I’m pleased to be able to share the summary of a new article that I produced in collaboration with a graduate from our BA (Hons) Business Management course. It’s really important, I think, to show students that the work that they produce as part of final-year projects is not just an exercise that they complete for their degree but that it also has the potential to share valuable insights. Ceara’s work made this article possible and it’s right, not just that this is recognised by listing her as an author, that she is the lead author for this work.

The article “Understanding good leadership in the context of English care home inspection reports” asks what the statutory inspector of residential care homes looks for when they assess the quality of leadership in the home. When conducting an inspection, the Care Quality Commission focus on five key questions, the last of which is “Are they well-led?”. We were interested about what, if anything, we could tell about the focus of their enquiries from the content of the reports that result. In doing so, our work is analytical but we’re not making normative judgements (i.e. are they right to focus on these elements?).

The main findings for our analysis are presented in four themes:

Safe and High-Quality Care - The literature review highlights the role that leadership is expected to play in driving improvements in organisational performance. Our work saw these ideas reflected in the assessments of care home leadership. Well-led homes are expected to have managers that are visible, hands-on, acting as role models and having good communication with staff, residents and their families.

Care Staff - In well-led homes staff feel respected and valued by managers with effective formal and informal methods of communication. This includes up to date record-keeping (rotas, training records, appraisals) as well as showing how staff and residents are kept up to date with information and encouraged to share their ideas.

Governance and Training - In respect to this theme, reports focus on record-keeping and being able to evidence that safety and quality assurance systems are in place, that staff access traiing and keep up to date with mandatory elements. The best performing homes typically had effective computer systems to support quality assurance work. In relation to training, well-led homes encourage both staff and managers to engage in professional development (including in leadership skills) and may collaborate with other homes in the form of training partnerships.

Integrated Working - Greater integration of care has been a central element of government policy for some time. Our review of these reports shows that the homes judged to have the best leadership would often be those that could evidence input from other health and social care professionals (GPs, social workers etc.), were supporting other homes by sharing good practice and knowledge, and had set up volunteer groups as ways to offer additional support to residents.

Discussion

The most notable finding was a lack of clarity about what constitutes good leadership - particular in respect to discussions within the leadership literature. We can, though, pick out some important points.

  1. The evidence from the reports we looked at suggests that the CQC focus on expected behaviours of leaders with less attention paid to personality, style, competences or capabilities. One way we see this is through the focus on providing evidence and keeping good records.
  2. Whilst the terminology of ‘transformational leadership’ does not appear there is a consistent message that homes in which staff share a sense of purpose and direction are those that are usually regarded as ‘well-led’.
  3. It is not clear whether the CQC primarily concern themselves with the performance of senior members of care home staff (those in ‘leadership positions’) when assessing the leadership of the home, or whether they seek to promote a more collective attitude in which leadership is something that is expected of all staff no matter what their level of seniority.
  4. Despite the rhetoric around the importance of leadership in relation to change processes there is very little specific content in reports to show that this is considered when the quality of leadership is being assessed in the home - beyond the basic idea that good communication may lead to better morale and lower staff turnover.

It is worth noting, of course, that this was a small-scale and limited study - however, it is clear that this type of analysis has real value because the statutory regulator, the CQC in this case, plays and important and influential part in steering the development of the sector. Peter Drucker noted that you “can’t manage what you can’t measure” - a similar idea is true here: home owners and managers will focus on areas that the statutory regulator tells them to address - you won’t manage what you will not be assessed on.