NCL Nursing and Midwifery systems leadership programme – evaluation report

This report of the evaluation of the NCL ICB Nursing and Midwifery System Leadership (NMSL) programme briefly describes the context of this system leadership programme, its aims, methodology and programme outline, followed by the evaluation methodology and its findings; as well as recommendations to inform future leadership education and training in NCL ICB.

A mixed methods evaluation methodology included:
1. self-reported confidence measures (distributed as pre- and post-programme questionnaires) were completed by fellows at three time points over 12 months
2. two focus groups with fellows
3. two individual interviews with two programme facilitators and a chief nurse in NCL ICB
4. a joint group interview with two chief nurses from NCL ICB NHS trusts
5. non-participant observation during two programme events.

Data collection began in Summer 2023 and ran in three waves until Spring 2024. From the 22 NMSL participants, at three time points (start of programme, mid-way through and after completion), there were 43 survey responses in total (wholly or partially completed questionnaires) with one third of these (32.6%, n=14) from the baseline survey, rising to 18 (41.9%) from the mid-point survey and 11 responses (one quarter of the total) being from the final wave of the survey. The average response rate across the three waves of the survey was high (65.2%), but with wide variation from 81.8% (mid-point) to 50% (final).

There were 22 participants at the first focus group, eight in the second.

The survey data were analysed using SPSS v.27 to produce descriptive and inferential statistics. The Kruskal Wallis test was used to test for significant change over the three waves of the survey in selected scale (ordinal) variables. The qualitative data from interviews were recorded and transcribed by a professional transcriber, then analysed thematically.

What we know now:
a. The mixed methods design showed that NMSL programme participants’ confidence improved as did their knowledge about systems leadership.
b. However, there are still silos of knowledge which shape their confidence in their roles as leaders and relatively little confidence in their roles as systems leaders in the local NHS or in relation to the ICB’s vision and priorities.
c. Clinical nurse/midwife leaders need support to develop knowledge, skills and confidence in systems leadership
d. There is a need for clinical nurse/midwife leaders to have ‘space-to-reflect’ on their leadership practice
e. Support to ‘time’ release fellows from practice is fundamental to success in programmes of learning especially where clinical nurse/midwife leaders have frontline roles
f. Fellows engage in peer learning effectively and co-construct peer networks for future practice
g. Clinical nurse/midwife leaders are open to novel learning programmes which develop them as future systems leaders.

What we can learn from this report to develop and support future NHS system leaders
a. Current and future cohort(s) on the NMSL programme need support to increase confidence in, and recontextualise knowledge of, system leadership, in their home NHS trusts
b. Nurse/Midwifery leaders need to understand how politics frame professional practice and systems leadership
c. There is a need to increase nurse/midwife leaders’ (at Band 8 and above) understanding of autonomy, accountability in systems working and their confidence and ability to raise issues
d. Current and future cohorts on the NMSL programme need to maintain networks which initiate and sustain cross system leadership through:
a. space-to-reflect action learning sets
b. access to funded coaching
c. access to career mentoring
e. Outcome measures which track confidence in system leadership over time and track cross system working initiatives should be developed
f. Systems leaders need support post leadership programme to sustain energy in system leadership networks.
g. Finding the courage to voice concerns is vital in whistleblowing and duty of candour and should be underpinned by an understanding of and a willingness to be autonomous and accountable.