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Author: Barbara Chidgey, Bevan Advocate


As Executive Chair of the Leading Wales Awards, each year I receive huge numbers of nominations for ordinary individuals with extraordinary leadership skills from across all corners of Wales. All of them demonstrate courage and integrity in times of challenge, change and constraint.

Leadership that creates the future

Over the fifteen years of reading and marking so many nominations, I have been able to identify a gap in leadership in Wales: transformational leadership. We are very good indeed at transactional leadership: striving to deliver on agreed targets and goals, which is important to keep our communities, organisations and businesses safe and stable.

But we are less adept at transformational leadership, which is the sort of leadership required to build the Wales we Want. This is the leadership that

  • inspires and engages buy-in from others
  • displays courage to challenge assumptions and the ‘old ways of working’
  • demonstrates a strong moral compass
  • treats everyone as individuals and builds trusted relationships
  • stimulates creative and innovative thinking and a safe space within which to test out new ideas
  • develops the skills of everyone – from grassroots to board room level

This is the leadership that creates the future: that delivers on the goals of the Wellbeing of Future Generations Act and ensures that we build the Wales that our children and grandchildren need us to build.

Bass & Avolio’s ‘Full Range of Leadership Model’ combines elements of both transactional and transformational models of leadership. Their model (and their subsequent research over two decades on that model) makes clear that the most effective leadership is that which delivers on specified goals with outlined, agreed expectations, and also complements that performance-focused leadership with other approaches designed to transform and build the future.

A leadership myth

Let’s immediately dispel the myth that leadership is only focused at the level of the Chief Executive, the Chair, the Executive Managers, the Medical Director, Clinical Board Directors or the Lead Clinician in a specialist area (or equivalent hierarchical posts in non-NHS organisations). Leadership is an element of every employee’s role and responsibility.

All of us can take on leadership role(s), whether at work or for a particular project or at home. Importantly, it is also our choice whether to pursue available leadership opportunities or not. Sadly, many choose ‘not’.

I agree that the roles of Chief Executive and Chair together with other senior roles must have a strategic leadership focus. That this focus is about delivering on the here-and-now together with building the future. A great deal of their strategic leadership must certainly be about managing service delivery performance.

However, those senior individuals are also leading the vison for the future; building and nurturing trusted relationships with other organisations. They understand the need to work continuously and tirelessly to really engage their own employees and patients. To maintain, develop and transform a sustainable Health Board they surely understand the need to deliver on the “full range” and provide exceptional leadership that is both transactional and transformational.

Delivering exceptional patient-centred care

The delivery of patient-centred care consistently by every NHS professional is, to me, all about leadership. Patient-centred care is not about more time or resources but is about transformational leadership behaviours and values.

Leadership behaviours that demonstrate genuine care for that individual patient, help to develop a safe space within which a vulnerable individual can talk about hugely important and sensitive stuff. In this trusted relationship, patients can be assisted to understand, come to terms with and lead the way on managing their health – as advocated by the principles of prudent healthcare.

The aspiration: a consistent approach of exceptional leadership that is exemplified through all the elements of exceptional patient-centred care.

What does exceptional patient-centred care feel like?

It’s the nurse who understands that their unwell patient trusts them to assist with washing and other personal care, whilst also encouraging that patient to talk about what really matters to them. These nurses also realise that in this circumstance the patient may be more likely to talk about matters that are very personal and, importantly, can contribute to improving their care. Moments like these provide great opportunities to communicate and to connect. This is transformational leadership.

The clinician who, even on a highly pressured day, still takes the time to build that human connection and trust with you so that they can appropriately update you on medical issues and recommendations. No matter how busy, they still give you the space you need to ask questions, to explain things clearly and to find out your concerns. This leads to good shared decision-making. This is transformational leadership.

The catering professional wheeling in that wonderful diversion of the food trolley (or the chance of a fresh cup of tea or coffee) who has a smile on their face, and quickly gets to know new patients by name together with their likes, dislikes and allergies. They know that they are bringing in light relief during the day from all that discussion and focus on illness. I have witnessed many doing their utmost to provide food or drink that tempts an unwell and downhearted patient to eat, not being the least bit judgemental, simply really kind. This is transformational leadership.

All the health professionals who contribute to a patient’s daily ward experience can help the patient adjust, find new ways of doing things, and to move forward personally and medically.

That is transformational leadership. That is exceptional patient-centred care.

From targets to transformation

The NHS is very focused on monitoring and meeting performance targets such as waiting times, resources, treatment schedules etc. In fact, a recent Bevan Commission report counted no less than 370 measures and outcomes operating within NHS Wales.

Complexity of the system aside, transactional leadership is an essential component to ensure the NHS is keeping patients safe.

However, being a patient is an experience. I believe that in the ongoing transformation of NHS Wales it is essential to focus on that “patient experience”, enhancing it whilst also delivering improved health outcomes in innovative, creative and sustainable ways.

I genuinely believe that we need to build on the target-focused leadership style that manages risk and performance by complementing it with other transformational leadership styles such as: influencing and engaging, inspiring and motivating, supporting creativity and innovation, and treating every patient as an individual.

That I believe is the huge and significant challenge for us in Wales, and our NHS counterparts across the UK. Truly delivering consistent patient-centred care in the context of well-managed resources and the achievement of clinical targets, in new ways and in a sustainable manner. What an aspiration!

Barbara Chidgey is a Bevan Advocate, patient, Executive Chair of the Leading Wales Awards, a professional doctorate student at Cardiff Metropolitan University and a former secondary school head teacher.

The views contained within this blog are those of the author and do not necessarily represent the views of the Bevan Commission.