Governance, leadership and regulation

The focus of this theme is how health and social care is led and governed, including internal and external systems of regulation for holding organisations and individual professionals to account for the quality and safety of services.

Research issues

A photograph of a gavel on a desk

Two key contextual factors present governance challenges in many OECD countries and across the UK: the drive to integrate care across acute and community care sector boundaries so that it is more patient-centred; and the resource pressures placed on health and social care services due to economic austerity, new health and care technologies and an increasing elderly population.

Integration requires the development of: systems leadership, which facilitates partnership working across organisational boundaries; governance frameworks for the integrated care systems which are being established; and place-based regulation of local systems. Resource pressures require the development of: compassionate leadership that is supportive of hard-pressed staff; resilience among managers and staff; devolved governance arrangements for areas such as Greater Manchester; governance of technologies such as personal diagnostic equipment; proportionate and supportive regulation enabling organisations to improve service quality and prevent performance decline.

Research strengths

Research on governance, leadership and regulation has expanded significantly over recent years. Our current research includes evaluations of governance, leadership and regulation processes, and of leadership development at a national level in England, locally in Greater Manchester, and in other countries of the UK. Internationally, we have contributed research-based thought leadership pieces on the characteristics of high performing systems, on e-health and on mergers and acquisitions. While the primary focus has been on NHS hospital care, we have also considered other sectors including mental healthcare, primary care, social care and private practice. Much of our research has been directly commissioned by the NIHR, the DHSC, the Health Foundation, the CQC and the NHS Leadership Academy, which has facilitated engagement and impact.

Future agenda

We aim to establish a longer-term programme of research in partnership with our key funders such as the CQC, GMC and NHS Improvement, and to expand this to include international comparative research and global health research. Our Institute supports this by increasing the critical mass of researchers working in this theme, with greater involvement of researchers from FBMH and more widely across FoH, building on recent joint work between researchers from AMBS with the Centre for Health Economics, Centre for Primary Care and CLAHRC-GM.

We envisage the following opportunities for future research:

  1. Developing a theoretical framework for effective healthcare board governance
  2. Exploring how NHS Trust Boards can achieve greater impact by drawing on their different sources of authority and influence
  3. Exploring the role of regulators across the UK in organisational turnaround, using the improvement capabilities framework
  4. Analysing the effects of clusters of management/leadership practices on organisational performance of acute hospitals, using data analytics techniques
  5. Evaluating large scale NHS leadership programmes (funder NHS Leadership Academy).

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