Once Implementing Change in the NHS: Effects of Clinical Leadership on Performance Improvement

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TITLE Once Implementing Change in the NHS: Effects of Clinical Leadership on Performance Improvement
RESEARCHER Karen Castille
Henley Management College
Brunel University (England)
Doctoral Dissertation: January 2006

The purpose of this study was to identify the critical success factors responsible for making change in National Health Care acute hospitals in England.

The researcher began by conducting seven to ten interviews with NHS staff in three hospitals (representing three varying levels of performance). Seventeen themes were identified at this stage, which were further refined via discussions with three focus groups (participants of which were familiar with implementing change in the NHS). Leadership emerged as the pre-eminent theme. Surveys were administered to all program managers at NHS acute hospitals in England (N=155), who were asked to complete an organizational performance measure (Excel Scale; Sharma, Netemeyer & Mahajan, 1990) and the Leadership Practices Inventory of the designated clinical leader. The response rate was 81 percent (N=126). The typical respondent was female (71%), 35-44 years old (42%), from nursing (44%) or managerial (45%) background, from a district general hospital (72%), and with an average of 13.3 months involvement in the change program. The clinical leads (leaders being assessed) were most male (78%), with an average of 13 months involvement in the change program, and 45-54 years of age (49%; 44% were 35-44 years old). Internal reliability in this study was .91 for Modeling, .96 for Inspiring, .94 for Challenging, .93 for Enabling, and .95 for Encouraging.

"The theme of leadership was consistently ranked as the most important of all themes in impacting on the successful implementation of change – by all respondents" (p 99) from the qualitative studies.

Regression analysis showed that the five practices combined accounted for almost 17 percent (p. < .001) of the explained variance in organizational performance. Evidence of multicollinearity resulted in further exploration. Stepwise regression showed that Inspiring a Shared Vision accounted for most of the explained variance R Square = .144; p < .001).

Factor analysis suggested two factors. The first factor (accounting for 41% of the variance) consisted of all six items for Inspiring, 5 from Challenging and 4 from Modeling and was subsequently labeled by the researcher as "generates and manages a vision." The second factor (accounting for 33% of explained variance) consisted of all six items from Enabling as well as Encouraging, 2 items from Modeling and 1 from Challenging, and was labeled "empowers others." Using this two factor model, stepwise regression analysis indicated that Factor 1 accounting for 11 percent of the variance and Factor 2 added another 4% of explained variance. Neither respondent gender nor duration of service added to the model.

"The primary conclusion from the research is that there is a positive relationship between transformational leadership, as described by the LPI, and organizational performance as measured by the Excel scale" (p 219).