There are countless definitions of leadership, but the majority concur that leadership is about working with people and organisations to achieve goals and to produce change. While overlapping with management, there is an enhanced focus on change, vision, inspiration and empowerment.
Leadership and management are already well-entrenched within the NHS, but the extent to which the two are integrated can often be questioned. Where failures to deliver high quality care have been documented, this has corresponded with a divide between managers and clinicians than cannot be bridged by clinical engagement alone. The results are limited clinical input to the leadership and management of organisations.
Why do we need clinical leadership?
Clinical leadership is about more than just attendance at meetings or having good communication pathways. One way of judging the clinical leadership of an organisation is whether clinicians are working in collaboration with managers to actually develop, promote and implement the strategic vision for the organisation or department. How are they using their clinical experience to shape strategy and practice rather than simply being ‘informed’ about it? To be truly effective, leadership must be distributed throughout organisations so that it is not just at a strategic level but within the practice or department where clinicians actually work on a day–to-day basis.
Clinical leaders help ensure that everyday front-line decisions are made with a focus on quality and the needs of the individual patient, coupled with an awareness of the implications of those decisions. It is increasingly recognised that the most effective leaders do not simply hand down directives but engage in dialogue and make mutual decisions while retaining the ability to step back and see the wider context at all times.
How can best practice clinical leadership be embedded into the system?
Clinical leadership in any setting requires a significant investment and it is important to be clear on the added value that it brings: the best-performing organisations are those that have enabled effective clinical leadership. This recognition has seen a surge in clinical leadership development activity across the NHS. The NLC has set up a Clinical Leadership workstream to generate a national focus, and several professional bodies are offering national leadership programmes. Undergraduate and postgraduate curricula are being enhanced in an effort to equip future leaders with the necessary skills. Clinical leadership development activities have increased within NHS organisations to address the current skills gaps. Several SHAs are now offering leadership development programmes such as the multidisciplinary programme run by Tribal in the West Midlands. These activities need to continue despite the financial constraints.
One size does not fit all and successful leadership development programmes will take account of the different roles and starting positions of current and future clinical leaders. Development must be based on a framework against which the competence of leaders can be assessed and evaluated on a continual basis, such as the Medical Leadership Competency Framework which posits a shared view of the skills required by clinical leaders and can be applied to all clinical professions.
It is also vital that clinical leaders have time to explore the context in which they are working as well as addressing relational issues such as influencing skills and making change happen. These skills need to be developed over time and cannot be taught in a classroom. In this context, development that focuses on “live” issues through action learning, coaching, mentoring and supported service improvement projects have much to offer, allowing participants to reflect on themselves and the impact they are having on those they work with. However, it is not enough to simply put such approaches in place. Programmes need to be adaptive, enabling participants to influence the level and nature of support they receive based on self-reflection and the evidence collated from learning by doing.
Good clinical leadership is vital, but a skills gap remains. This gap must be addressed, particularly in the context of primary care commissioning, as poor clinical leadership now will have a lasting impact on health outcomes. However, clinical leadership does not exist in a vacuum; management skills will help to shape lasting change. Those in “management” roles need “leadership” skills and vice versa. A true partnership between clinical leaders and managers is valuable, both in development of clinical leaders and in everyday working practices. The relationship is should become one of co-production – it is not enough that new ideas are generated; these ideas will need to be translated and contextualised to prove both the business case and the positive effect on patient care.
It has been demonstrated time and again that trying to manage high quality, high performing healthcare organisations without clinical leadership does not work. Nor is it easy to build a genuine working rapport and partnership between clinical leaders and managers. It requires investment in time and resources and success will not happen overnight. It is clear, however, that the gains are worth the investment both in the short term and the long term. Leaders learn from other leaders. Laying the seeds for effective clinical leadership now will ensure a fruitful future where effective clinical leaders are plentiful in successful NHS organisations.
Sarah Atkinson is a director in Tribal’s health practice. Dr Steve Blades, MRCGP, is a specialist in commissioning and clinical leadership