The Project

Leading Better Care: Leading Across Difference

Action Research Project: NHS Lothian 2014 – 2019
Dr. Radha Adhikari (External Researcher), Dr. Janet Corcoran (NHS Lothian), Rakiya Suleiman (NHS Lothian) and Kenny Barber (NHS Lothian)


‘Leading Better Care Leading Across Difference’ is a leadership development project, designed specifically to support Black and Minority Ethnic (BME) nurses and midwives in their leadership development and career progression within the organisational hierarchy in Lothian, Scotland. The project aims that, ultimately, they will take on leadership roles and influence policy, in order to provide person-centered care to patients. 

Issues to be resolved

The rationale behind this project is based on evidence that suggests that an inclusive, fair and positive working culture, where all staff from diverse backgrounds are valued equally, is vital for an organisation to achieve optimal outcomes. This leadership development project is mindful of the evidence suggesting that exclusion and inequalities, across every dimension of life, contribute to lower levels of wellbeing, as well as prospects of poorer health outcomes and reduced life expectancy (Limb 2014; Coghill 2015). It aims to tackle these very issues and promote a fair and inclusive working culture, to promote the overall health, wellbeing and productivities of staff and patients in NHS Lothian.

What they did

An Action Research (AR) method underpinned this project, comprising a
number of AR intervention cycles. The cycle began with a collaborative assessment of the situation of BME nurses and midwives. Having specifically identified their professional support needs, it explored ways of addressing them and bringing positive change in their careers as well as promoting a positive working culture in NHS Lothian. The rolling out of the planned interventions followed a design stage and then an evaluation of the whole programme was made. The project followed this cyclical

Project activities carried out since 2014 included initial survey, examination of workforce data within NHS Lothian (in 2014). After this initial assessment of BME issues, leadership development training were designed and these have been offered to a total of 17 cohorts of BME nurses and midwives. By the end of 2019, a total of 120 BME nurses and midwives have completed the training programme. Similarly, a total of 220 NHS line-managers and 35 mentors too, have received training on how to support BME nurses and midwives and promoting a positive and inclusive workplace culture in NHS Lothian. Thereafter Focus Group Discussions (FDGs) were conducted with BME participants and their line-managers. A further activity in this period was collecting pre and post-training evaluations and feedback from all participants in the training sessions. This included using standardised pre-and post training confidence scales to assess any positive impacts on confidence. 

What was the outcome? 

The project has made significant progress and notable achievements, in both numerical as well as in qualitative terms. With the support from the project facilitators, a number of BME staff have achieved their career promotion goals, and other staff have been motivated to apply for promotion. Some of the other key achievements include:

  •  The project has been recognised as a Best Practice, in promoting diversity and an inclusive workplace culture, by the Scottish Government. 
  •  Overall qualitative gain: BME staff and their line-managers have gained better understanding on the issues and challenges BME staff face in their career progression; all participants have learned and realised their individuals potentials, and developed strategies to work together to provide quality patient care. 
  •  All project participants now feel more confident in a number of areas, including conducting difficult conversations and becoming reflective in their professional practice. Most importantly, they feel that they are valued members of staff and supported by the management, all of which has a positive impact on person-centred care provision and NHS Lothian values.

The project has established a firm foundation and has opened up a number of avenues for further work on BME leadership development initiatives and continued to promote positive and inclusive workplace culture.

Finally there has been an overwhelmingly positive response from all parties, both training participants and project team members. Regarded as a pioneering project of its kind in Scotland with significant positive outcomes, it is felt that these activities should be incorporated into overall professional development programmes in Lothian. All involved are also convinced of the need to roll out the project regionally and nationally in Scotland for, given the positive gains this project has achieved, it should be continued beyond 2019. As already highlighted, a stable and valued
workforce is key to quality health care provision. Making investment in this type of workforce development programme has game changing potentials. 

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