Stephen Eames on the new NHS leadership

It identifies those that do best in operational effectiveness, talent management and performance management.

The research, by McKinsey and the London School of Economics, also cites evidence - confirming what we all know - that the main differentiator between hospitals that perform consistently better in these areas and those that don't is the strength of clinical leadership. It concludes that it is important the NHS helps clinicians become better leaders, because this will improve the overall management of hospitals and ultimately the quality and productivity of healthcare.

I know it is trite, but who can argue with the principle that clinical organisations should be clinically led? So why does delivering clinical leadership remain a challenge?

Part of the answer lies in the fact that a large body of evidence suggests successful leaders have to have credibility within the group they are expected to lead, so not only do clinicians have to be led by clinicians but managers have to be led by someone with credibility and a good track record in management.

I have spent years working with clinical directors and managers of all types and am of the vintage that lived through resource management and its permutations. From this vantage point I humbly offer a few reasons why success is often elusive.

To truly become business leaders with a clinical background, doctors in particular have to go through a catharsis. I have seen this happen and when it does it is tremendously rewarding. But far too often it is just too difficult a cultural shift to make.

Some of the most commercially aware clinicians with the strongest business acumen are simply likely to make a lot less money if they dedicate too much time to leadership and management.

Developing strong clinical leadership means power sharing - both strategically and operationally - and it is risky. So often the right language is spoken and structures are put in place but the organisation doesn't really mean it.

Leadership is about setting direction, motivating and building teams, whereas management is about controlling, supervising and monitoring. For example, on budgets, the manager's responsibility is to stay within budget, but the leader's responsibility is to fight for new resources through use of networks and advocacy. Therefore clarity on role needs to be established up front.

The deeply ingrained myth is that commercial discipline and focus can jeopardise clinical practice and patient care.

One methodology I would advocate for connecting all this while putting in place the bedrock for overcoming these barriers is service line management. A number of foundation trusts, including my own, have piloted this over the past 18 months and seen a dramatic effect on the development of clinical leadership and business systems.

The first and most important step is to ensure this (or any other methodology you choose) is not a "bolt-on", but is firmly embedded in the vision, values, behaviours and business objectives that are driving the organisation forward.

We first piloted service line management in general surgery. Our surgeons and their teams have successfully delivered an impressive programme of change which achieves the holy grail of improving quality and reducing costs.

Initially they sought to deliver a few short term wins. These included reducing day-before admissions by 95 per cent, shifting more elective procedures to higher-margin day cases, decreasing controllable "did not attends" and cutting the number of beds through decreasing the bed capacity buffer available to meet variable emergency demand.

This initial work has matured into this year's annual operating plan for surgery, which aims to cut surgical beds through streamlining elective demand, increasing discharge timeliness through removing weekend hold-ups, matching staffing levels and mix to demand through higher staffing flexibility, increasing theatre use and decreasing consumable costs.

This work has been guided by strong principles developed by the surgical division and the teams involved. These included a commitment to support corporate objectives, ensuring plans did not negatively impact on other services and improving quality levels and staff working conditions while delivering efficiency savings.

They have also identified critical success factors which we are now rolling out across the trust. These emphasise multidisciplinary working, applying the 80:20 rule (where 80 per cent of the effects come from 20 per cent of the causes)by focusing on big or easy ideas, using data and sense checking it against practical experience and not compromising on best practice.

Most important of all though has been the impact on the surgeon who led this work. His message from it all is that patients are receiving better care because he and his team have been equipped with the skills to understand how to drive improvement in their service, leading them to take ownership rather than leave responsibility for improvement in the hands of others.

He characterises this by describing a change in approach from "slash and burn" to "change and learn". And he freely admits he has been on a journey that has given him confidence to lead and a thirst for further personal development.

The recent Department of Health publication Inspiring Leadership for Quality: the approach suggested chief executives should devote up to two days a week to nurturing talent; although goodness knows where this fits in with the other seven. Maybe there could be the makings of breakthrough performance and new levels of excellence to rival the best that industry can offer.