difference is it going to make? Number five creates a real challenge but is almost certainly inappropriate in this context. What is relevant to the organisation at present? Number four might help the orga nisation to develop more integrated ways of working in order to deliver on a strategic objec tive. Thinking carefully about intended outcomes, or how you think progress can or wil l be judged, can be very valuable in helping you to clarify your purposes and in the design o f your project or activity. Setting about developing a systematic process for identifying appropriate succes s criteria will mean asking: What are the key performance areas we are trying to influence? What will be the criteria for success for each of these? Make sure these are fea sible but reasonably challenging. 12

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What kinds of data will we need to collect and analyse? Be careful to keep these processes within manageable proportions. How will we measure progress? The most common types of standards for making judg ements about achievements are: comparative how we compare with similar developments elsewhere progress how we are doing compared to the past target how we are doing against any standards or targets we have set ourselves o r others have set for us. Are there any particular circumstances that may need to be taken into account in judging performance? 3.7 Summary of the Planning Process A Checklist Once you have thought these issues through, the chart on the next page will help you pull together your plans for using the LQF. Use the columns to record: WHY do you want to use the LQF? Outline your purpose and rationale. WHAT is the scope of your project? What do you plan to do? WHO will be involved both directly and indirectly? WHEN will things happen and in what order? What is your timeline? SO WHAT do you hope will be the outcome? What will success look like in this con text? 13 www.nhsleadershipqualities.nhs.uk

WHY WHAT WHO WHEN SO WHAT www.nhsleadershipqualities.nhs.uk

3.8 Evaluating the impact of your LQF project This section is designed to help you think through your approach in evaluating t he impact of the LQF. We have included it because several Early Implementation sites identified t hat they needed a better understanding of evaluation processes. In evaluating the impact of your LQF project it may be helpful to consider which of the following you are hoping to achieve: Purpose is to... Good Practice Things to avoid PROVE Something It is helpful and important to collect convincing evidence of success Beware of the temptation to identify limited or over ambitious objectives or to ignore or suppress any negative outcomes. IMPROVE Something It is highly desirable to have the objective of improving the quality of an initiative as it progresses. The danger is that the focus on continuing incremental improvement may get in the way of realising that an initiative has fundamental flaws. LEARN Something Asking questions, developing success criteria and engaging in review meetings provide opportunities for reflection and analysis. All generate learning opportunities. Evaluation processes, which become tiresome bureaucratic exercises, are unlikely to have this potential. Evaluation is an activity that almost everyone agrees is important but which is often forgotten in the perpetual rush to get things done. It should rarely feel simply a neutral and ob jective exercise. Nevertheless, it is important not to be naive about, nor overwhelmed by, the pro cess. Remember that every time you make judgements about how a project is going, and make decis ions in the light of these, you are engaged in evaluation. Evaluation in essence means putting a v alue on things. www.nhsleadershipqualities.nhs.uk

Even if you feel the main impetus for undertaking an evaluation is because you a re being held to account this does not prevent you from using the process for developmental proce sses. You can use the following diagram to map where you might place your LQF evaluation activ ity. Accountability DevelopmentHigh High Low We collect all the data required by others and use this with other information that we regard as important to inform our thinking and planning. We collect all the data required by others but once we have sent it to them do not think about it again. Low No one is requiring us to do anything but we have lots of ongoing informal reflection and review which helps us a great deal but which we do not always record and don t make available for others. We collect a bit of routine information but we know that those requesting it are not really interested as long as they can claim evaluation is happening. 16 Another important aspect to consider is the level at which you want to focus. Do you, for example, want to know about impact in terms of: The reaction of the individuals involved in your LQF project The leadership behavioural changes that have occurred in individuals as a conseq uence The impact on organisational performance on staff and on organisational outcomes . The timing of any evaluation activity will need to reflect the nature of the foc us. Looking for organisational performance impacts, very shortly after the activity has finished , will almost certainly be disappointing. A further study in a few months time, however, might yield muc h more evidence of learning and change. This can be illustrated using information gathe red as part of the LQF Early Implementation Project Evaluation. www.nhsleadershipqualities.nhs.uk

Case Study: Participants views of the impact of the LQF on them as leaders Using a variety of statements, we asked those who had participated in the use of the LQF to assess its impact on them. The graph below shows the personal impact they had experienced. 0 100 Raising awareness Behavioural change Career progression Skill development Participants views of LQF impact 0 100 Raising awareness Behavioural change Career progression Skill development Participants views of LQF impact 90 80 70 60 50 40 30 20 10 We can see from this that the biggest impact perceived by the majority of partic ipants (on the far left of the graph) was expressed as raised awareness: a) of the impact of their behaviour on others, and b) of their organisation s requirements of them as a leader. The next five columns articulate changes in individuals behaviour (for example, s haring information more willingly, empowering others and an increased willingness to take qualified risks). However, when we look at longer term personal career and skill development (the five columns t o the right), it becomes clear that it is easier to establish some outcomes more than others. Issues that might impact on organisational performance, like better decision-making and increased creativity , are both longer term and harder to prove. www.nhsleadershipqualities.nhs.uk

The last issue to consider in this section takes evaluation to a further level. Thinking about what has happened and why, in the context of a specific project, has the potential to increase understanding of the whole department, team or organisation and how it works. In the context of the LQF, for example, it may emerge that particular skills or attributes may need to be developed across the whole organisation. It may be helpful to consider why this should be. As the following examples illustrate, organisational contexts and cultures can b e powerful influences: A strong emphasis on getting things done, with lots of projects developed by ene rgetic individuals, might highlight that there is little overall direction and suggest an organisational need for more strategic thinking. Alternatively, it might be attributable to str ong central control from the top with little encouragement for individual thinking. As the statements below demonstrate, difficult feedback for an individual may in dicate an awkward customer or a culture in which people are prepared to discuss their prof essional practice, but not their interpersonal relationships. The feedback was very hard for X because people suddenly had the opportunity to say what they had been waiting ten years to say. Our clinicians are very good at critiquing and analysing their practice but find it much more difficult to talk about relationships within the team. Remember that, in addition to helping you to place a value on what you have done , an evaluation process should be designed to help you make decisions about the future. www.nhsleadershipqualities.nhs.uk

The design of your LQF evaluation process can be focused around the following qu estions: What do we want or need to know? This will depend on your purposes and the criteria you have identified for succe ss (see sections 2.1 and 3.6). What do we know already? You may have information available that is already being collected. Don t collect it again. How best can we find this out? In depth internal or external evaluation is one possibility. You may have a rela tionship with a local University or have members of staff undertaking further study who would li ke to contribute to such processes. However, much can be done on a smaller scale and within the i nitiative. You will need to identify any information that needs to be collected systematically from the beginning and make sure this is done. Don t underestimate the value of ongoing rev iew that may occur relatively informally. Devising economic ways of making these activiti es a little more systematic, and recording the outcomes, can be very productive. Organised Review Days, which include elements of systematic reflection, would be excellent examples of this p rocess. How can we ensure that what we find out makes a useful difference to what we do? For this to happen the evaluation processes need to be integrated into the ongoi ng processes of planning and development. It helps to step outside the action at intervals an d ask: How are we doing? Is this what we expected? If not why not? There may be very good reasons. What might we need to do more or less of? Is there anything else we need to know? Designing your LQF evaluation process www.nhsleadershipqualities.nhs.uk

4. Using the Framework for different purposes This next part of the Good Practice Guide will give some more detailed examples of the ways that organisations have applied and used the Framework for a variety of purposes. The use of the LQF 360 tool for personal, team and/or organisational learning will be looked at in s ection five. Several of the Early Implementation sites used the LQF to foster change and orga nisational development (OD). Among the participating organisations, many were newly created . These included: PCTs, SHAs, recently merged acute hospital trusts and a care trust. Th e following examples illustrate how the LQF s flexibility has allowed different OD purposes to be addressed. 4.1 Organisational development Case Study: Introducing best leadership practice in a PCT Western Sussex PCT used the Framework to work towards a shared culture and new s tyle of leadership in their largest directorate, based on demonstrable LQF values and qu alities at Director and senior operational lead levels. The aim was to ensure that, irrespective of their previous roles and background, leaders in this new organisation would be operating according to best leadership practice from the outset. The Trust used the LQF to produce job descriptions for new posts and to underpin a development programme. Managers undertook a self-assessment exercise against the 15 qualities in the Framework and were offered individual coaching sessions to w ork on their personal development needs. Only at a later stage did they opt to complete the f ull 360 exercise. Participants felt that the leadership development programme brought the team much closer together at a key time and gave something back for individuals as well. The qualities in the LQF provided the glue that connected the two. Good Practice: Be clear about the specific purpose of your project and think carefully about if/when you might use the LQF 360 tool to enhance learning Have systems in place to support individual development. www.nhsleadershipqualities.nhs.uk

Case Study: Working towards the creation of open communications and developing leadership capability across a health and social care community In County Durham and Tees Valley Health Community, the Chief Executive has supported the Head of OD in spreading the use of the LQF across the health econo my. Presentations to hospital trusts and PCTs have aimed to develop a common languag e of leadership and provide an opportunity to share experience. Once understood, the Framework can then be used to address particular local needs. For example, one P CT is using it for team development for frontline nursing teams. Others have opted to focus on personal development using the LQF 360 tool and local facilitators have been deve loped to ensure that participants receive good feedback.This can then be used to inform p ersonal development plans. Good practice: Work at a strategic level to encourage understanding and engagement with the LQF. Don t assume that everyone will be familiar with the model Allow people to take responsibility for identifying what will be of greatest benefit for their context. Case Study: Developing an integrated approach to OD in an Acute Trust The LQF can be very effective when its use is embedded into other OD work. When the decision was made to become an LQF site, Nottingham City Hospital was in the pro cess of developing its OD strategy around three key elements: the modernisation of se rvices, high performing teams and effective leadership. The Trust has a strong track rec ord of OD and the LQF project coincided with its selection as a pilot site for the Improve ment Partnership for Hospitals. These initiatives were seen as complementary; paralle l strands of development work with interlocking elements. The Trust had also undertaken an in ternal restructuring exercise and this identified the participants for the LQF project. As the Director of HR explained: We wanted to get a balance between service deliverers and service improvers; that is the leadership of current delivery and leadership of future service development. The Divisional and Care Pathway leaders across the Trust were selected a mixed g roup comprising medical consultants and other health professionals. All have complete d the 360 tool and the Head of OD is now looking at how the learning from this can be shar ed to ensure that it will benefit both the organisation and the participants.

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Good Practice: Integrate your LQF project with other organisational projects and systems LQF works best where there is an established culture of learning and development LQF can be used to enhance inter-professional learning. Plan in advance how learning might be shared. 4.2 Leadership development programmes and courses The LQF has been used by several organisations to shape the design and content o f courses, modules or in-house leadership development programmes. In some cases the LQF has been bu ilt into existing programmes, elsewhere it has underpinned the development of new leadership progr ammes for a variety of staff groups. As the following examples show, the purpose and content of the courses vary, again demonstrating the flexibility of the Framework. Case Study: Wessex Courses Centre (for Hampshire and Isle of Wight WDC) develope d a leadership development programme comprising of four, two-day residential modul es. The LQF was one of a number of leadership modules introduced and the programme s conte nt was mapped against the LQF, which was also used as tool for ongoing personal development after the conclusion of the course. The programme is being evaluated by the Healthcare Education Innovation Unit at Southampton University. Participants cam e from all 18 trusts in the Hampshire and Isle of Wight health community. Good Practice: The LQF can be integrated into leadership programmes alongside other leadership models. The fact that it is health-specific helps participants to engag e readily with it. The flexibility of the model enables it to be applied to any healthcare context and this can enhance inter-organisational learning. 22 www.nhsleadershipqualities.nhs.uk

Case Study: Christie Hospital NHS Trust had already designed a Leadership Development Programme in collaboration with Manchester University s Centre for Healthcare Management when the LQF was published. Following a team 360 report, th e content of the programme was modified for the second cohort. This put more focus on strategic leadership behaviours. The next stage will involve the development of an Associate Facilitator from the Trust, working in collaboration with the University. Good Practice: Use the Framework flexibly. It isn t always necessary to give equal weight to all of the behaviours; select those that are most appropriate to your programme s needs. Several sites developed working relationships with local higher education providers. Think about how you might resource this and what benefits might develop as a result of collaboration. Case Study: East Kent Partnership Trust staff have been developing an in-house, accredited, modular, development programme aimed at middle managers. This has be en done in partnership with Kent County Council Social Services, reflecting the need to encourage cross-sector learning. The five modules are structured around the LQF and cover: Managing Teams, Developing Teams, Delivering the Service, Working with Partners and Devel oping Strategy, and Clinical Governance. It has been accredited by the Open College Ne twork. Good Practice: The LQF was developed by and for the NHS but it has been used successfully with social care leaders in a number of the Early Implementation Projects. A lit tle more care may be needed to ensure that facilitators language is not sectorspecific as this can be unhelpful and excluding. Case Study: NHS Logistics Special Health Authority is working hard to strengthen leadership capability within the organisation. It has offered all of its 36 seni or managers a six-month leadership development programme based on the LQF. Three, two-to-three day workshops provide an opportunity to work on issues identified in individual and/ or team 360 reports and participants also work as members of a learning support group throughout the programme. Personal action plans are developed as part of the pro cess and some participants have made use of personal coaching sessions. There is a simila r programme for the CEO Team. Good Practice: Try to build in time for identifying development needs before designing your programme s content. This helps to secure engagement by ensuring relevance.

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4.3 Recruitment and Selection Processes Several sites have used the LQF to assist with recruitment and selection process es. For example: Case Study: Leeds Teaching Hospitals Trust has been using the LQF to inform the job descriptions of senior managers and behavioural-style questions have been used i n recent selection processes. Some examples are given below: Tell us about a situation where you have had to work with the conflicting interests of stakeholders How did you achieve a successful outcome? Describe how you have co-ordinated and developed effective performance across diverse teams and working groups. Case Study: West Berkshire PCTs Professional Development Team are working with staff to develop leadership profiles for specific professional groups, so that t he leadership qualities required for different posts can be identified. These can then be applied in creating and developing posts and when considering the type of applicant who would be ideally suited to a particular role. Good Practice: The examples above demonstrate how different organisations are using the LQF in various ways to strengthen their recruitment and selection processes. Think about how it can be used to add real value to the processes already in place in your organisation. For example, to inform job descriptions, person specifications, job advertisements and interview questions. LQF may also be part of a broader recruitment and retention strategy. For example, one trust commented: We recognised a need to address our G grade nurse succession planning and retention issues. The LQF enabled them to focus more clearly on the organisation s requirements. At this stage, there is more limited evidence to demonstrate whether the LQF is being used to formally assess candidates at interview and whether this is having an impact on final selection. The more widely the LQF is used the more it will become embedded in recruitment and selection processes. The next case study demonstrates how a fully-integrated approach to t he recruitment and selection of senior leaders is being piloted by one SHA/WDC. www.nhsleadershipqualities.nhs.uk

Case Study: Hampshire and Isle of Wight SHA set up a steering group to develop L QFbased tools and guidance to support recruitment to senior posts across the NHS. Working with the Hay Group and Southampton University, the group has identified five streams of activity which comprise the complete recruitment process. The aim of the project is: To establish best practice tools, rules and templates for agencies across the NHS , that reflect the LQF, are consistent with NHS culture, and that support the comp lete recruitment pathway. We recognised that the need to recruit quickly to senior po sts can override the cost benefit of getting the specification right; often the tend ency is to rush ahead with a job description and person specification based on the la st post holder. With this in mind: The tool starts with an organisational and environmental analysis to identify th e six critical LQF behaviours that need to be demonstrated by the successful candidate to the v acant or new Chief Executive and Director post in a Trust or PCT. It advises on best recruitment practice and establishes the principle that every experience that potential candidates have with the recruiting organisation should be gold star . It provides a range of selection tools with the focus on a one-to-one behavioura l interview, which provides rich information on the candidate linked to the identified key LQ F behaviours and is fed into the formal panel process. This information also supports the development of the Personal Development Plan for the successful candidate and provides evidence-based feedback for unsuccessful candi dates. The recruitment and selection process ends with a personal support package for t he successful candidate, which is linked to the outcome of the process and, in part icular, the LQF strengths and areas for development that have been identified. The tool has been piloted for a Chief Executive appointment in an Acute Trust an d a Director appointment in a PCT. The feedback from the panel and the candidates was extreme ly positive and the Chief Executive of the SHA has stated that the tool should be used for a ll future appointments at this level in Hampshire and the Isle of Wight. For further infor mation about the Executive Recruitment and Selection tool contact: Nicola Hartley, Director of Workforce Development,Hampshire and Isle of Wight Wo rkforce Development Confederation. Telephone: 01962 893761 nicola.hartley@hants-wdc.co.u k or Richard Samuel, Assistant Chief Executive, Hampshire and Isle of Wight Strategic Health Authority, Telephone: 02380 725402 richard.samuel@hiowha.nhs.uk www.nhsleadershipqualities.nhs.uk

Good Practice: Throughout the selection and recruitment process, the use of the tool needs to b e supported by a Recruitment Lead who understands the LQF and is able to challenge old ways of thinking. This is a great way of introducing LQF in a less threatening way than 360 feedbac k. It may lead to other opportunities to use the LQF and/or 360 tool, for example, f or executive team development. There is a need to develop local knowledge and understanding of the Framework within the organisation. This is a good way of securing Chief Executive support for the use of the LQF an d 360 feedback. 4.4 Role and career development Case Study: Defining leadership roles across PCTs West of Berkshire s three PCTs have made very creative use of the LQF and are now linking it to the Agenda for Change . They see the LQF very definitely as a wider framework underpinning development activity. Working in groups with clinical and non-clini cal staff, they have used the LQF to define job profiles by discussing and exploring what the be haviours mean in their context. Staff leading the project feel that the LQF has had a maj or impact. Their views are captured in these points: LQF raises peoples awareness of their leadership role and abilities in performing that role. It provides a point of discussion in teams; how the team should work together, c larifying roles in the team and identifying areas for team development. In conjunction with leadership development programmes it works well if people ar e already tuning into these concepts. It also helps clarify the characteristics of effectiv e leadership . Individuals say it helps them feel more successful by identifying the facets of leadership that they are already demonstrating. It also helps them to relate better to other managers in very different jobs by identifying the common ground that they have. The impact will be reinforced if it becomes more embedded in the organisation s HR processes.

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To demonstrate how this work is impacting on practice, members of the Profession al Development Team provided case studies for the Good Practice Guide. These are two examples: The Diabetes Educators in West Berkshire work with GP practices and other communi ty services to ensure delivery of more effective diabetes services. Their role has been evol ving over the last two years from that of traditional Diabetes Nurse Specialists to that of Diabete s Educators. This is a change in function from direct clinical care to education and training, which ha s not been clearly understood in the PCTs. They have used the LQF to explain their role in terms of new functions, their specific skills and the necessary leadership qualities required to work ef fectively. The West Berkshire Speech and Language Therapy department has recently employed a therapist with allocated sessions for Clinical Governance. Many aspects of this relate dir ectly to the LQF. We therefore feel that it will be an important tool in ensuring the ongoing develop ment and success of our service. Our intention is to use the Leadership Profiles to gain a clear idea of which leadership qualities are required for a range of posts within the service. These could then be applied in creating and developing posts and when considering the type of applic ant who would be ideally suited to a particular role. It is likely that some teams will use the LQF as an integral part of the apprais al process to facilitate development within the existing team. (Identifying strengths and areas for devel opment, and further developing individuals roles, especially where a therapist wishes to take on additional responsibility or move into a leadership role). It is hoped that therapists will make full use of the SPARK Leadership Development Tool kit developed by the Professional Development Team. For details of this contact Maggie.Woods@berkshire.nhs.uk or Ros.Crowder@berkshire.n hs.uk Case Study: Developing the Leadership element of the Modern Matron role Hinchingbrooke Health Care NHS Trust designed a leadership development programme for its nine Modern Matrons. The participants were new in role and had not received any previous leadership development training. They were able to develop a common language aro und the LQF qualities and used the 360 tool and the programme to define and agree the lea dership elements of their role: The LQF was seen as an opportunity to begin their development and the group was positive, although apprehensive, about receiving feedback on their leadership behaviours. www.nhsleadershipqualities.nhs.uk

Case Study: Developing the team leadership capability of middle managers Hillingdon Hospital NHS Trust conducted an audit of the organisation s leaders and used the LQF as a benchmark for assessing leadership and development activity. The re sults showed that the Trust was managing to provide organisational and service leadership opp ortunities but that middle and junior managers needed support in developing team leadership beh aviours. A development centre approach is being worked through (underpinned by an in-house team assessment based on the IIP Standard and Aston University research questionnaire s) to act as a gateway to leadership and management development options. The LQF may provide th e Framework for the development centre design. Good Practice: The LQF can be a vehicle for developing a genuine shared understanding about desired leadership behaviours in a wide range of clinical and non-clinical roles . 28 It can be particularly useful in defining new roles, especially where leadership is based on influencing rather than traditional, hierarchical patterns of authority . The LQF can be used to address specific needs, for example, team leadership. It may not be necessary to use the whole Framework. Being clearer about the expectations of others, and of their own leadership strengths, can boost an individual s confidence. This can also provide clarity for future personal and career development. www.nhsleadershipqualities.nhs.uk

5. Using the LQF 360 Tool The feedback was really useful. I was surprised that people rated me as a leader; I don t see myself that way, more as a team member. My two areas for development were strategic influencing and political awareness - I ll need both of these in my new job as it s a highly political environment. Most of the organisations involved in the Early Implementation Project have been using the LQF 360 tool to support personal and/or team development. The preferred provider of the LQF 360 tool is RightManagement. If you are considering using the LQF 360 tool in your organisati on you will need to access the Leadership Centre website (www.nhsleadershipqualities.nhs.uk) for further information. 5.1 The LQF 360 tool and Personal Development I had very positive feedback and this gave me a boost. I think I ve got a good level of self-awareness so there weren t many surprises, but I did learn the extent of the impact of my behaviour on others and this was a bit unsettling. For example, my long working hours and the fact that I m so busy mean that others are reluctant to bother me; I m not seen as accessible. My personal style is seen by some as being very direct; I may need to soften this at times. The benefits of using the 360 tool were identified as part of the LQF Early Imple mentation Project evaluation. Our questionnaire asked co-ordinators, facilitators and participants for their views on the 360 tool. Their responses show that: The 360 tool is seen as providing a suitable basis for personal feedback The 360 exercise is regarded as a valuable process to undertake The on-line form is easy to use and the questions are generally easy to understa nd Participants particularly value the feedback sessions with facilitators It can be used to inform personal development plans and, as the comments below i llustrate, most participants are able to identify development action as a result of completing t he 360 process. The facilitation was positive, very professional. A lot of preparation had been undertaken. There was open discussion of whether your perceptions matched raters and whether action was required. The structured reflection was really useful. It was the highlight of the whole process; more useful than appraisal and personal development planning. www.nhsleadershipqualities.nhs.uk

Stage of Process Good Practice With Hindsight Before you use the 360 tool consider: Is it appropriate? At what stage should you use it? How does it fit with your objectives? Is it a stand alone exercise or part of a widerdevelopment programme? Can you resource it? Section Two of this Good Practice Guide shouldhelp you to work through these que stions. Some sites have used the 360 tool at the start ofprogrammes, others at the end. E ither way, try to beclear why you are using it, how it fits with otherdevelopmen ts and what your success measures will be. Some of the best outcomes have been where use ofthe 360 tool has been integrated into otherprocesses and aligned with organisational priorities. The 360 tool is quite resource-intensive. Several sitesfelt they underestimated i ts impact on staff time andyou may need to keep the number of participants small to make it manageable. The 360 is completed on-line; staff access to IT resources may be an issue. Development needs will be identified from the exercise; you should plan how to resource these staffexpectations may be disappointed othe rwise. Training and information Participants Raters FacilitatorsTo build confidence and ra ise awareness of the LQF, arrange briefing sessions for participants and ratersbefore they complete the 36 0 tool. Develop extraguidance notes if necessary. Only trained facilitators can be used to provide thefeedback these may be intern al or external to theorganisation but they must be registered and trainedby the providers of the tool. Do not rely on one or two facilitators. If possible developa team of trained sta ff so that participants have a choiceof feedback facilitator. Very senior managers may prefer an external facilitator, doctors may wish to receive feedback from a fellowdoctor to medical staff. This will have trainingimplications, especially if the Doctor facilitators have nopre vious involvement with feedback of this kind. Managing the process- Who will co-ordinate the 360 process? - Keeping people engaged A named project leader is essential as a point ofcontact. He/she will chase up r eports from raters andparticipants, liase with the providers, arrangefeedback se ssions etc. A good project leader canmake a huge difference. The process of 360 completion and feedback islikely to slow down or stagnate unle ss you have clearleadership and management arrangements in placeto keep it to sc hedule. Expect some drop out but tryto minimise this. Providing feedback Creating a positive experience Supporting people after feedback Additional support Well-facilitated feedback on the 360 assessment hasbeen very highly valued by par ticipants in the EarlyImplementation Project. For some the feedback can be quite painful; plan inadvance how you will support these individuals, perhaps with additional follow-up sessions. Check that the facilitators are aware of what their roleentails. Some may be new to the LQF and the skillsrequired in providing 360 feedback. Facilitators mustbe appropriately experienced to be able to provide thefeedback to the participant. The process needs to be handled sensitively; badlyfacilitated feedback can be a very damagingexperience. www.nhsleadershipqualities.nhs.uk

Stage of Process Good Practice With Hindsight Sharing the learning with peers with line managersSome participants have received both individual andteam 360 reports. An awareness of team strengthsand developmen t areas can encourage a more openorganisational culture. If handled well, sharing can enhance trust andopenness between colleagues. If others, (for example, line managers) are to beinvolved this must be negotiate d and agreed at theoutset. Be clear about how the learning might be shared, formally or informally. Individual confidentiality mustbe protected but the orga nisation and theparticipants may be disadvantaged if there is nosharing of learn ing from the 360 exercise. However, people can t be expected to share in a low-trust, blame culture. Some participants reported that they wanted moreinvolvement and support from lin e managers. Maximising the learning planning development building it into organisational proce sses Line manager involvement after feedback can help tocapitalise on the learning th rough personaldevelopment planning or by building the 360 outcomes into the appraisal process. Several sites have used mentoring and coaching orlearning sets to support partic ipants in taking forwardtheir personal development. Others have builtcompletion of the 360 assessment into leadershipdevelopment programmes. The 360 report is not an endpoint . Someorganisations funded the use of the tool but had noplans or resources for the next stage ofdevelopment. The 360 tool is unlik ely to make anysignificant impact in these circumstances. Evaluating progress and development Do you intend to monitor progress againstiden tified needs? Who will be responsible for this? If the 360 tool outcomes are to be linked withperformance management how will it fit withexisting performance review processes in yourorganisation? This should b e made clear toparticipants and line managers. Some sites are considering repeat 360 toolassessment after a year to try to asses s progress. Thismay or may not be appropriate for you. The timing of 360 tool feedback needs to map ontothe organisation s timetable for a ppraisal andperformance review. Work is in progress to align the LQF with otherHuman Resources Management system s and withthe Agenda for Change . www.nhsleadershipqualities.nhs.uk

The 360 assessment alerted me to the things I need to work on. For example, I thought I empowered others - I went away with an action plan to work differently with my direct reports. The evaluation of the Early Implementation Project has yielded a lot of informat ion about people s experience of using the 360 tool and this section summarises the key learning poi nts. Factors to consider when using the 360 tool with different staff groups One of the questions that has been raised during the Early Implementation Projec t is: Can the LQF 360 tool be used with all staff in leadership roles? The organisations that ha ve used the 360 tool have involved staff from a range of healthcare professions as well as no n-clinical managers working at strategic and operational levels. Their feedback to the eval uation team in interviews and questionnaires is summarised here: The LQF was developed by senior NHS leaders. The 360 tool therefore fits well wit h the leadership roles and responsibilities of those working at executive and director level, irrespective of the type of organisation It can be more challenging to use the 360 tool for non-executive director develop ment, but further work is being done on this by the Appointments Commission Many middle managers have used the LQF 360 tool successfully, however there can b e some limitations, depending on the scope of the individual s role. For example, a Domes tic Manager s job may involve little contact with organisations in the wider health co mmunity, therefore strategic influencing and political astuteness might feel irrelevant, especially to the manager s raters. The Right Coutts 360 tool takes account of this Clinical professionals may need help with the managerial language in the qualities . There may be some resistance due to language differences but good briefing and facilit ation can successfully deal with this Those in new clinical leadership positions seem to have found the 360 tool exerci se very useful in defining the leadership element of their roles and identifying their l eadership development needs Doctors in several organisations have completed the 360 feedback process. As show n below, the results have been interesting and varied. www.nhsleadershipqualities.nhs.uk

33 Case Study: Involving Doctors in the 360 Process Your organisation may be planning to offer leadership development to medical lea ders and if completion of the 360 tool is to form part of this, the following guidance may be helpful. The information comes from a number of NHS trusts involved in the Early Implementati on Project. Receiving 360 feedback is a new experience for most doctors and so, understandabl y, many will be apprehensive. The doctors were willing to talk about the potential benefits of it for their successors but not for themselves. They saw it as something for the new blood to engage with. Few of them would entertain it. Others may be sceptical about the validity of the process. They will want to kno w more about the underlying research that has informed the tool. It helps if you have the support and involvement of a senior medic, for example, the Medical Director. (Conversely his/her opposition can be a serious barrier). For those who do engage with the opportunity to gain 360 feedback, it can be good preparation for the new consultant appraisal process but the fit between the two needs defining. It was easy to complete on-line and I thought it was quite a perceptive tool. The language was OK, just one or two areas where managerial and medical language didn t sit quite comfortably. I deliberately chose peers who might be more challenging as raters. The feedback session was very good; I did better than expected! I ve never had any formal appraisal feedback as a medical managerthis was my first inkling of others perceptions of me. The experience can be a positive one. For those who have gone through the feedback process they have greatly enjoyed it and reported having benefited from the one-to-one feedback. They liked the detai l of the data produced. They appreciated having the feedback from their peers; thi s is not an opportunity many of them have in their working relationships. Many doctors will not have had feedback from non-medics during their career. The y may ask for the feedback to be delivered by an external facilitator or a fellow doct or you will need to plan for this. The line management arrangements can be complex for doctors, especially those wi th University contracts or senior medical management and care pathway leadership ro les. Explore the implications of this with participants. www.nhsleadershipqualities.nhs.uk

5.2 Using the 360 tool for team development Leadership does not happen in a vacuum and the best way forward may be to do som ething at the level of the whole team, department or organisation as well as focus on indi vidual behaviour. Several of the Early Implementers have used the LQF 360 tool with teams. These ap plications range from executive management teams and boards to nursing teams and multi-disc iplinary teams in mental health trusts. In this section we are focusing on sites which have commissioned team 360 tool re ports and which have used the tool explicitly for team development, with shared learning a nd development planning. This distinguishes them from sites where all the individuals in a team have undertaken the 360 exercise primarily for personal development. The following case study dem onstrates good practice in the use of the 360 tool to support team development. North Essex: Using 360 tool for multi-disciplinary management team development in a Care Trust The infrastructure that was already established supported the successful running of the project. We d been doing work for some time to establish a common organisational culture an d to encourage multi-disciplinary management team development. Four management teams took part. Participation did mean a substantial time investment as team members all rated e ach other. It was helpful for people to have their individual feedback before the team development day; it meant they were already familiar with the feedback process, language and approach befo re they had to absorb the composite report. Ideally the same facilitator would work with indivi duals and the team. The feedback was well-received and teams were interested in learning about their strengths and identified development needs. Bath and North East Somerset PCT: Executive team development The management team completed individual 360 tool assessments and then attended an externally facilitated away day. The away day considered leadership versus manag ement, strategic versus operational management, how to work together, models of organis ational effectiveness and team and individual objectives. The outcomes have been changes to the management team s agenda, responsibilities and structure. Using it with the top tea m first means they now understand it and recognise its usefulness. This will help in rol ling it out to middle management teams. www.nhsleadershipqualities.nhs.uk

The feedback I got from my team revealed a couple of problems which I was unaware of. I decided to regard this as a positive catalyst for change and arranged a team away-day in which we developed some ground rules which represented some fundamental decisions about the way we would work together. How to make 360 tool work for teams Consider whether the LQF 360 tool will help your group or team in meeting your id entified objectives. For example, will the tool be suitable for all members of your team, including the more junior staff? Will all the members willingly participate? What impact might this have on the learning process? You will need to address with participants any potential tension between protect ing confidentiality of individual feedback and sharing of learning for team and orga nisational development. Secure agreement and make sure that everyone understands the proces s in advance. Will the facilitator work with the whole team? If not, consider how information will be shared between facilitators - again there are ethical issues to consider. It may be advantageous to give feedback on individual 360 tool assessment before explaining the composite report. This aids understanding of the concepts. A team composite report makes sharing the learning from the 360 tool process easi er. Plan to include extra time for team development sessions. Think about how the team will take forward action on any identified development needs. A clear strategy will give you the best chance of achieving change. Aim to have ag reement on how this will be done. Learning sets are one approach; a structured development programme might be another option. www.nhsleadershipqualities.nhs.uk

6. Conclusion Although the LQF is designed to have universal application within the NHS, this Good Practice Guide demonstrates that how and when you use it should be based on the particula r situation within your organisation. You will need to customise it and match it to your org anisation s needs. In addition to offering suggestions and pertinent questions, this Guide offers y ou examples of a variety of NHS organisations using the LQF and the 360 feedback tool for a number of purposes with different groups. These illustrate good practice in action but are not inte nded to be templates for you to imitate. These examples, whether developing shared cultures and a common language, encouraging personal and professional development or enhancing leaders hip capacity throughout the organisation, can all be interpreted as acts of leadership. Ident ifying and developing the best way forward for your circumstances will require thoughtful a nd effective leadership from you and your colleagues and call upon the qualities the Framewor k embodies. The way ahead is up to you. The Leadership Qualities Framework www.nhsleadershipqualities.nhs.uk

7. How has Good Practice been identified? The NHS Leadership Centre commissioned a one-year evaluation of the Early Implem entation Project to review the different applications of the LQF in the participating sit es. Staff from three organisations in a working partnership undertook the evaluation: The Centre for Professional and Organisation Development, School of Health and S ocial Care, Sheffield Hallam University The Development Partnership, Bromley The Institute for Employment Studies, Sussex University The members of the evaluation team were committed to working closely with the Ea rly Implementers in order to generate as much learning as possible from their divers e experiences. These were captured through telephone interviews, questionnaires, site visits an d case studies. Learning was also shared at the four network meetings organised by the Leadershi p Centre. Each of the organisations participating in the Early Implementation Project identifie d its own purpose(s) and objectives for using the LQF. A majority also used the LQF 360 tool, which wa s developed to accompany the Framework. Examples of the use of the LQF in action and quotations from the Early Implement ers have been used throughout this guide to demonstrate good practice. A list of the participating Early Implementers can be found in the appendix to t his document. 37 www.nhsleadershipqualities.nhs.uk

Appendix Addenbrookes NHS Trust Bath and North East Somerset PCT Birmingham & Black Country Strategic Health Authority Birmingham Heartland s & Solihull NHS Trust (Teaching) Bristol North PCT Cheshire and Merseyside Strategic Health Authority Christie Hospital NHS Trust Cornwall Health Community (working with Hampshire and Isle of Wight Strategic He alth Authority) County Durham and Tees Valley Health Community East Kent NHS and Social Care Partnership Trust East Lancashire Hospital NHS Trust (Formally Blackburn Hyndburn & Ribble Valley Health Care NHS Trust & Burnley Health Care Trust) Great Ormond Street Hospital for Children NHS Trust Hampshire and Isle of Wight Health Community Hampshire and Isle of Wight Strategic Health Authority Hillingdon Hospital NHS Trust Hinchingbrooke Health Care NHS Kettering General Hospital NHS Trust Langbaurgh PCT Leeds Acute Trust Leicestershire, Northamptonshire & Rutland Strategic Health Authority Lewisham PCT National Walk in Centres Primary Care Newham Healthcare NHS Trust

NHS Logistics Special HA North Cumbria Acute Hospitals NHS North Essex Mental Health Partnership NHS Trust & South Essex Partnership NHS Tr ust North Staffordshire Combined Healthcare NHS Trust North Warwickshire PCT, George Eliot Hospital NHS Trust & Rugby PCT Northumberland and Tyne and Wear Strategic Health Authority Nottingham City Hospital NHS Trust Plymouth Hospitals NHS Trust Royal Orthopaedic Hospital NHS Trust Shropshire & Staffordshire Strategic Health Authority Somerset Coast PCT, Royal Bournemouth and Christchurch Hospital NHS Trust South London & Maudsley NHS Trust West Midlands South Strategic Health Authority West of Berkshire PCTs (Reading PCT, Wokingham PCT, Newbury & Community PCT) Western Sussex PCT For full contact details of all Early Implementation Sites and to learn more abo ut their projects, please visit: www.nhsleadershipqualities.nhs.uk