Introduction The future of the NHS is dependent on innovation, yet getting new ideas into practice at scale and thereby gaining optimum value remains a challenge. An overlooked area is the social rather than technical aspect of innovation scaling including NHS leadership.

Leadership is a key indicator of employee, team, and organisational creativity and hence learning to lead innovation is as important as the innovation itself. Leadership that enables innovation at scale, risk-taking and experimentation differs from traditional top-down, command-and-control leadership, strategic planning and safety cultures built on assurance, consistency and rigour, and hence requires a fundamental shift in thinking and beliefs beyond the reach of education alone.

Coaching is a leadership development tool based around helping individuals change their ways of thinking, feeling and behaving in relation to a problem. How might coaching bridge the innovation leadership competency gap?

Aims and objectives of the research project or activity This study explores explored the relationship between coaching and innovation leadership from the perspective of senior NHS coaches. More specifically this research aims to:

• Identify what coaches understand by innovation leadership

• Explore how coaching might best support innovation leadership

• Make recommendations to those providing and commissioning coaching, innovation programmes and the wider NHS on the role of coaching in supporting cultures of innovation

Method or approach The methodology included a literature review and qualitative research in accordance with the principles of interpretative phenomenological analysis (IPA) (Smith et al., 2009). Study participants were identified through non-probability purposive sampling and included internal and external coaches with high levels of coaching experience who were actively coaching NHS leaders. Semi-structured telephone interviews included open questions relating to coaches’ characteristics (i.e. ‘who’); coaching agendas (i.e. ‘what’) and coaching approaches/schools (i.e. ‘how’) (Segers et al., 2011, Tuffour, 2017) and explored the difference between coaching a successful innovation leader and usual leadership coaching. Data analysis included in-depth, systematic, qualitative analysis of verbatim narrative accounts. An email, consent form and brief overview of the research was sent to all participants prior to interview to assure them of confidentiality and cover ethical considerations. 

Findings Despite unfamiliarity with the term, coaches described innovation - meaning creativity and its implementation - as a core leadership skill, and ‘innovation leadership’ as a style more suited to managing complexity and ambiguity than the prevalent pace-setting style. Leaders did not have to be innovators themselves but needed to intentionally enable the right conditions by developing key competencies common to ‘innovation leaders’.

Coaches described how most NHS leaders in their experience used coaching mainly for resilience. However, in contrast, leaders who promoted innovation used it to stretch themselves to generate new thinking and behaviours in a safe space and then recreate this in the workplace; in other words, they used coaching as an innovation catalyst. This is consistent with other studies which found that coaching helps leaders recognise the need for change, shift their beliefs, identity and meaning, and then role-model coaching behaviours to benefit staff i.e. enhanced creativity and its implementation both within and beyond the coaching session.

An evolution from one to one coaching was to adopt coaching as the dominant leadership style to explicitly build capacity and capability and a culture of innovation and improvement.

Key messages Enabling innovation at scale is fundamental given the challenges faced in health and care. This study identified that leadership needs to be more innovative, innovation is highly complex and senior coaches can enable leaders to develop innovation cultures. Given the paucity of literature, these insights aid understanding of ‘innovation leadership’ and opportunity for further research.`

Authors have called for leadership development to help improve innovation spread and adoption and this study suggests it should include coaching. NHS organisations need to prioritise innovation, create clarity about what coaching is for, encourage three-way contracting (between coachees, their line manager and coach), use only accredited coaches and align coaching with culture change programmes e.g. compassionate leadership and quality improvement. The large numbers NHS coaches should understand innovation and be more actively aligned to support the innovation agenda. A national framework of specialist coaches in innovation should be created.