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Inclusive Leadership: The Key to Successful Quality Improvement

By Navina.evans@nhs.net | Thursday, June 7, 2018
Inclusive Leadership_The Key to Successful QI

East London NHS Foundation Trust (ELFT) embraces the “all teach, all learn” spirit of quality improvement (QI). After winning multiple awards for high-quality care while earning some of the highest employee engagement scores in the UK’s National Health Service (NHS), ELFT often shares what they’ve learned about supporting a culture of continuous improvement throughout their organization (including patients and families), violence reduction, decreasing wait times, and other universal challenges with organizations around the world.

It’s no surprise then that ELFT Chief Executive Dr. Navina Evans advocates what she calls “inclusive leadership.” Recently named one of the most influential NHS chief executives in England, Dr. Evans, a child and adolescent psychiatrist, sat down with IHI for an interview about the leadership lessons she’s learned.

On the organization she leads

We call ourselves a medium-sized NHS provider trust in England. We provide mental health services for a large geographical area across the city of London out to rural Bedfordshire. We also provide community health services that support people with chronic and long-term physical health conditions outside of hospital settings. You might say we’re somewhere in between primary care and hospital settings.

On leadership lessons that could apply to any organization

I’ve been a chief executive for about two years, and prior to that I was on the board as a chief operating officer and deputy chief executive. For me, the most important thing has been seeking out people who have views and opinions that are different from mine and listening to uncomfortable feedback, especially if it’s consistent. Sometimes you feel like you want to just shut them out, but they’ve got some very valuable insights.

The other lesson is to ask people how we can do things differently. I don’t have to come up with the ideas, other people do, and [leaders] need to facilitate that.

The third lesson is involving patients, carers, and families in helping us do our work better. We don’t just ask for feedback. We get their help with quality improvement so we can do our jobs better.

On why ELFT so willingly shares what they’ve learned with others

When we share with others, we also learn a lot. We never go out and share what we do without coming back with lots of ideas. For example, we’re currently buddying with another [NHS] trust. [The UK Care Quality Commission has put them in] “special measures” because they’re struggling on the quality front and we’ve been asked to help them make improvements. Some of our staff have gone over to support them. But they’ve come back to us and said, “They may be in special measures, but they do certain things really well, and we could learn from them.”

On why she believes in inclusive leadership

Over the years in our organization, we’ve tried, failed, and learned from all sorts of top-down, command and control ways of trying to get things done. What we’ve learned is that there are leaders and then there’s leadership. Leadership is something that everybody in an organization can demonstrate and take on at different points in time, no matter their rank or professional identity.

Encouraging [leadership at all levels] to grow and take shape has resulted in quite a lot of good improvements. And the quality improvement methodology encourages that because the manager doesn’t have to be the leader of QI projects, and change ideas can come from anywhere.

On the media attention when she was named chief executive

I was quite surprised at the reaction to my appointment as chief executive. The fact that I’m a woman, I’m Asian, and I’m a doctor, and the fact that our [board] chair is also a woman from an ethnic minority background generated a lot of excitement. It was very flattering, but at the same time I felt quite sad that this is so surprising in our multicultural country.

Diversity is important. If I may be so bold, we’re at risk of getting a bit stale [in the NHS]. We don’t make the most of all the assets that we have in terms of our people in the health service. We have the same old solutions, the same old people, coming up with the same old answers. Diversity brings new ideas, new solutions, and a wider range of understanding about the subtleties of culture, behavior, and values. Also, particularly at the leadership level, it’s important for patients and staff to see themselves represented.

On how to address diversity and equity

We should openly talk about these issues. Some of our leaders talk about the need for diversity of opinion and diversity of thought without necessarily acknowledging that we need more women, and people with other protected characteristics, to help bring more diversity of ideas and perspectives.

We need to have open and honest conversations that allow people who don’t get it, to say they don’t get it so we can discuss it together. [Equity is] not just morally right. It benefits [all of us] in pounds and pence or dollars and cents.

I had someone say to me the other day, “Navina, when I see you, I just see that you’re a really good chief executive. I don’t see your gender or your color.” He was trying to be nice. I had to say, “No, please see those things. It’s important that you see that I’m a woman and that I’m Asian.”

Throughout my career, my training, and my development, I knew I had to put in more effort than others to prove that I was meant to be where I was. Even now, I walk into a meeting of chief executives, and the men do look at me sometimes as if they don’t know who I am. It’s a sort of “Are you sure you’re in the right room? Are you here to take the minutes? Are you here to make the tea?” kind of look.

On the importance of succession planning

Ours is an organization that’s been quite unashamed and bold about succession planning in a very open way, which brings challenges in itself. But we feel it’s very important because we have a culture, we have values, and we want leaders to come through the organization that share all of that.

At the same time, you don’t want to be too inwardly focused. People talk about bringing in “new blood,” and so you’ve got to think about that to bring in fresh perspectives. We don’t want to become a closed system.

Organizations that don’t do succession planning well are at a disadvantage because you can suddenly have a vacuum in key parts of your leadership system. You should have somebody who can step in at short notice. It doesn’t mean that person is inevitably going to be the next leader, but it’s important to have a plan.

Editor’s note: This interview has been edited for length and clarity.

You may also be interested in:
Building a Culture of Improvement at East London NHS Foundation Trust

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