Healthcare · Scottish Borders · 2024–2026

An NHS board, leadership cohorts

Four cohorts, 62 clinical and operational leaders, and a manager-contracting requirement the client initially wanted to remove from the design.

62
Participants
Four
Cohorts
94%
Manager attendance
+0.7
360 improvement
The work

What happened

Programme
Leadership development

The board wanted a leadership programme for clinical leaders moving into operational roles — a genuinely difficult transition, because clinical authority is expertise-based and operational authority is not.

Our design required each participant’s manager to attend the first and last session and to agree two support commitments. The client asked us to drop it: sixty-two managers, four cohorts, unworkable diary. We said we would rather not run the programme than run it without that, and explained why — that the return-to-work gap is where cohort programmes die.

They kept it. Manager attendance across the four cohorts was 94%, which is higher than we have achieved anywhere else, and the two managers who did not attend both had participants who disengaged by module three.

The 360 instrument was run at module one and module five. Mean improvement across the 62 participants was 0.7 on a five-point scale, concentrated in "gives me feedback I can act on" and "makes decisions without unnecessary delay". Two participants got worse; both were in roles that changed mid-programme, which we report because averaging it away would be dishonest.

Next step

Start with the diagnostic, not the programme

Six weeks of interviews and a baseline measure, and a written finding — including the finding that the problem is structural and a development programme will not touch it. We have delivered that one twice.