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Leadership development: does it make a difference?

Ruth J. Boaden
Manchester Business School, University of Manchester, Manchester, UK
Abstract
Purpose This paper seeks to examine the impact of a leadership development programme provided for, and funded by, the NHS. Design/methodology/approach It analyses the context, process of delivery and outcomes of the programme in the light of relevant leadership research. The programme itself is described after some consideration of the literature. Although the programme was originally commissioned by the NHS Leadership Centre for Human Resource (HR) professionals from the NHS, it is now offered to any aspiring or newly-appointed director, and aims (amongst other things) to enable NHS staff to manage people more effectively within the context of change. Findings The paper concludes that the programme has, to date, been successful in impacting on personal and organisational contribution, as far as individual participants, commissioners and providers are concerned, and as far as can be measured within current understanding. Originality/value The programme ts well with the most recent typologies of leadership development. Keywords National Health Service, Leadership, Development, Self development Paper type Case study

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Received November 2004 Revised May 2005 Accepted July 2005

Introduction The formation of the NHS Leadership Centre in April 2001 enabled a number of leadership development programmes previously commissioned by a variety of areas within the NHS to be brought together. It also fullled the commitment within the NHS plan that:
To deliver a step change in the calibre of NHS leadership, the government will establish a new Leadership Centre for Health (Department of Health, 2000).

This paper describes the impact of a leadership development programme originally commissioned by the human resource (HR) directorate of the Department of Health in mid-2000, for HR professionals, which is now run under the auspices of the NHS Leadership Centre and offered to any professional within the NHS who aspires to a director post, or who has recently been appointed to one.
The author would like to thank the team providing the programme in Manchester, both academic and administrative staff, and in particular Claire Harris for her perceptive and effective data analysis and Amanda Shephard for the analysis of the second and third intakes. Thanks to all the programme contracts within PricewaterhouseCoopers and the NHS Leadership Centre. However, it is the participants in the programme who have made this paper possible and it is to them that thanks are mostly due.

Leadership & Organization Development Journal Vol. 27 No. 1, 2006 pp. 5-27 q Emerald Group Publishing Limited 0143-7739 DOI 10.1108/01437730610641331

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Leadership itself has long been a popular and widely-used term and yet one that dees an agreed denition (Alimo-Metcalfe and Lawler, 2001). The increasing body of evidence that leadership makes a difference to organisational effectiveness, e.g. (Bass, 1998), has prompted those who commission and fund leadership programmes, particularly within the public sector, to focus on organisational outcomes and improvements as a tangible benet from investment in such programmes. Other initiatives within the public sector, e.g. the modernisation initiatives co-ordinated by the NHS Modernisation Agency, are also increasingly identifying effective leadership as a key success factor in the long-term sustainability of organisational change (NHS Modernisation Agency, 2002):
Effective leadership is a key ingredient in modernising todays health services. Better leadership means better patient care and improved working practices for NHS staff (NHS Modernisation Agency, 2004a).

This paper provides a critical analysis of a leadership development intervention (programme) within the NHS, and focuses on its effect on both individuals and the organisation. It discusses the context of the programme, its structure and the process by which it is provided, and its outcomes. The conclusions show that there is an inextricable link between personal development and service change and that it is probably not possible to achieve long-term improvement in one without affecting the other. The author of the paper was, at the time, one of the directors of the programme and had designed the programme jointly with another colleague. However, she did not lead the evaluation process, which was designed by PricewaterhouseCoopers, and data analysis was carried out by another academic colleague. Theoretical background It is not possible, or appropriate, to review the whole area of leadership and leadership development here, particularly when there are a number of excellent such reviews already available (e.g. Vance and Larson, 2002; Alimo-Metcalfe and Alban-Metcalfe, 2002; Van Wart, 2003). For the purposes of this paper, the areas of leadership, leadership development, and leadership within the NHS will be considered. Leadership There was a large and signicant shift in terms of the study of leadership in the 1980s when the paradigm moved from transactional to transformational (Alimo-Metcalfe and Alban-Metcalfe, 2001). Previous models of leadership such as contingency models (Vroom and Yetton, 1973) focused on behaviours and styles as being predictors of effective outcomes, depending on the situation. The increasing pace of change during the 1980s led to transformational models being developed, which focussed on charisma and vision (Bass, 1985). A distinction between management and leadership has been often raised in the literature (Kotter, 1990) and is summarised in Table I. This is included here because the implications of this distinction in terms of leadership development will be returned to later in the paper. It is argued (Alimo-Metcalfe and Alban-Metcalfe, 2002) that transformational leadership is coming to be equated with leadership per se; transactional with closed-ended, relatively

Activity Agenda creation

Leadership Establishing direction: Developing future vision Articulating the vision in a way to inspire others Aligning people: Enthusing others to join in achieving the vision Creating teams that understand and are engaged in developing the vision and means to achieve it Motivating/inspiring: Energising staff to overcome barriers by inspiring, maintaining positive expectations, valuing and developing Tends to produce: Change, often dramatic, and potential for effective change

Management Planning/budgeting: Developing detailed strategic plans Allocating resources Organising/stafng: Developing planning and stafng structures, aims and objectives Providing policies and procedures for guidance, and monitoring systems Controlling/problem solving: Detailed monitoring of results Identifying deviations, organising corrections Tends to produce: Order/predictability, efciency Results expected by stakeholders

Leadership development

HR development for achievement

Execution

Outcomes

Source: Alimo-Metcalfe and Alban-Metcalfe (2002); Kotter (1990)

Table I. Comparison of leadership and management

static, management. This distinction has been clearly taken on board by the NHS, which argues that both aspects are needed within single individuals in the NHS:
We need leadership in setting out the vision and working with and through people to achieve it. We need excellent management in systematic and tested approaches to secure delivery and improvement. Many people, of course, take on both roles (Department of Health, 2002b).

Although some academic authors have pursued the notion that the two different aspects of leadership require different psychological types (Zaleznik, 1977), the view of the NHS is that leadership is everyones job:
Everyone in the NHS has a leadership role. The very way we behave is a demonstration of our leadership skills (NHS Modernisation Agency, 2003).

Another view on the same issue describes splitting the job of an individual into management and leadership components, with the leadership element being regarded as discretionary (i.e. a matter of choice) and predominant amongst the roles of senior managers (Kakabadse et al., 1996). This distinction is described by these authors as being pertinent where there are substantial conicting priorities as in the public sector at a senior level. It is argued that the choices made will impact on the performance of the organisation. This notion of choice is one that will be returned to later in the paper. Leadership development Not only is the business of leadership development a growth area for many providers, including universities, there is also an acknowledgement that there is gradual evolution of a paradigm to locate this activity (Fulmer, 1997; Conger, 1993). It is argued (Conger, 1993) that as our understanding and denitions of leadership have

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changed, so the approach taken to leadership development also needs to change. This evolution can be summarised as shown in Table II (Fulmer, 1997). Although this model was developed in the US and describes activity there, it is also applicable to the UK that may be more advanced in this respect:
British business schools have been much more innovative than their American counterparts in designing programs that take the learning out of the classroom and into the real world (Fulmer, 1997, p. 68).

It is argued that many approaches to leadership development are not innovative (Conger, 1993) and are based around four areas which have been used for many years: skill-building (e.g. decision-making), concepts (e.g. what makes leaders different from managers), outdoor adventures (to build teamwork) and feedback (ranking on a scale of leadership dimensions). A review of leadership development in context (Day, 2000) concludes that there is a difference between developing leaders using a traditional, individualistic conceptualisation of leadership and leadership development which has its origins in a more contemporary, relational model, although he claims that organisations need both approaches. This need for a more contemporary approach is also reected in a model of competency (Doh, 2003) that will require signicantly different approaches to leadership development, focusing on strategic and global issues in a decentralised environment, within the context of sensitivity to diversity, interpersonal skills and communities, and with a focus on anticipating the future and mobilising their organisation to shape it. This need for leadership development to reect the context is also highlighted by (Hartley and Hinksman, 2003) in another signicant review of the literature on leadership development. There is also a signicant literature on learning, at both an individual and organisational level, and its relationship to training (Antonacopoulou, 2001) and this area is continuing to develop. Modes of learning may include (Akin, 1987) emulation of a mentor, role learning, learning through doing, validation, learning of concepts and personal growth. Some of these are more suited to formal development programmes than others. Action learning is regularly cited as a key tool in leadership development (Bowerman, 2003; Watkins and Marsick, 1993); and the literature gives examples of such programmes (Bowerman, 2003). A review of the difculties encountered when using action learning for leadership development (Conger and Toegel, 2002) describes inadequate opportunities for reection, poor facilitation and a failure to follow up on project outcomes as ways in which the potential of this technique is not fullled.
Past Participants Programme design Purpose Period Players Presentations Place Source: Fulmer (1997) Listener Event Knowledge Past Specialists Style University campus Transition Student Curriculum Wisdom Present Generalists Content Corporate facility Future Learner Ongoing process Action Future Partners Process/outcome Anywhere

Table II. The evolving paradigm of leadership development

Whilst there is some debate over the extent to which leadership can be taught (Doh, 2003), and what might constitute such teaching, there is agreement that leadership clearly requires personal commitments on the part of the learner (Doh, 2003) and this may challenge the traditional role of educators. This new paradigm puts new demands on those termed traditional educators respect is earned by what the teacher is able to stimulate others to know (Fulmer, 1997). The new paradigm is summarised by the author as focused on learning as an action-oriented, lifelong process where global partners work together to produce a positive, protable future for all (p. 70). An assessment of the state of leadership development in the UK and its implications for the NHS, was published in 2001 (Alimo-Metcalfe and Lawler, 2001), about the time that the programme discussed in this paper commenced. Its conclusions were different from those expected, because the ndings showed that leadership development in both the private and not-for-prot sectors is sporadic, haphazard and illogical although the authors do acknowledge that the concepts and practices of leadership development are in an early stage of evolution, a view in line with those from the US (Conger, 1993; Fulmer, 1997). There are also some observations about the role of organisational politics in leadership development (Alimo-Metcalfe and Lawler, 2001), which conclude that there is a huge gap between aspiration and achievement [in terms of a logical process of identifying potential leaders], a gap lled by politics. An additional perspective on this issue is provided by the concept of fair process (Chan Kim and Mauborgne, 2003) where employees will commit to a managers decision (even one they disagree with) if they believe that the process used was fair. It is argued that this concept can be applied to leadership development (Bowerman, 2003); although organisations say they want to develop leadership, they fail to understand the implications and do not create an environment in which such leadership can thrive. Proponents of action learning approaches make similar points (Revans, 1998). Literature is also developing on why leadership development efforts may fail (Ready and Conger, 2003). These authors cite the ownership is power mind-set (where the focus from senior levels is more about traditional models of command, control and power rather than shared accountability). They also describe programmes that are products, rather than being designed around the issues within the organisation that need to be addressed as tending to fail. They argue that the metrics used to assess the effectiveness of leadership development may be inappropriate since they focus on activity rather than capability, a view that is shared by other authors. Does leadership make a difference? There have been a number of reviews (Bass, 1998; Gasper, 1992; Lowe et al., 1996; Patterson et al., 1995) demonstrating that transformational leadership has a strong positive relationship with objective measures of organisational productivity as well as subjective measures (e.g. job satisfaction). Most of these meta-analyses have been performed within the US. There is also a growing body of literature looking at various aspects of leadership and their relationship with performance (Moshavi et al., 2003); for example, consider leader self-awareness and performance. The impact of leadership can be considered on either workplace colleagues, or by some measure of organisational success (Alimo-Metcalfe and Alban-Metcalfe, 2002), or perhaps on both.

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Whether leadership development programmes have a positive measurable outcome in organisational terms is something that is much more difcult to demonstrate, although it is regarded as important. A review of research in this area (Vance and Larson, 2002) concludes that although work in the social sciences indicates that leadership styles can have a major inuence on performance and outcomes, minimal transfer of this work to the healthcare system is evident. Whilst acknowledging that it is difcult to conduct, these authors call for more research in this area, in the light of the move to evidence-based practice in healthcare. They also raise the issue that much of the research to date has utilised qualitative research methods, and they argue for more quantitative work, although this is not a universal view (Conger, 1998; Burgoyne and Williams, 2004). Another review (Collins, 2001) concludes that while approaches to evaluation are focusing more on performance issues, the results are mixed and there are inherent difculties in doing this (Burgoyne and Williams, 2004). The lack of scholarly knowledge about leadership development is again cited here, but it is also pointed out that most leadership models were developed for a more stable and predictable environment than now, highlighting the need for further understanding of the relationship between leadership and change. Leadership within the NHS Leadership and leadership development within the NHS has come to increasing prominence in recent years, not only with the formal establishment of the NHS Leadership Centre[1], but also with the publication of a document which sets out the new management task for the next three years and addresses how, together, we are going to create a coherent core of values and systems and build a management and leadership community in the NHS of international standing . . . combined with specic national initiatives that will help managers and leaders in practical ways (Department of Health, 2002b). At the same time the code of conduct for NHS managers was published (Department of Health, 2002a), in response to the Kennedy report, and this code draws heavily on the NHS leadership qualities framework (Department of Health, 2002c), which is itself now heavily promoted within the NHS. The NHS, like many other public sector organisations, is keen to learn lessons on leadership from other sectors and from an international base, and this is reected in the new programmes that are being commissioned (e.g. the Gateway to Leadership programme which recruits managers from other sectors to work in the NHS (NHS Modernisation Agency Leadership Centre, 2003). There is also an emphasis on leadership development for groups currently underrepresented in terms of leadership positions (e.g. the Breaking through programme (NHS Modernisation Agency, 2004a). The work of the Leadership Centre was categorised into three areas (NHS Modernisation Agency, 2004b): strategic leadership, front-line leadership and building capacity. All these work streams include programmes for both clinical and non-clinical staff, from a variety of professions from chairs and chief executives to social care and staff from learning disabilities organisations. The NHS plan states that leadership development in the NHS has always been ad hoc and incoherent . . . that will now change (Department of Health, 2000) and the recent work plan shows evidence of this starting to be achieved. The Leadership Centre has commissioned a number of formal programmes and taken on board others that were previously provided by particular

functions (NHS Modernisation Agency, 2004b), although this was not without some concern from certain professional groups, where a lot of work on leadership in some areas had already been developed (Moiden, 2002). The Leadership Centre has indicated its intention to move away from mainly focussing on providing leadership development programmes and products to exploring how to contribute to leadership policy, ensuring best practice at local level, promoting diversity in leadership and research the results of effective leadership (NHS Modernisation Agency, 2003) and its role in the NHS Institute for Innovation and Improvement reinforces this, although the detail is still evolving. It is clear that the establishment and development of the NHS Leadership Centre has increased the prole of leadership, and its effective development, within the NHS. The programme History and objectives of the programme The Leadership Through Effective Human Resource Management (LTEHRM) programme (the programme) was commissioned to prepare both human resource (HR) professionals and other leaders as experts in the management and development of people and as full members of the team charged with building capability and delivering change in the NHS (Harris, 2000). The programme is open to people aspiring to be directors and those already at director level in the NHS, initially from England, although subsequent funding has provided places for participants from both Wales and Northern Ireland too. Three intakes of participants have completed the programme with the fourth due to nish the core part of the programme in autumn 2005, and the fth intake having started in April 2005. The aims of the programme are to enable both HR professionals and other NHS leaders to become experts in the management and development of people by[2]: . raising the prole of HR within the NHS by developing HR professionals as full members of the team charged with building capability and delivering change; . embedding a consistently high level of managerial skill across the NHS, taking into account the demands of the NHS plan on HR professionals in radical restructuring and reorganisation; . to combine academic knowledge with practical insights that can be applied in the workplace; and . to develop an understanding of the needs and development of the NHS. And to enable participants to identify and address their own development needs in particular: . to enable participants to develop understanding and skills in building organisational and individual capability for change; and . to enable participants to develop understanding and skills in delivering change in organisations. There are very few published accounts of other similar programmes, although one that has received attention was commissioned by the Ofce for Health Management in Ireland and found on evaluation to be effective from the point of view of both participants and line managers (Gavin et al., 2001; Hardacre and Keep, 2003).

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Initially the LTEHRM programme was aimed at HR professionals:

Those charged with the management of human resources are key members of each executive team, both as experts in the management and development of people, but equally important as full members of the team charged with building capability and delivering change. This programme is concerned with developing the skills which this group of HR professionals will need (quotation from tender document).

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Subsequently, intake one of the LTEHRM programme attracted predominately professionals from the HR function. However, this focus has lessened in subsequent intakes as other funding was attracted, the reputation of the programme developed and its applicability to a wider range of people was recognised. It was not designed to teach or enable learning of detailed technical HR/personnel practice. This development of emphasis on people management rather than HR as a profession is reected in the fact that the programmes title has changed to Leadership through effective people management for the fourth and fth intakes. Structure and content of the programme The core part of the programme was developed and is provided by the Manchester School of Management (MSM), UMIST (in partnership with the Manchester Centre for Healthcare Management (MCHM), Victoria University of Manchester[3]), and the (then) HR Consulting group of PricewaterhouseCoopers (PwC)[4]. There are also two international partners (Erasmus School of Management and Harvard School of Public Health) providing optional parts of the programme. Table III shows the responsibilities of the various partners. The core programme incorporates half-week blocks of teaching every two to four months (residentials), service improvement projects (SIPs) to work on in between, learning sets facilitated by university and PwC staff and a support website. The residential part of the core programme is delivered by academic staff from MSM and

Programme element

Co-ordinating partner

Table III. Responsibilities of the programme partners

Manchester School of Six core residentials The core programme Management Service Successful completion of the core programme leads to the award of the Improvement Projects Postgraduate Certicate in Human Learning sets (day 1) Resource Leadership Optional element 1 Diploma/MSc: Successful completion of the core programme and management report leads to the award of the diploma in human resource leadership Successful completion of the core programme and dissertation leads to the award of the MSc in human resource leadership Optional element 2 Erasmus/Harvard electives Erasmus and Harvard Universities with PricewaterhouseCoopers Learning sets (day 2) PricewaterhouseCoopers Optional Element 3 Aspiring Chief Executive programme (ACE) Note: Optional elements 2 and 3 do not form part of the UMIST assessed qualication

MCHM, by invited speakers from other universities and employers, and by experts from within PwC. The service improvement projects are written up and assessed throughout the programme, if academic accreditation of any form is desired. There are two learning set days between each residential module the rst is facilitated by MSM and focuses on the service impact of the programme to date (including support for SIPs if required) and the second day is facilitated by PwC and focuses on personal development. A brief indication of some of the benets of this approach can be found in (Trapp, 2002). Whilst the content of the programme is not the main focus of this paper, a summary of the key areas covered is given in Table IV for information. In intakes 1 and 3 the number of participants were such that two groups were run one consisting of deputy directors (the accelerated group) and one consisting of directors (the advanced group), each with 45 participants. Both groups covered the same material and had broadly the same input with some minor variations where speakers were not available to come to both groups. In intake 2 there were fewer participants so accelerated and advanced groups were taught together in the
Programme element The core programme Six core residentials (each 2.5 days long) Service improvement projects (after modules 2-5) on a topic related to the material from the residential, with a review of learning after module 6 Learning sets Introduction to the programme, the process of learning and some preliminary work to raise awareness of key trends and inuences Drivers for change and trends, both nationally and internationally and the role of people management in this A focus on the individual: their leadership roles, change management and personal development A focus on the effective management of people, the challenges this raises, and the effect on patient care A focus on the organisations and systems that work to improve patient care, quality improvement, seeing things through the patients eyes Review of learning at personal and organisation level, with workshops on mentoring, change and personality, emotion at work, team working and stress and bullying

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Module 1: Introduction Module 2: Todays healthcare agenda and the NHS response Module 3: Leadership and change Module 4: Improving the patient experience: making it happen through people Module 5: Improving the patient experience: making it happen through organisations Module 6: Assessment of personal and organisational development

Optional element 1 Diploma/MSc: The diploma requires the writing of a further SIP in an area of the participants choosing The MSc requires attendance at a 2-day Research Methods module and the writing of a dissertation of 20,000-40,000 words on a topic of the participants choosing (which is usually applied research based in the workplace but does not have to be). There are up to two years to complete this work Optional element 2 Erasmus/Harvard electives (each one week long) Erasmus focuses on the European health system, and on some key national service framework areas Harvard focuses on the US health system and has a strong clinical bias Optional element 3 Aspiring chief executive programme (ACE) This programme includes personal coaching and two residential workshops where chief executives talk about their experiences

Table IV. Summary of content of the programme

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residential modules (a total of 45 participants) although their learning sets were separate to enable them to discuss work and personal development issues with their peers. Evaluation of the programme The evaluation process is regarded as a key part of the programme and assesses the value of the programme to participants and the NHS, as well as ensuring that experience from the programme is being built into future provision, enabling continuous improvement. The evaluation is therefore both formative (during the programme contracted for ve years as a whole) and summative (after one complete cycle of the programme) (Burgoyne and Williams, 2004). The process, based around Kirkpatricks model (Kirkpatrick, 1994), was designed to: . ensure the programme met the agreed needs of the NHS; . demonstrate the impact of the programme on personal development, organisational development and service/patient improvement; . provide a systematic means of evaluating and continuously improving the programme; and . help participants cement their learning and support on-going professional development. The model (see Figure 1) was used to enable evaluation of the programme at all four levels through a range of mechanisms. Data on reaction at level 1 is gathered throughout the programme in the form of feedback questionnaires completed at the end of each residential, and through verbal reports at the following learning set meeting. At the end of the core programme participants are also asked to re-assess the residentials, so that a comparison of

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Figure 1. The Kirkpatrick model

immediate and delayed reaction can be made. Details of achievements at level 2 are gathered through marks for assessed work throughout the programme, and in the work required for module 6 of the core programme. Participants are required to produce a project detailing their developments in knowledge (level 2) and how these have translated into changed behaviours (level 3), and how they relate to the structure of the programme. They are also required to provide a presentation on their assessment of the benets of the programme for the NHS and its value for money (level 4). In both the report and presentation they are encouraged to use external sources of evidence tangible benets, the view of peers and superiors, as well as their own views. In addition, benets described in the SIP reports are analysed independently and key themes drawn out. However, in light of the evaluation breaking down the programme into its constituent parts as part of this process, it must be emphasised that the programme is a total experience, as illustrated by the following quote from a participant on the rst intake:
It is still early days to evaluate impact on targets as the change is still underway and will be for some time. Additionally, I do not feel that it is a specic project that has had the most impact, but rather the whole experience of being part of the programme and all its component parts it is hard to separate out what specic benet has come from what aspect of the programme when so much of it has been inter-linked and holistic in approach.

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Outcomes from the programme The evaluation process described in the previous section shows that outcomes are at a variety of levels and in a variety of areas. For the individual participant there are a variety of academic accreditation options; a Certicate of Attendance, Postgraduate Certicate, Diploma (participants must produce a management report) or MSc (participants must produce a dissertation). To date between 30 and 40 participants have continued to the MSc stage of the programme each year and the rst graduates nished in December 2003. However, as the objectives of the programme show, the programme aims to achieve far more than this. This paper provides results from evaluation of the rst three intakes of the programme about 250 people in total. Reponses were analysed from 63 participants in intake 1 (62 per cent), 32 in intake 2 (80 per cent) and 57 from intake 3 (63 per cent). Detailed analysis of the outcomes for the rst intake of participants, from the evaluation process, shows that all objectives have been achieved to a greater or lesser degree. The list of key benets generated by analysis of participant reports from intake 1 (not by giving a list of factors and asking participants to rate them), and their link to the objectives is shown in Figure 2. In particular, the following can be noted: . The prole of HR within the NHS has been raised by development of the HR community and the movement of participants to new jobs, combined with their increased personal condence and motivation. . There is evidence of a variety of transactional skills and transformational leadership characteristics also having been improved, as shown by the data generated from the analysis of participant evaluation reports. It would be expected that this will also follow from personal development.

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Figure 2. Achievement of programme objectives

There is clear evidence that practical insights have been applied in the workplace and tangible benets obtained. Many participants pointed out that it was in their view too early to quantify the benets but they had no doubt that more would be achieved in future. Most participants reported a greater understanding of the needs and development of the NHS, which is having knock on effects on the credibility of HR as well as delivering change and improving patient focus and (ultimately) patient care. There has been signicant personal development, which is continuing to have an impact on participants roles and inuence, as well as their career paths.

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In terms of leadership, this was one the factors that emerged from the analysis of the SIPs, although participants were not asked explicitly to comment on it, because it is not explicit as an objective. However, there is clear evidence that leadership skills and self-awareness (Moshavi et al., 2003) have improved, as shown by the quotations below. It should be borne in mind that these quotations were also supported by tangible evidence as part of the overall evaluation process. It should also be noted that there were many other examples of personal and organisational change that could be classed as leadership developments this comes down to the denition of leadership used for the purposes of this paper the participants own denitions have been used.
Leadership in general The learning both personally and professionally has been phenomenal. I am more capable as a leader. The programme has also highlighted my own contribution to successfully managing change in terms of my own personal approach and leadership style. Greater competence in inuencing others whose support I need. I am taking a more proactive leadership role. The quality of my leadership contribution within the trust and the local health community has been signicantly inuenced. The increased knowledge and understanding gained from the programme has enabled me to be able to display leadership and vision across the Trust. Delivering results I have been able to call on leadership qualities developed through the programme to deliver two important roles for the service. I believe that this (staff feedback) provides some evidence of my successful leadership of the organisation and am aware that this has been a key area of development.. Self-awareness The various exercises and questionnaires completed during the programme have enabled me to assess where I sit personally on the leadership ladder. The understanding of leadership competencies and the self knowledge about my own leadership competencies gained has been critical in maintaining my ability to cope with the current context.

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The need for strong leadership was emphasised on all modules and I think now that I have a better insight into my leadership capabilities and of the possibilities for HR to lead in areas, which historically, the function has been peripheral. The learning set has provided me with opportunities as well as frameworks to develop a greater understanding about my preferred leadership style.

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The programme made me think about my own qualities in leading effective services.

What about the patient? It can be argued that outcomes from any type of leadership development within the NHS should lead to improved patient care, although most of the empirical work on this appears to have come from the nursing profession to date (e.g. Gantz et al., 2003). The structure and content of the programme were designed to enable participants to think this aspect through, something which HR professionals in particular had not always considered in detail, unlike those in more front-line roles. Each SIP report had to include a section on the impact of the ndings and analysis for the organisation, the patient and for the participant. This is illustrated by the following quotations from SIP reports:
Increased awareness of the impact on patients My awareness of linkage to patient care has increased dramatically over the last 18 months. I have worked with the management team . . . on how I undertake my role . . . and we have become more patient focused. I am now fully committed to leading transformational change to improve patient care and to ensure that these changes are embedded and become the norm so that there can be no going back to type. Changes in behaviour and/or practice related to patient care Completing projects, and having to assess the impact on patient care as part of the process, have helped me to maintain a focus on patients which is not always apparent in a primary and community care environment. I often remind staff within the HR Directorate that we are about improving the patient experience. I will challenge the views of others in situations when I would not have done previously, to ensure that the impact on patient care is priority. I have found a new way of working which demonstrates the value of my knowledge, my ability to achieve results both personally and through others, my ability to take personal ownership of my actions and their consequences and relate all that I do to the patient. A very direct result of the programme has been HR participation in user involvement in the trust.

The impact of the programme The commissioners and their context This programme was already running when the NHS Leadership Centre was formally established, having been commissioned by one of the functional directorates of the (then) NHS Executive. However it has developed to t within the overall portfolio of leadership programmes funded by the NHS and has just been commissioned for a

further two intakes of up to 100 participants each. During the time that the programme has been running it is clear that the understanding of leadership within the NHS, as well as the ways by which it can be developed, has evolved considerably. What is clear from informal feedback to the providers is that the focus of this programme on translating learning into behaviour and into changes in the workplace and improvements in patient care is in line with this evolution and the current focus of leadership development activity within the NHS. The NHS Leadership Centre does not appear to have an agreed denition of leadership it could be argued that this is a strength rather than a weakness, given the diversity of denitions available. Although a clear vision of what leadership means is recommended (Alimo-Metcalfe and Lawler, 2001), it is in practice difcult to see how this can be done within the NHS when there is no central agreement, and possibly the adoption of a single denition would only restrict the potential for development. However, perhaps the leadership qualities framework is a tight enough denition, without being too restrictive, although it has been developed from a very small and organisationally narrow sample further more wide-ranging research is needed to validate it. However, the lack of a central denition, and the lack of a formal denition within this programme too, has caused some consternation with participants. The popularity of the US charismatic leader philosophy led to some participants initially being reluctant to consider more detailed aspects of organisations, which they felt to be about management not leadership. However, by the end of the programme, this understanding of both the transactional and transformation aspects of leadership had developed and was acknowledged by participants to be inuential and important. The contextual model of leadership (Alimo-Metcalfe and Lawler, 2001) was not a major focus of this programme although participants often believed that there was something different about the NHS context that made the translation of ideas and models from other sectors problematical. The view from the programme commissioners was supportive of both learning from other sectors and also from other countries (as evidenced by the inclusion of two international modules in the programme). However, participants who had previously worked in other sectors did note that the NHS was more complex than many other types of organisation, an observation supported by other evidence (Alimo-Metcalfe and Alban-Metcalfe, 2001). Models of transformational and situational leadership were explored within the programme. Structure and mode of delivery This programme appears to t very well with the characteristics of effective development programmes (Alimo-Metcalfe and Lawler, 2001): a strong action learning approach, using direct personal and business issues as the focus of activity, encouraging and expecting participants to implement changes in their work environments, and having the strong support of senior management and the support of line managers. This last point is perhaps the one that, in practice, was most difcult to achieve. It was not that managers did not want to provide support, but that day-to-day pressures, especially those around the achievement of targets, including nancial issues, took priority at times. The signicant organisational and structural changes resulting from Shifting the balance of power (Department of Health, 2001)

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affected a number of participants and the extent to which they were able to give time and energy to the programme and to their own development. This appears not to be a unique feature of the NHS (Alimo-Metcalfe and Lawler, 2001). There was evidence from the staff involved with the programme that this type of programme required a change in their role with much more emphasis on facilitation than in other types of teaching. All the university staff teaching on the programme were research active (in line with the overall philosophy of the provider institutions) and involvement with the programme gave new opportunities for research, but also grounded research activity in reality. The use of action learning (albeit not in its purest sense, since all learning sets were facilitated) is in line with effective leadership development, as described in the literature, and is something that the providers have gone on to use in other programmes subsequently, with similar success. In terms of the new paradigm of leadership development (Fulmer, 1997), this programme can be seen to be well within the future paradigm with the focus on participants as learners, the design of the programme being exible and responsive to changes in the context as well as participant and provider feedback, clearly designed for action and looking to the future in terms of preparedness for change. Not only did the programme take place in Manchester, but also all across the UK and in Europe and the US one of the many benets of the partnership between a management consultancy and a university as providers of the programme. The programme also covers the areas suggested by (Conger, 1993) as those required in effective leadership development programmes. Outcomes The evidence is clear that best practice organisations always assess the outcome of their leader (Fulmer and Wagner, 1999), and this programme is no exception in this. There is also evidence that focusing on behaviour change will lead to changes in results/tangible outcomes (Ulrich et al., 1999) and again there is evidence from this programme to support this. The focus of evaluation was on the impact of the programme, not whether the leadership characteristics of the individuals had altered per se. Although the participants were asked to make some attempt to link the various elements of the programme to the changes that had resulted, many pointed out that it was the overall effect that was important, not the individual elements. However, it was patient care where much of the impact would ultimately be felt. Many participants pointed out that they were now much better placed to utilise evidence effectively which is a factor not often cited in the leadership literature, but appeared to be important within the NHS culture:
While I have always had reasonable credibility amongst my colleagues and peers I now experience greater involvement and respect from clinical academics than I have before.

This enthusiasm for gathering and analysing evidence was also apparent in the relatively large numbers choosing to carry out an MSc dissertation, which gave the opportunity to investigate a topic in much more detail than is possible within the core programme. Such research will enable both theoretical and empirical investigation. The dissertations (which are more substantial pieces of empirical research, up to 25,000 words in length) appear to be yielding similar service benets, and a more comprehensive and rigorous analysis of this aspect will be carried out in due course.

This increased use of evidence has enhanced the ability of the participants to exercise the discretionary element of leadership (Kakabadse et al., 1996) through more informed decision making. The gap between aspiration and achievement (Alimo-Metcalfe and Lawler, 2001) was evident, as it seems to be in most leadership development programmes, in that at times participants had problems in putting their proposed changes into practice because of the context in which they were working. Not only was there organisational instability as the result of restructuring, but a preponderance of national initiatives and continued emphasis on performance measures made it difcult for some to nd the space to make changes within the daily pressures of their relatively senior roles. This political aspect (Alimo-Metcalfe and Lawler, 2001) was also evident in those whose motivation for coming on the programme was more to be seen as participating in such a high-prole initiative the gap between their aspirations and the reality of their involvement was large, and those whose motivation to implement change and commit time to the programme was overcome by other factors tended to gain less both individually and organisationally from their participation. A number of participants moved jobs either during or after the programme (Harris et al., 2003) and although this was often for promotion as a result of the increased capabilities developed through participation on the programme, there were some cases where participants felt that their style no longer tted with the context of the organisation and this was a factor in them moving to another role. Details of job changes and the factors that inuenced them are reported elsewhere (Harris et al., 2003). So can the programme be considered as a success? In the terms that are described independently it appears so (Ready and Conger, 2003). There was some evidence of the ownership is power mind-set, with the senior focus not always being as much on shared accountability as some participants would have liked, but never to the extent that the effects of the programme were negated. The programme was clearly designed around the needs of the NHS and has constantly evolved as the context has evolved. At the time the best available metrics for success were used those generated by the participants themselves (see Figure 2), within the context of the large number of performance measures already used within the NHS, including some specic to the HR function (for those from that professional background). However, it is acknowledged that there is always more work to do in this area as performance measures evolve (Department of Health, 2004). Conclusions and the future The context. The programme has beneted from the changes in organisation of, and emphasis on, leadership development within the NHS, by being designed in a way that meets the future requirements of the NHS and its leadership development. The popularity of the transformational leadership approach appears to have shifted the emphasis away from the transactional aspects of leadership/management despite clear research evidence that both are necessary. The evidence in this paper shows that the NHS can learn from other sectors (approaches taught were not exclusive to the NHS and speakers from other sectors were used in various parts of the programme) although this is challenging for both thinking and behaviour for those who are learning. The programme. The characteristics of this programme have been shown to be consistent with the evidence from literature concerned with effective leadership

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development, in as far as such qualitative evidence can be argued to support other evidence. In particular, the use of action learning and the application of knowledge in the workplace are recognised as important. The approach of this programme is consistent with the evolving paradigms of leadership development. All programmes have their weaknesses, and this one is no exception. This paper has deliberately focused on the positive outcomes from this work that are without doubt the vast majority, and therefore it is not intended to describe or address the weaknesses in detail here. Many related to structural issues, which were addressed in subsequent intakes, or to the volume of work required for full participation in the programme, which was difcult for some participants to manage given the responsibilities of their NHS roles. This was not necessarily a weakness of the programme but certainly coloured some of the responses from participants during the evaluation. Although it could be argued that the lack of denition of leadership in the programme was a weakness, evidence has shown impact on a wide range of what could be termed leadership behaviours. Feedback and perceptions were gathered from a number of different perspectives at different points in the programme (Alimo-Metcalfe and Alban-Metcalfe, 2002) The outcomes. The evaluation of this programme focused on learning at both personal and organisational levels. The increased awareness and utilisation of evidence has increased the discretionary leadership capabilities of participants. It is inevitable that politics will inuence implementation of change and the context of leadership development, and this programme is no exception. Despite the recommendations of the literature (Alimo-Metcalfe and Lawler, 2001) that leadership development is best over carried out over a period of time, rather than through a one-off course, this caused some difculty for participants because it appears to be increasingly difcult to take time away from the workplace, the more senior the role in the organisation. Whilst there is always an element of personal organisation and work prioritisation in this, there were clear examples of pressures that could not be avoided (e.g. industrial tribunals, CHI reviews) which interfered with the ability of the participants to attend. Those who completed the programme are without exception positive about its effect on them as individuals and about its effect on their organisations and the patients who they serve, but acknowledge that participation was very hard work. However, political issues have not in general or totality negated the positive impact of the programme. The process of evaluating the programme is continuing to develop, in line with broader changes in the environment, but the key ultimate focus is on the improvement of patient care within the NHS. The problems associated with developing appropriate performance metrics were to some extent minimised by using self-generated categories for the rst intake something that is being rened for future intakes, although we intend to retain some element of self-generated metrics since it provides a richer source of data than simply asking participants to rate pre-determined factors. The future. Issues that are continuing to develop in importance within the programme content and focus include the role of leadership and teams something that is often raised as more collaborative initiatives are introduced within the NHS, and partnership working developed, as well as being considered by academics (Kakabadse, 2000). There is also continued scope to develop the link between effective leadership

and patient care, both in terms of research and also within the programme. To date, no independent or patient-focused measures of effectiveness have been utilised; changes in patient care have been reported by participants but not independently veried. Another potential research area that can be linked with the programme is that of context and culture; something that has come to increased prominence as primary care trusts seek to mature and full their purpose within the overall health economy. This will in turn impact on the role of acute trusts and other healthcare providers. Much literature on leadership and culture appears to assume that there is one culture per organisation (Alimo-Metcalfe and Nyeld, 2002), but experience of the NHS shows that this is not the case and therefore leaders may have to be much more exible about utilising styles appropriate to the particular sub-culture, once it is assessed (Scott et al., 2003). The issue of professional cultures is also increasing in importance as the modernisation agenda is developed (Degeling et al., 2003). It is also hoped that further funding will be made available to track the career paths of participants on the programme, as was done for the rst intake (Harris et al., 2003). Within this context there is also scope for gender-focused research and analysis, which has not to date been carried out in this context. Lessons for others?. The issue of generalisability of results is always a factor in research, as well as in evaluation of programmes of this nature. Any study of this type will be limited by its nature as a self-reported study of a single group in a common context. There is also the issue of potentially different understanding by individuals of terms used and concepts identied. However, these limitations are balanced out to some degree by the depth of the study and the level of detail, particularly from qualitative data, which it has yielded. However, there do appear to be some key lessons from this programme that are transferable to others. The main one is clearly that it is possible to design and implement leadership development programmes for/within the NHS that make a difference both to the individual participants, to their organisations and then ultimately to the patients who the NHS serves. Other lessons include: . action learning is a useful method for this type of development; . time available away from the workplace is key, but availability of this is not only a matter of personal motivation and organisation; . providing participants with a variety of views and perspectives on leadership is key in enabling them to develop the discretionary aspects of leadership behaviour through the assessment of evidence, which increase in importance with the level of the participant within the organisation; . measuring the impact of leadership development is an evolving process and one where it would be useful to share best practice and experience; . taking part in such programmes is hard work for participants, but benecial for individuals in terms of personal development but also career development, as well as beneting organisations who sponsor participation; and . developing and providing such programmes is a new challenge for some parts of the provider community but one that has proved to be benecial from a variety of perspectives.

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Notes 1. Now incorporated into the new NHS Institute for Innovation and Improvement, from 1 July 2005 (www.executive.modern.nhs.uk/default.aspx). 2. These are as stated for the rst intake: they have been slightly modied for subsequent intakes to reect the fact that the programme is not now only provided for HR professionals. 3. UMIST and the Victoria University of Manchester will merge in October 2004 to form the University of Manchester. Both the groups providing this programme will be part of the new Manchester Business School, part of the faculty of Humanities of this new university (www. manchester.ac.uk/). 4. On 1 January 2003, PricewaterhouseCoopers in the UK began trading as a limited liability partnership and is now called PricewaterhouseCoopers LLP. This programme is provided with the HR services group (www.pwc.com/Extweb/service.nsf/docid/ 31205693A297A1B480256CDE003C2CF4).

References Akin, J. (1987), Varieties of managerial learning, Organizational Dynamics, Vol. 16, pp. 36-48. Alimo-Metcalfe, B. and Alban-Metcalfe, R.J. (2001), The development of a new transformational leadership questionnaire, Journal of Occupational and Organizational Psychology, Vol. 74 No. 1, pp. 1-27. Alimo-Metcalfe, B. and Alban-Metcalfe, R.J. (2002) Leadership, in Warr, P. (Ed.), Psychology at Work, Penguin, London. Alimo-Metcalfe, B. and Lawler, J. (2001), Leadership development in UK companies at the beginning of the twenty-rst century lessons for the NHS?, Journal of Management in Medicine, Vol. 15 No. 5, pp. 387-404. Alimo-Metcalfe, B. and Nyeld, G. (2002) Leadership and organizational effectiveness, in Robertson, I.T., Callinan, M. and Bartram, D. (Eds), Organizational Effectiveness: The Role of Psychology, John Wiley & Sons Ltd, Oxford. Antonacopoulou, E.P. (2001), The paradoxical nature of the relationship between training and learning, Journal of Management Studies, Vol. 38 No. 3, pp. 327-50. Bass, B.M. (1985), Leadership and Performance beyond Expectations, Free Press, New York, NY. Bass, B.M. (1998), Transformational Leadership: Industrial, Military and Educational Impact, Lawrence Erlbaum, Mahwah, NJ. Bowerman, J.K. (2003), Leadership development through action learning: an executive monograph, International Journal of Health Care Quality Assurance, Vol. 16 No. 4, pp. vi-xii. Burgoyne, J. and Williams, S. (2004), Systematic Review: Evaluation and Leadership Development, Henley Management Caollege, Henley-on-Thames. Chan Kim, W. and Mauborgne, R. (2003), Fair process: managing in the knowledge economy, Harvard Business Review, Vol. 81 No. 1, pp. 127-37. Collins, D.B. (2001), Organizational performance: the future focus of leadership development programs, The Journal of Leadership Studies, Vol. 7 No. 4, pp. 43-54. Conger, J. (1993), The brave new world of leadership training, Organizational Dynamics, Vol. 21 No. 3, pp. 46-58. Conger, J.A. (1998), Qualitative research as the cornerstone methodology for understanding leadership, Leadership Quarterly, Vol. 9 No. 1, pp. 107-22.

Conger, J. and Toegel, G. (2002), Action learning and multi-rater feedback as leadership development interventions: popular but poorly deployed, Journal of Change Management, Vol. 3 No. 4, pp. 332-48. Day, D.V. (2000), Leadership development: a review in context, Leadership Quarterly, Vol. 11 No. 4, pp. 581-613. Degeling, P., Maxwell, S., Kennedy, J. and Coyle, B. (2003), Medicine, management, and modernisation: a danse macabre?, British Medical Journal, Vol. 326 No. 7390, pp. 649-52. Department of Health (2000), The NHS Plan: A Plan for Action, a Plan for Reform, Department of Health, London. Department of Health (2001), Shifting the Balance of Power, Department of Health, London. Department of Health (2002a), Code of Conduct for NHS Managers, Department of Health, London. Department of Health (2002b), Managing for Excellence, Department of Health, London. Department of Health (2002c), NHS leadership qualities framework, available at: www. nhsleadershipqualities.nhs.uk/ (accessed 1 March 2004). Department of Health (2004), Standards for better health: health care standards for services under the NHS a consultation, available at: www.dh.gov.uk/Consultations/Live Consultations/LiveConsultationsArticle/fs/en?CONTENT_ID 4071582&chk FCVs0o (accessed 1 March 2004). Doh, J.P. (2003), Can leadership be taught? Perspectives from management educators, Academy of Management Learning & Education, Vol. 2 No. 1, pp. 54-68. Fulmer, R. (1997), The evolving paradigm of leadership development, Organizational Dynamics, Vol. 25 No. 4, pp. 59-72. Fulmer, R.M. and Wagner, S. (1999), Leadership: lessons from the best (lessons in leadership), Training & Development, Vol. 53 No. 3, pp. 28-33. Gantz, N.R., Sorenson, L. and Howard, R.L. (2003), A collaborative perspective on nursing leadership in quality improvement: the foundation for outcomes management and patient/staff safety in health care environments, Nursing Administration Quarterly, Vol. 27 No. 4, pp. 324-30. Gasper, J.M. (1992), Transformational Leadership: An Integrative Review of the Literature, Western Michigan University, Kalamazoo, MI. Gavin, K.T., OHara, T., Keep, J. and Flanagan, H. (2001), Integrated leadership development programme for health service professionals from pioneer to prophet, Clinician in Management, Vol. 10, pp. 91-6. Hardacre, J.E. and Keep, J. (2003), From intent to impact: developing clinical leaders for service improvement, Learning in Health and Social Care, Vol. 2 No. 3, pp. 169-76. Harris, B. (2000), Leadership through Effective HR Management, NHS Leadership Centre, London. Harris, C., Boaden, R. and Shephard, A. (2003), Career Tracking Cohort 1 of the Leadership through Effective HRM Programme, UMIST, Manchester. Hartley, J. and Hinksman, B. (2003), Leadership Development: A Systematic Review of the Literature, NHS Leadership Centre, London. Kakabadse, A. (2000), From individual to team to cadre: tracking leadership for the third millennium, Strategic Change, Vol. 9, pp. 5-17.

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25

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Kakabadse, A.K., Kakabadse, N.K. and Myers, A. (1996), Leadership and the public sector: an internationally comparative benchmarking analysis, Public Administration and Development, Vol. 16, pp. 377-96. Kirkpatrick, D. (1994), Evaluating Training Programmes, Berrett-Koehler Publishers, San Francisco, CA. Kotter, J.P. (1990), A Force for Change: How Leadership Differs from Management, Free Press, New York, NY. Lowe, K., Kroeck, K.G. and Sivasubramaniam, N. (1996), Effectiveness correlates of transformational and transactional leadership: a meta-analytic review, Leadership Quarterly, Vol. 7, pp. 385-425. Moiden, N. (2002), Evolution of leadership in nursing, Nursing Management, Vol. 9 No. 7, pp. 20-5. Moshavi, D., Brown, F.W. and Dodd, N.G. (2003), Leader self-awareness and its relationship to subordinate attitudes and performance, Leadership & Organization Development Journal, Vol. 24 No. 7, pp. 407-18. NHS Modernisation Agency (2002), Managing the human dimensions of change, available at: www.modern.nhs.uk/home/key/docs/Managing%20Human%20dimensions%20of% 20change.pdf (accessed 18 February 2004). NHS Modernisation Agency (2003), An introduction to the NHS leadership centre, available at: www.modern.nhs.uk/1115/Introduction.pdf (accessed 24 February 2004). NHS Modernisation Agency (2004a), Breaking through. Building a diverse leadership workforce: programme outline, available at: www.modern.nhs.uk/1115/17445/ BTprogramme.pdf (accessed 24 February 2004). NHS Modernisation Agency (2004b), Leadership Centre work review, available at: www. modern.nhs.uk/1115/17445/BTprogramme.pdf (accessed 24 February 2004). NHS Modernisation Agency Leadership Centre (2003), Gateway to leadership, available at: www.gatewaytoleadership.nhs.uk/ (accessed 24 February 2004). Patterson, C., Fuller, J.B., Kester, K. and Stringer, D.Y. (1995), A Meta-analytic Examination of Leadership Style and Selected Compliance Outcomes, Society for Industrial and Organizational Psychology, Orlando, FL. Ready, D.A. and Conger, J.A. (2003), Why leadership development efforts fail, MIT Sloan Management Review, Vol. 44 No. 3, pp. 83-8. Revans, R. (1998), ABC of Action Learning, Lemos and Crane, London. Scott, T., Mannion, R., Davies, H. and Marshall, M. (2003), The quantitative measurement of organizational culture in health care: a review of the available instruments, Health Services Research, Vol. 38 No. 3, pp. 923-46. Trapp, R. (2002), On a health drive, People Management, Vol. 8 No. 21, pp. 48-50. Ulrich, D., Zenger, J. and Smallwood, N. (1999), Results-based leadership, Executive Excellence, Vol. 16 No. 4, pp. 13-14. Van Wart, M. (2003), Public-sector leadership theory: an assessment, Public Administration Review, Vol. 63 No. 2, pp. 214-28. Vance, C. and Larson, E. (2002), Leadership research in business and health care, Journal of Nursing Scholarship, Vol. 34 No. 12, pp. 165-71. Vroom, V.H. and Yetton, P.N. (1973), Leadership and Decision Making, University of Pittsburgh Press, Pittsburgh, PA.

Watkins, K. and Marsick, V. (1993), Sculpting the Learning Organisation: Lessons in the Art and Science of Systematic Change, Jossey-Bass, San Francisco, CA. Zaleznik, A. (1977), Managers and leaders: are they different?, Harvard Business Review, Vol. 55 No. 5, pp. 67-78. About the author Ruth J. Boaden is Senior Lecturer in Operations Management at Manchester Business School. Her research interests cover a wide range of areas within health services management and include work in electronic health records, reengineering, operating theatre management and scheduling, patient safety, the management of emergency admissions, bed management and chronic disease management. Her main areas of interest are in quality and improvement and the use of industrial methods within the NHS. She has published widely in these areas as well as in the areas of IT implementation and quality management. She set up and teaches on the Leadership through effective people management programme for the NHS Leadership Centre, which is run in partnership with PricewaterhouseCoopers and provided for directors and deputies from across the NHS. She is also a non-executive director of Pennine Acute Hospitals NHS Trust that she nds a challenging but rewarding opportunity to put theory into practice! Ruth J. Boaden can be contacted at: Ruth.Boaden@mbs.ac.uk

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