1: Leadership and Management

There is a forum (a clear working group or within another meeting) that has present:
1) a manager supportive to the CAPA model,
2) either a clinical leader or clinician/s empowered to lead on CAPA and
3) an admin lead. This forum has regular meetings to discuss CAPA which are minuted and circulated to the team. (The discussion may form part of a broader meeting)

It’s our experience that when a CAPA implementation seems difficult, or CAPA is said to ‘not work’, it is often that there was little coherent leadership as described above.

Managers are required to convey the targets of change, to manage the implementation plans, to monitor CAPA when it is in place as well as to empower others. A clinician is needed to represent the clinical voice, to act as a bridge to the team and develop the vision within a quality clinical framework. An admin lead is needed as they will understand how any plans will work in practice. They are often the only ones who see the whole pathway!

The National Health Service [NHS] Leadership Qualities Framework in England describes the issues for a Specific Organisation/Services in need of change. They describe two key difficulties:

  1. If performance is generally good staff can be complacent and resistant to change (‘if it isn’t broken, why fix it?’)
  2. If there is a strong internal focus (on people and systems) then little attention may be paid to wider system changes and/or the young person and family perspective.

They note the key challenges as:

  • How to raise awareness of the big picture and generate energy for change
  • How to get the organisation/service to understand it is part of a wider system
  • How to focus staff on needs of young people and families and other community stakeholders.

It’s our view that, to achieve the above goals, staff need to have their values and needs focused on. So we suggest using the model of the 4 different management styles to move forward with change (Hersey and Blanchard, 1977). Try using these styles in order…

Tell: State the non-negotiable goals

Sell: Allow space to think about the values that will matter to clinicians (i.e. not just budgets and targets)

Participate: Work with others to bring about the changes and vision

Delegate: Allow staff to work independently on developing and implementing CAPA.

Don’t spend too long TELLING!

Hence the importance of CAPA Key Component number 1! To achieve the above goals you need to start with a management/leadership group with a supportive, participative manager, a clinician empowered to act as well as voice concerns and an admin person who will know how it will work and understand the client perspective well.

This group will empower people and hold yourself and the staff to account.

What happens if you don’t have leadership?

You are highly unlikely to get change going, or to sustain it.