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GenerationQ

Penny Pereira, assistant director at The Health Foundation, discusses quality improvement and leadership development.

In 2010 The Health Foundation launched a new leadership and quality improvement programme: GenerationQ. It aims to develop leaders who understand how complex health systems work and have the skills to inspire others to transform healthcare quality and bring about sustainable, system-wide change.

It grew out of our experience that quality improvement requires not just evidencebased and clinically meaningful improvement programmes but also skilled leaders who have a good theoretical knowledge of both hard quality improvement and the softer relationship skills need to foster innovation, risk taking and dissemination. GenerationQ offers just that. It is a fully-funded 18-month programme for senior leaders, including clinicians, that integrates the study of leadership, technical skills of quality improvement and the human skills that are at the heart of our people driven organisations. The programme is delivered in partnership with Ashridge Consulting and Unipart Expert Practices.

GenerationQ Fellows take part in an integrated set of activities including forums, workshops and one-to-one coaching. Fellows are required to have support at executive level from their employer and to submit not just written assignments but also to lead significant improvements in the quality of care delivered in their workplace and produce reflective writing about how their leadership style is developing. They also maintain a relationship with the Health Foundation following their fellowship to promote healthcare improvement.

Taking part in GenerationQ is an exciting, challenging and life changing experience. As Janet Smallwood, Co-director of GenerationQ on behalf of Ashridge Consulting and Unipart, says: “GenerationQ is a great deal of work and it requires people to put their heads above the parapet and do things differently. It is not for the faint hearted.”

Interviews with some of the first cohort indicate how the experience has made them better leaders, better able to support quality improvement and better at relating to colleagues. They reported that the programme helped them in being more resilient to the challenges they faced in the NHS.

Tom Smerdon, general manager for Surgery at Great Ormond Street Hospital for Sick Children, joined the first GenerationQ cohort that completed in 2012. He explains some of what he learned. “I don’t think I am alone in struggling with change programmes that do not deliver their expectations. You can have all the right things in place – a methodology, project plans and so on – but still find yourself in a place where unpredicted things happen and projects go adrift. So I came to GenerationQ from the point of view of having an interest in the way creative change occurs and how people and teams adapt to change and how that generates change in a chaotic way.”

Mark Brassington was deputy programme director of the Whole Hospital Change Programme at Nottingham University Hospitals Trust when he joined the first cohort of GenerationQ. This involved a whole range of projects right across the hospital including pharmacy, therapy and imaging as well as reviewing length of stay, administration, humans resources and finances. In each case he was looking to achieve whole system change to improve workflows and patient pathways and deliver efficiencies.

He describes how he changed from a ‘tick box’ manager to a leader supporting behaviour change as he developed through GenerationQ. “Due to the daily pressures, it is all too easy to fall into the trap of managing the process and it is how I used to do it, tick a box and move on. But if we want a change to stick then we have to manage the behavioural aspects of change. GenerationQ has been invaluable in achieving this. It has helped me understand how we make improvements sustainable and how we embed them in business as usual. One of the most important lessons is that, as change agents, we need to engage with people very early on and to be explicit about managing the personal interactions rather than the process of change.”

Hilary MacPherson, consultant obstetrician and gynaecologist and associate medical director at NHS Forth Valley and another of the first cohort, says GenerationQ has changed her leadership style, giving her the courage to try new ideas. She was attracted to the programme because of its focus on quality improvement – an area she felt she was missing despite having been on several leadership courses.

“I have got so much out of it. GenerationQ is a very demanding programme; it requires you to do reflective writing rather than just attend seminars and workshops and submit your assignments. I had a great opportunity to meet the Chief Executive, Directors and Chair of my organisation. It established an amazing learning community and there is nothing better than being part of a team that you feel is energising, dynamic, challenging and that gives you new insights. It was hugely inspiring and gave me the motivation to read much more widely and to explore new ideas.

“I’ve seen my own team flourish as I have changed my leadership style with GenerationQ. They are now doing different things and trying out new ideas to develop the service and reduce length of stay. Being part of GenerationQ was just such a privilege and I am so thankful to the Health Foundation for giving me that opportunity. It is adult education at its absolute best.”

Janet Smallwood says these comments reflect her wider experience of the way in which fellows have grown through GenerationQ. “Fellows will often refer to the relationship skills they have learned. While it might seem obvious that relationships are important to delivering sustained quality improvement, learning the relational skills is not something that many have consciously considered,” she said.

She describes relational leadership as having “an exquisite awareness” about the nature of the interaction with others and being able to make choices about how you interact. “It is about paying attention to the fine detail of how you interact with people whether on a group basis or individual basis. It is much easier to say ‘I am in charge and I am going to tell you what to do’. The relational leader engages on an adult-to-adult basis where learning is shared and reciprocated. These are skills that can be learned and practised but it is really important that the learning is congruent – that the people who teach them also practise relational leadership – and that is what Ashridge Consulting and Unipart aim to do in GenerationQ.”

There is a role for this type of leader in the NHS, she argues. “I think there is a risk in the NHS that we blame dysfunctional leadership for some of the difficulties around spreading quality improvement but we do not acknowledge the impact of the high level of uncertainty and anxiety in the system and what it does to our senior leaders. Learning to be a relational leader is a lot to do about learning to live with uncertainty and ambiguity.

“GenerationQ does not promise that there is a right answer, or even that there is an answer at all. It asks fellows to experiment with different ways of seeing leadership, challenges them and their organisations to look at improvements in different ways and to learn what works in their local contexts.”

GenerationQ is delivering these relational leaders – people who are skilled not just in implementing the programmes that we know work but also in developing the relationships that will make them sustainable. At a time when the NHS faces greater challenges and greater uncertainty than ever before, these are the leaders it needs.

What is GenerationQ?

GenerationQ is a pioneering leadership programme designed to develop a new generation of skilled and effective leaders for quality improvement in healthcare.

GenerationQ is designed to equip fellows with the skills to drive forward and influence improvements across services and organisations.

The programme is grounded in best practice in leadership. By taking part, GenerationQ fellows will:

• Become more effective leaders who are better equipped to lead quality improvement.
• Become more aware of their impact as leaders and develop a leadership style that supports quality improvement.
• Enhance their organisation’s capability for quality improvement by developing its culture and environment.

They will do this by:

• Participating in an innovative learning experience.
• Putting their ambition for quality improvement into practice.
• Working closely with the multidisciplinary group that makes up GenerationQ.
• Gaining an academic qualification at postgraduate diploma or masters level.

The Health Foundation delivers the 18-month programme in partnership with Ashridge Consulting and Unipart Expert Practices. The first cohort completed the programme in January 2012; two more are currently underway and recruitment for a fourth starts in 2013.

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