Title: Healthcare Leadership with Political Astuteness (HELPA): a qualitative study of how service leaders understand and mediate the informal 'power and politics' of major health system change: developing lessons on the acquisition, use and contribution of political astuteness
Funder: Department of Health and Social Care

Abstract: The implementation of strategic change in healthcare services is notoriously difficult. Various contextual factors are shown to influence change processes, and there is growing recognition that the informal organisational politics (small 'p') of healthcare services can be significant, such as the competing interests of stakeholders or resistance from powerful groups actors. Research in other settings shows that the leaders of change often need particular 'political skills' or 'astuteness' to understand and influence their informal political environment, which includes the ability to read situations, persuade others, build coalitions and mediate conflict. Although political astuteness is now recognised within some NHS Leadership programmes, it is not based on evidence from within the NHS. The purpose of the proposed study is to investigate the acquisition, use and contribution of leadership with ‘political astuteness’ in the implementation of strategic health system change with the aim of informing the co-production of materials and resources for the recruitment, training and development of current and future service leaders. The research will involve four linked Work Packages (WPs). WP1 involves two systematic reviews of the literatures, first, on political astuteness to establish the 'state of the art' theory, and second, of the health services research literature to identify evidence of the specific political context and forms of political astuteness, through applying learning from other sectors. WP2 involves interviewing up to 40 national and regional healthcare leaders and stakeholder representatives to understand their acquisition and use of political astuteness. These participants will be selected to take into account differences in their professional background, service setting, and change initiatives. We will also interview 20 people who have recently completed NHS Leadership training to understand their acquisition and use of political astuteness. WP3 involves in-depth analysis of the use and contribution of political astuteness in the implementation of three Sustainability and Transformation Plans (STPs) as exemplars of health system change. These STPs will be selected from the East Midlands and London in consultation with study advisors. Within each STP, the research will investigate the senior strategic leadership teams before focusing on project leadership within three common system change areas: i) urgent care, ii) integrated health and social care, iii) and resource prioritisation and allocation. Concurrent data collection (6-8 months per case) will be managed between Nottingham (2 East Midlands cases) and UCL (1 London case), involving observations of meetings, shadowing key actors, and ethnographic interviews. For each case, data collection will involve c30-50 hours of observations (total 150) and c30 purposively sampled interviews (total 90). WP 4 will use the study findings to co-produce new learning and recruitment materials for use by the NHS. Through a series of workshops, we will work with current NHS Leadership providers, and other professional and patient representatives to review the study findings and identify questions, scenarios and tasks for potential learning and recruitment tools. These will be developed iteratively and piloted with university and NHS partners.

Lay abstract: The implementation of change in healthcare services is often difficult. It is increasingly recognised that informal ‘politics and power’ influences how change happens. It is easy to appreciate how national politics and government influences healthcare, but it is not always clear to understand how the more informal ‘political’ influences change, such as the competing interests of different stakeholders. Research in other industries shows that those responsible for implementing change need particular skills and capabilities to help them understand and influence their informal political environment. These skills are sometimes described as ‘political astuteness’ and include the ability to read situations, recognise divergent interests, persuade others, and manage conflict. Although these have been studied in other settings, there is limited research about this skills in healthcare services. The purpose of the study is to investigate how service leaders develop and use these skills when seeking to make strategic change. Through this new understanding, the research will inform the co-production of materials and resources for the recruitment, training and development of current and future service leaders. The study involves four Work Packages (WPs): The first WP involves a review of the existing research on political astuteness and health service change, where learning from other industries will be used to develop new insight about health service change. The second WP involves interviewing up to 40 national and regional healthcare leaders and stakeholder representatives to understand how they have developed and used political astuteness in different settings. We will also interview 20 people who have recently completed NHS Leadership training to understand their views about the development and use of political astuteness. The third WP involves in-depth analysis of the implementation of three Sustainability and Transformation Plans (STPs). These STPs have been designed to shape the long term sustainability and improvement of local health care systems. Within each of the three selected STPs, the research will look at the political astuteness of the senior strategic leadership teams, before focusing on the political astuteness of project leaders responsible for making change in three areas: i) urgent care, ii) integrated health and social care, iii) and resource prioritisation and allocation. Data collection will involve observations, shadowing key actors, and interviews. The fourth WP will use the study findings to co-produce new learning and recruitment materials for use by the NHS. Through a series of workshops, we will work with current NHS Leadership providers, and other professional and patient representatives to identify questions, scenarios and tasks for potential learning and recruitment tools. These will be developed iteratively and piloted with university and NHS partners.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE