The EFMD business magazine

The EFMD business magazine

Cultural change on a national scale

cultural change

Trying to change the culture of any large organisation is always a significant challenge. Trying to do so across a £116 billion enterprise that delivers services on a national scale is even more demanding. 


Attempting to do this across the 9,000 organisations that make up the English National Health Service (NHS) could be seen as foolhardy. But this is exactly what the NHS Leadership Academy and Alliance Manchester Business School were tasked with doing when we set out to work together to design and deliver a suite of new programmes as part of a KPMG-led consortium of partners.

The context

The English NHS is over 60 years old, and every statistic about it screams big. It is the fifth-largest employer and the largest healthcare system in the world. It employs one out of every 24 people working in England with its top leaders responsible for 1.5 million staff and the care of over one million people every day. It is a tax-payer funded system, free at the point of need, and, as a nation, England spends £116 billion every year delivering healthcare to its citizens.

Contrary to popular belief, the NHS is not one organisation but a collection of over 9,000 separate bodies structured to buy, deliver or regulate healthcare for the citizens of England.

Like all healthcare systems around the world, however funded, it is also a system under financial strain. England has growing demand, an aging population and no growth in budgets. Ensuring the drive for financial value, whilst maintaining the quality of care, is a key element of any NHS leader’s job.

In 2013 a nationally commissioned report into failings of care at Mid-Staffordshire Hospitals NHS Foundation Trust was published. This report found that there had been significant failures of care including seriously low staffing levels and many examples of patients left in agonising pain, dehydrated or lying in their own excrement. There was a lack of care and compassion, chronically low staff morale and a bullying culture, which led staff to fear for their jobs if they pointed out poor care.

While there were individuals who were culpable, the report was very clear that there had been a focus on finances at the expense of patient care, a failure of leadership at every level and, because of this, people had died who need not have done. Throughout the country there was also concern that this was not an isolated incident in one of those 9,000 organisations but a systemic challenge facing the NHS.

Around this time the NHS created its first national Leadership Academy. A review of leadership styles among top leaders in the NHS revealed a strongly dominant and homogenous pace-setting mode. While this behaviour can drive results, it does not engender a climate of compassionate care.

A call went out for a consortium to work with the Academy to design and deliver patientcentred leadership programmes from the frontline to the boardroom, that would demonstrably change the culture of leadership in the NHS. The outcome of these programmes would be leadership that would enable the delivery of care that we would all want for ourselves or our family.

A consortium of Alliance Manchester Business School, KPMG, National Voices, the University of Birmingham, Leo Learning, Cumberlege Eden & Partners, Harvard School of Public Health and others answered this call. Together with the Academy we designed two unique highly blended experiential programmes that are changing the behaviour of leaders across the service.

The programmes

The programmes were designed and implemented at pace including taking a masters degree through the quality assurance processes of two major UK universities. Commission to delivery took less than eight months.

While aimed at two different levels of leaders, the programmes (the Nye Bevan Programme and the Elizabeth Garrett Anderson Programme) are built around the same core leadership principles that define what high-quality leadership should look like in today’s NHS:

  • Making person-centred co-ordinated care happen
  • Creating a culture for quality
  • Improving the quality of the patient experience
  • Understanding self to improve the quality of care

The Nye Bevan Programme is the more senior of the interventions and targets leaders aspiring to executive and board-level roles. It is 12 months long and opens with patient representatives who share their stories and views of the NHS.

As part of the design, we created an entire virtual health and social care system based around the fictitious county of Glenvern, with hospitals, patients, social services, GPs and local politicians. There is a highly interactive virtual campus alongside four residential modules supported by self-managed learning sets.

Participants deal with scenarios such as poor care, complaints and reconfiguration of services, presenting or defending decisions they make during the programme in simulations where the “actors” are actually real journalists or politicians.

Finally, there is an assessment where, again, we put patient’s views at the very heart of the programme by having them sit on viva panels, discussing and agreeing whether participants have demonstrated the necessary credibility to pass the programme.

The Elizabeth Garrett Anderson programme targets mid-level leaders aspiring to a more senior role. This two-year programme is an experiential behavioural development intervention as well as an MSc in Healthcare Leadership and is awarded jointly from the Universities of Manchester and Birmingham.

It develops leaders through practical, relevant and applied learning that they can apply in the workplace but which also prepares them for their future leadership role. The programme has a comprehensive virtual campus, which drives learning alongside three residential workshops and 11 action learning sets.

Despite its large scale, with almost 2,000 participants enrolled, the bespoke design delivers a personalised experience.


About 3,000 participants across both programmes have taken on board new ways of working and are now changing old mindsets and bringing system-wide change. Across two graduating intakes, an average of 48% Anderson and 37% Bevan participants have reported a promotion, with 94% of Anderson participants attributing this to the programme.

Having attended a participant focus group, the Anderson external examiner commented: “Overall the feedback received was excellent and the team are to be congratulated for this. Students were especially positive about the quality of learning resources on offer, the grounding in practice and the residential elements of the course. Many were able to give very lucid examples of how the course had altered their own professional practice as leaders in the NHS and how it had strengthened their commitment to leading change.”

The Institute for Employment Studies, the external evaluators for Bevan, said: “The programme is unusual in the particular emphasis it places on the impact of leaders on the wider health and social care system.The team based the evaluation approach on a stakeholder map, starting at the centre with the programme participant and rippling outwards through other stakeholders: colleagues, patients and service users, the organisation, and the wider health and social care system. The evaluation team put particular emphasis on participants’ impact on and beyond their organisation as a key aim of the Nye Bevan Programme is for its graduates to make a substantial difference for the better via a new style of leadership”.

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