Articles / The NHS Healthcare Leadership Model: A Complete Guide to the 9 Dimensions of Leadership
Development, Training & CoachingDiscover the NHS Healthcare Leadership Model, including its 9 dimensions, self-assessment tools, and how to apply this evidence-based framework at every career stage for improved patient outcomes.
Written by Laura Bouttell • Sun 4th January 2026
The National Health Service stands as one of the world's most complex organisational systems, employing over 1.3 million staff and delivering care to 66 million people across England. Leading within such an environment demands more than clinical expertise or managerial competence—it requires a sophisticated understanding of how to inspire, connect, and develop others whilst navigating unprecedented operational pressures.
The NHS Healthcare Leadership Model provides precisely this foundation. Developed by the NHS Leadership Academy in 2013, this evidence-based framework has shaped how healthcare professionals at every level understand and develop their leadership capabilities. Unlike traditional competency frameworks that reduce leadership to a checklist of skills, the Healthcare Leadership Model focuses on observable behaviours that drive genuine improvement in patient care.
Whether you are a ward nurse taking on your first supervisory responsibilities, a clinical lead managing a service, or a senior executive shaping organisational strategy, the Healthcare Leadership Model offers a common language for leadership development. This comprehensive guide examines the model's nine dimensions, explores practical applications for self-assessment and development, and provides guidance on leveraging this framework throughout your NHS career.
The Healthcare Leadership Model represents a fundamental shift in how the NHS conceptualises leadership development. Created through extensive research involving strategic interviews with experienced NHS leaders, focus groups across various organisational levels, and collaboration with the Open University and Korn Ferry Hay Group, this framework distils what effective healthcare leadership looks like in practice.
At its core, the model recognises a crucial insight: technical competence, professional skills, and managerial excellence all contribute to good leadership, but the genuine differentiator lies in care, compassion, and authentic investment in staff. This philosophy reflects what patients and communities have consistently asked from their healthcare leaders.
The Healthcare Leadership Model replaced the earlier NHS Leadership Framework in 2014, incorporating lessons learned whilst addressing criticisms that previous competency frameworks were overly reductionist. The development team, led by John Storey and Richard Holti of the Open University, conducted comprehensive reviews of leadership literature, international best practice, and private-sector learning to create something genuinely fit for purpose.
The resulting framework emphasises that leadership is not confined to those with formal authority. A healthcare assistant demonstrating initiative on a ward, a junior doctor coordinating a multidisciplinary team, or a receptionist improving patient experience—all exercise leadership within their spheres of influence. The model's accessibility to staff at every level represents a democratic vision of healthcare leadership that acknowledges the distributed nature of excellent patient care.
Three principles underpin the Healthcare Leadership Model:
Universal applicability: Whether you work with a team of five or five thousand, in clinical or non-clinical settings, the model describes leadership behaviours relevant to your role. This inclusivity encourages leadership development as a professional responsibility for all healthcare workers, not merely those with management titles.
Behavioural focus: Rather than abstract competencies, the model describes observable actions—things you can actually see leaders doing at work. This concreteness facilitates meaningful self-reflection and targeted development planning.
Progressive development: Leadership behaviours exist on a spectrum rather than as binary attributes. The four-part scale from essential through proficient and strong to exemplary provides a developmental pathway that acknowledges growth potential regardless of current capability.
The Healthcare Leadership Model comprises nine interconnected dimensions, each addressing a distinct aspect of effective healthcare leadership. These dimensions function both independently and synergistically, creating a holistic framework for understanding leadership excellence.
| Dimension | Brief Description |
|---|---|
| Inspiring Shared Purpose | Valuing service ethos and behaving consistently with NHS principles |
| Leading with Care | Understanding team members and creating supportive environments |
| Evaluating Information | Critically assessing information to inform evidence-based decisions |
| Connecting Our Service | Understanding how services interconnect across the health system |
| Sharing the Vision | Co-creating compelling futures with stakeholders at all levels |
| Engaging the Team | Creating environments where diverse teams thrive through involvement |
| Holding to Account | Establishing clear expectations whilst providing necessary support |
| Developing Capability | Continuously building individual and collective capabilities |
| Influencing for Results | Affecting change beyond formal authority through relationships |
Inspiring shared purpose involves valuing a service ethos, demonstrating curiosity about improving services and patient care, and behaving in ways that reflect NHS principles and values. Leaders who excel in this dimension create a collective sense of purpose that motivates teams toward high-quality care, connecting individual contributions to patient outcomes through compelling narratives.
Why it matters: Healthcare teams comprise diverse professionals—clinicians, administrators, support staff, and managers—each bringing different training and priorities. Effective leaders unite these perspectives around shared values, inspiring belief in common goals that deliver benefits for patients, families, and communities.
What it is not: This dimension explicitly excludes turning a blind eye to problems, using values to push personal or tribal agendas, hiding behind values to avoid doing one's best, self-righteousness, misplaced tenacity, and shying away from doing what one knows is right.
Leading with care acknowledges that healthcare leadership occurs within an inherently human context. Leaders who embody this dimension understand their team members' unique qualities and create safe, supportive environments where staff can flourish.
Why it matters: Staff experience directly influences patient outcomes. Research consistently demonstrates correlations between workforce wellbeing and care quality. Leaders demonstrating genuine concern for their teams create conditions where compassionate patient care becomes the natural expression of organisational culture.
What it is not: Leading with care does not mean avoiding difficult conversations, accepting poor performance, or prioritising staff comfort over patient safety. Care and accountability must coexist.
This dimension involves critically assessing information from multiple sources to generate ideas and inform improvement plans. Effective leaders distinguish signal from noise whilst maintaining intellectual humility, combining analytical rigour with openness to diverse perspectives.
Why it matters: Healthcare decisions increasingly rely on data, evidence, and diverse stakeholder input. Leaders must synthesise complex information—clinical outcomes, patient feedback, financial constraints, workforce metrics—to make evidence-based decisions that respect different perspectives and meet service user needs.
What it is not: Evaluating information does not mean analysis paralysis, dismissing experiential knowledge, or privileging quantitative data over qualitative insight. Effective evaluation integrates multiple ways of knowing.
Connecting our service means understanding how health and social care services fit together and how different people, teams, and organisations interconnect. This systems perspective enables leaders to anticipate consequences of decisions and design interventions addressing root causes rather than symptoms.
Why it matters: The NHS operates as a complex adaptive system where decisions in one area cascade through interconnected services. Leaders who understand these connections can navigate organisational politics, share risks appropriately, and build collaborations that serve patients across traditional boundaries.
What it is not: This dimension excludes rigid thinking, considering only one's own part of the organisation, believing only one's view is correct, dismissing politics as a dirty word, failing to engage with other system parts, or focusing solely on departmental depth at the expense of broader service understanding.
Sharing the vision involves co-creating compelling futures that engage stakeholders at all levels. Unlike top-down declarations, this dimension emphasises participatory approaches involving patients, communities, and frontline staff in shaping organisational direction.
Why it matters: Visions imposed from above rarely generate the commitment needed for successful implementation. When leaders genuinely share the vision—listening, incorporating feedback, acknowledging constraints—they build ownership that sustains momentum through inevitable challenges.
What it is not: Sharing the vision does not mean seeking consensus on everything, avoiding difficult decisions, or pretending all perspectives carry equal weight. Strategic clarity remains a leadership responsibility.
Engaging the team means creating environments where diverse teams thrive through meaningful involvement and shared decision-making. Leaders distribute responsibilities based on capability rather than hierarchy, unlocking collective intelligence.
Why it matters: Healthcare delivery depends on coordinated teamwork across professional boundaries. Engaged teams demonstrate higher productivity, better patient outcomes, and greater innovation. Disengaged staff represent both a human cost and an organisational risk.
What it is not: Engagement does not mean abdicating leadership responsibility, avoiding unpopular decisions, or treating all opinions as equally valid regardless of expertise. Leaders remain accountable for team performance.
Holding to account involves establishing clear expectations whilst providing necessary support and resources for success. This dimension balances autonomy with responsibility, creating cultures where teams maintain high standards through intrinsic commitment rather than external monitoring alone.
Why it matters: Accountability structures protect patients and ensure consistent care quality. When expectations are unclear or consequences absent, standards drift. Effective leaders make accountability a supportive process focused on learning and improvement rather than blame.
What it is not: Holding to account does not mean micromanagement, punitive responses to honest mistakes, or accountability without corresponding authority. Effective accountability enables rather than constrains.
Developing capability means continuously building individual and collective capabilities through coaching approaches and reflective practice. Leaders view staff development as integral to everyday work rather than periodic training events, building adaptive organisational capacity.
Why it matters: Healthcare evolves constantly—new treatments, technologies, and care models emerge whilst patient expectations shift. Organisations that systematically develop capability maintain their ability to respond effectively. Leaders who neglect development eventually lead organisations unable to meet future challenges.
What it is not: Developing capability does not mean sending everyone on courses, ignoring performance issues, or assuming development is solely an HR function. Effective development is embedded in how work gets done.
Influencing for results means affecting change beyond formal authority by building networks, forming coalitions, and developing persuasive narratives. Leaders mobilise action across organisational boundaries through credibility and social capital rather than positional power alone.
Why it matters: Few healthcare improvements can be achieved within single teams or organisations. Change requires influencing colleagues, partner organisations, commissioners, and policy makers. Leaders who rely solely on formal authority find their impact severely constrained.
What it is not: Influencing for results does not mean manipulation, prioritising relationships over substance, or avoiding direct communication. Ethical influence builds trust rather than depleting it.
For each dimension, the Healthcare Leadership Model presents behaviours on a four-part scale: essential, proficient, strong, and exemplary. This progression reflects increasing sophistication and impact rather than hierarchical position—junior staff may demonstrate exemplary behaviours in some dimensions whilst senior leaders remain at proficient levels in others.
| Level | Description |
|---|---|
| Essential | Foundational behaviours expected of everyone in healthcare roles |
| Proficient | Developed behaviours demonstrating consistent application |
| Strong | Advanced behaviours showing significant positive impact |
| Exemplary | Sophisticated behaviours representing sector-leading practice |
The scale's design carries important implications for development planning:
Non-hierarchical progression: Your position on the scale for each dimension reflects behavioural sophistication, not seniority. A band 5 nurse might demonstrate exemplary inspiring shared purpose whilst a service director remains at proficient level. This democratises leadership excellence and challenges assumptions about where leadership resides within organisations.
Dimensional variation: Few individuals demonstrate uniform capability across all nine dimensions. You might be exemplary in leading with care yet essential in influencing for results. Honest self-assessment across dimensions reveals a personal leadership profile with distinct strengths and development areas.
Contextual sensitivity: The appropriateness of different scale levels varies by role and situation. Not every position requires exemplary behaviour in every dimension. Development planning should prioritise dimensions most relevant to current and aspirational roles.
The NHS Leadership Academy provides free self-assessment tools enabling individuals to evaluate their leadership behaviours against the nine dimensions. This process forms the foundation for meaningful development planning.
To use the self-assessment tool:
The tool presents behaviours as questions, prompting reflection on how consistently you demonstrate specific leadership actions. Honest engagement with these questions—rather than aspirational responses—yields the most useful development insights.
Create protected time: Self-assessment deserves focused attention rather than completion between meetings. Block dedicated time where you can reflect thoughtfully on each dimension.
Consider specific examples: For each question, recall concrete situations where you demonstrated—or failed to demonstrate—the behaviour in question. Abstract self-ratings lack the specificity needed for development planning.
Acknowledge discomfort: The dimensions that prompt defensiveness or rationalisation often indicate the most significant development opportunities. Notice your emotional responses as diagnostic information.
Review periodically: Leadership capability evolves. Repeat self-assessment at six to twelve month intervals to track progress and identify emerging development priorities.
Beyond self-assessment, the Healthcare Leadership Model includes a 360-degree feedback tool providing multi-perspective insight into leadership behaviours. This tool gathers evaluations from managers, peers, direct reports, and others familiar with your work.
The feedback questionnaire collects assessments from multiple raters who evaluate your behaviours against the nine dimensions. Raters also indicate how important they consider each dimension for your role, providing context for interpreting results.
Following data collection, a comprehensive report presents your self-assessment alongside aggregated rater feedback. An accredited facilitator guides you through interpreting the report, helping you understand patterns, discrepancies, and development implications.
Cost: The 360-degree feedback tool costs forty pounds (plus VAT) per person. Organisations ordering fifty or more places receive additional allocations.
Rater selection: Choose raters who observe your leadership behaviours regularly and can provide honest, constructive feedback. Include diverse perspectives—those you lead, those you work alongside, and those to whom you report.
Facilitator support: The feedback session with an accredited facilitator transforms data into actionable insight. This conversation helps you understand not just what the feedback says, but what it means for your development.
The Healthcare Leadership Model underpins various NHS Leadership Academy programmes, each designed for specific career stages and development needs.
Target audience: Those new to the NHS or seeking foundation-level leadership skills
Format: Self-guided online learning with interactive discussions
Outcome: NHS Leadership Academy Award in Leadership Foundations
The Edward Jenner programme suits healthcare professionals early in their careers who want to understand leadership fundamentals and deal more effectively with daily workplace challenges. Named after the pioneer of vaccination, this programme establishes the groundwork for subsequent leadership development.
Target audience: Staff in their first formal leadership role
Format: 100 hours online learning plus three behavioural workshops
Outcome: NHS Leadership Academy Award in Leading on the Frontline and Postgraduate Certificate in Healthcare Leadership
The Mary Seacole programme helps frontline leaders translate individual success into consistent team performance. Named after the Jamaican-born nurse who provided care during the Crimean War, this programme emphasises practical application alongside theoretical understanding.
Target audience: Mid-level leaders seeking to drive change and improve patient experience
Format: Intensive development combining online learning, workshops, and action learning
Outcome: Enhanced capability to lead service improvement and transformation
This programme equips leaders to navigate the complexities of middle management, where they must balance upward accountability with frontline engagement.
Target audience: Leaders at all levels seeking to shape knowledge, attitudes, and behaviours
Format: Flexible learning addressing specific leadership challenges
Outcome: Enhanced leadership effectiveness across the nine dimensions
Named after the scientist whose work contributed to understanding DNA structure, this programme supports leadership development across diverse healthcare contexts.
Target audience: Senior leaders aspiring to board roles
Format: Twelve-month programme including residential elements
Outcome: Preparation for executive leadership and board-level contribution
The Nye Bevan programme has developed over one thousand senior leaders, with nearly forty percent reporting more senior roles following completion—ninety percent attributing this directly to the programme. Named after the architect of the NHS, this programme prepares leaders to shape healthcare at the highest organisational levels.
The Healthcare Leadership Model's universal design enables application across career stages, though emphasis and approach vary with role and experience.
At early career stages, focus on:
Inspiring shared purpose: Understand NHS values and demonstrate consistent commitment to patient-centred care. Even without formal authority, you influence team culture through your daily actions.
Leading with care: Develop relationships with colleagues and patients that exemplify compassionate practice. Notice how your behaviour affects others' wellbeing and work experience.
Evaluating information: Build habits of evidence-based practice and critical thinking. Question assumptions and seek diverse perspectives when making decisions.
Use the self-assessment tool to establish baseline understanding of your leadership behaviours. Consider the Edward Jenner programme to formalise early leadership learning.
Transitioning into formal leadership, emphasise:
Engaging the team: Learn how to involve team members meaningfully in decisions and create environments where diverse perspectives contribute to better outcomes.
Holding to account: Develop confidence in setting expectations and having accountability conversations. Balance support with appropriate challenge.
Developing capability: Take responsibility for team members' growth, not just task completion. Identify development needs and create learning opportunities within daily work.
The Mary Seacole programme specifically addresses this transition, helping new leaders avoid common pitfalls whilst building sustainable leadership practice.
At middle management level, prioritise:
Connecting our service: Develop understanding of how your service relates to the broader health system. Build relationships across organisational boundaries.
Sharing the vision: Translate organisational strategy into meaningful direction for your teams whilst advocating upward for frontline realities.
Influencing for results: Build coalitions and networks enabling change beyond your formal authority. Develop persuasive communication skills.
The 360-degree feedback tool becomes particularly valuable at this stage, revealing how your leadership is perceived across different stakeholder groups.
Senior leaders should demonstrate sophisticated capability across all dimensions whilst particularly excelling in:
Inspiring shared purpose: Shape organisational culture and maintain collective focus during periods of challenge and change.
Connecting our service: Navigate complex system relationships, representing your organisation whilst contributing to broader health economy effectiveness.
Influencing for results: Build strategic relationships with commissioners, regulators, partner organisations, and policy makers. Mobilise collective action on system-level challenges.
The Nye Bevan programme prepares senior leaders for board-level responsibility, whilst the Leadership Competency Framework for Board Members (introduced in 2024) sets specific expectations for executive and non-executive directors.
Understanding how the Healthcare Leadership Model relates to other leadership frameworks helps contextualise its distinctive contribution.
| Aspect | Transformational Leadership | Healthcare Leadership Model |
|---|---|---|
| Origin | General management theory | NHS-specific evidence base |
| Scope | Single leadership style | Nine integrated dimensions |
| Focus | Inspiring change through vision | Comprehensive leadership behaviours |
| Application | Universal across sectors | Tailored to healthcare context |
The Healthcare Leadership Model incorporates transformational leadership principles—particularly in dimensions like inspiring shared purpose and sharing the vision—whilst integrating other approaches including distributed and democratic leadership. This eclecticism reflects healthcare's complexity, where different situations demand different leadership responses.
The Healthcare Leadership Model succeeded the NHS Leadership Framework in 2014, incorporating lessons learned whilst addressing limitations:
Behaviour focus: Where the earlier framework emphasised competencies, the Healthcare Leadership Model describes observable behaviours, making assessment and development more concrete.
Universal applicability: The Healthcare Leadership Model explicitly applies to all staff regardless of formal role, whereas the Leadership Framework implied hierarchical application.
Four-part scale: The essential-to-exemplary progression provides more nuanced developmental guidance than binary competency achievement.
Introduced in 2024, the Leadership Competency Framework for Board Members sets expectations specifically for executive and non-executive directors across six competency domains. This framework complements the Healthcare Leadership Model, applying its principles at board level whilst addressing governance-specific responsibilities.
From 2026/27, the Board Leadership Competency Framework will integrate with the broader Management and Leadership Framework, creating alignment between board-level and organisation-wide leadership development.
Translating framework understanding into leadership improvement requires deliberate practice and organisational support.
Start with self-assessment: Before requesting 360-degree feedback, develop self-awareness through honest self-assessment. Understanding your own perspective provides context for interpreting others' feedback.
Focus development efforts: Rather than attempting improvement across all nine dimensions simultaneously, identify two or three priorities based on role requirements and developmental readiness.
Seek feedback continuously: The formal 360-degree tool provides structured insight, but informal feedback gathered regularly accelerates development. Ask colleagues specific questions about your leadership behaviours.
Connect development to work: Leadership capability develops through practice, not just study. Identify specific work situations where you can deliberately practice target behaviours.
Reflect systematically: Keep a leadership journal noting situations where you demonstrated—or failed to demonstrate—target behaviours. Regular reflection transforms experience into learning.
Integrate with appraisal: The Healthcare Leadership Model provides shared language for performance conversations. Use the dimensions to structure discussions about leadership expectations and development.
Support 360-degree feedback: Make the 360-degree tool accessible across the organisation, training facilitators and normalising multi-perspective feedback as developmental rather than evaluative.
Align programmes: Ensure internal leadership development aligns with Healthcare Leadership Model dimensions, creating coherent developmental pathways from early career through senior leadership.
Model from the top: Senior leaders demonstrating their own engagement with the framework—including sharing development areas—legitimise vulnerability and continuous learning throughout the organisation.
The Healthcare Leadership Model continues evolving alongside broader NHS leadership development infrastructure.
A new 360-degree feedback tool is scheduled for release in autumn 2026, replacing the existing Healthcare Leadership Model tool whilst aligning with updated Standards and Curriculum. The new Management and Leadership Framework, currently being implemented, establishes consistent professional standards across all NHS managers and leaders.
These developments represent evolution rather than revolution—the core principles underlying the Healthcare Leadership Model remain relevant whilst tools and frameworks adapt to contemporary challenges.
Regardless of framework iterations, certain principles endure:
Leadership is behavioural: What leaders do matters more than what they know or who they are. Observable behaviours provide the foundation for development and accountability.
Leadership is distributed: Effective healthcare requires leadership contributions from staff at every level. Frameworks that democratise leadership development serve patients better than those concentrating leadership in formal roles.
Leadership is contextual: Healthcare's complexity demands adaptive leadership responding to varied situations. No single style or approach suits every circumstance.
Leadership is developmental: Leadership capability grows through deliberate practice, feedback, and reflection. Investment in leadership development yields returns in patient outcomes and organisational effectiveness.
The NHS Healthcare Leadership Model is an evidence-based framework developed by the NHS Leadership Academy in 2013 to help healthcare staff at all levels develop their leadership capabilities. The model comprises nine dimensions describing observable leadership behaviours, presented on a four-part scale from essential through proficient and strong to exemplary. Unlike traditional competency frameworks, it focuses on what leaders actually do rather than abstract qualities, making it practical for self-assessment and development planning across diverse healthcare roles.
The Healthcare Leadership Model is designed for everyone working in health and care, regardless of formal leadership responsibility, clinical or non-clinical role, or organisational level. Whether you manage a large department or work in a small team without supervisory duties, the model helps you understand and develop leadership behaviours relevant to your contribution. This universal applicability reflects the NHS's recognition that effective patient care requires leadership from staff at every level, not just those with management titles.
The self-assessment tool is freely available through the NHS Leadership Academy website. Register for a free NHS Leadership Academy ID, then log in and register for the Healthcare Leadership Model under Available Programmes. The tool presents behavioural questions for each of the nine dimensions, enabling you to reflect on your current leadership practice and identify development priorities. Completing the self-assessment takes approximately thirty to forty-five minutes and provides a foundation for personal development planning.
The self-assessment tool captures your own perspective on your leadership behaviours across the nine dimensions, providing valuable self-awareness but limited by potential blind spots. The 360-degree feedback tool gathers assessments from multiple perspectives—managers, peers, direct reports, and others familiar with your work—revealing how your leadership is perceived by those around you. The 360-degree tool costs forty pounds plus VAT and includes a facilitated feedback session helping you interpret results and plan development.
Programme selection depends on your career stage and development needs. The Edward Jenner programme suits those new to healthcare seeking foundation-level leadership understanding. The Mary Seacole programme supports staff in their first formal leadership role. The Elizabeth Garrett Anderson programme addresses mid-level leadership challenges, whilst the Rosalind Franklin programme offers flexible development across levels. The Nye Bevan programme prepares senior leaders for board roles. Consider your current responsibilities, career aspirations, and specific development needs when selecting a programme.
Many NHS organisations integrate the Healthcare Leadership Model into appraisal processes, using the nine dimensions to structure conversations about leadership expectations and development. The model provides shared language enabling meaningful discussion between appraisers and appraisees about leadership behaviours, strengths, and improvement areas. The new Management and Leadership Framework reinforces this integration, establishing the Healthcare Leadership Model principles as professional standards applicable across NHS management and leadership roles.
The Healthcare Leadership Model remains current, though updates are planned. A new 360-degree feedback tool scheduled for autumn 2026 will better align with updated Standards and Curriculum. The broader Management and Leadership Framework currently being implemented establishes consistent professional standards whilst building on Healthcare Leadership Model foundations. These developments represent evolution rather than replacement—the core principles and nine dimensions remain relevant whilst tools and supporting infrastructure adapt to contemporary NHS challenges.
The NHS Healthcare Leadership Model offers more than a framework for assessment—it provides a vision of leadership suited to healthcare's unique demands. In a system where decisions directly affect patient outcomes, where resources are perpetually constrained, and where staff wellbeing determines care quality, effective leadership becomes a moral imperative rather than merely an organisational preference.
By understanding and applying the nine dimensions, healthcare professionals at every level can develop leadership capabilities that serve patients, support colleagues, and strengthen the NHS. The journey from essential to exemplary is neither quick nor easy, but the destination—leadership that embodies care, compassion, and collective responsibility—remains worth pursuing.