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28 November 2011
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Does clinical leadership help patients or doctors CVs?

By Anna Moore

The topic of ‘clinical leadership’ has the habit of bringing up all sorts of responses which, with the increasing amount of airtime it’s receiving, are more and more frequently being debated. In my experience so far, views vary from those keen to understand more and get involved, to the unconverted who assume it’s just another means of a small group of clinicians drawing attention to their careers.

This brings me onto the next issue, of why clinical leadership actually matters and whether it’s relevant to all doctors. Well, leadership and medicine have a long history together. For as long as people have sought health advice, doctors have been seen as leaders. All doctors, even F1s, are asked to lead clinical colleagues albeit in different capacities as we move through our training. What are we doing when we run a crash call…? Running a ward round…? Leading an audit project…? Doctors end up using some fairly sophisticated skills to manage these situations from their first days on the wards: advanced communication skills, assertion, delegation, team work, identifying a problem, stepping up to deal with it, analyzing the issues at hand, working out the problems ahead, the risks, communicating this with the people around you, winning confidence and setting a team on the ‘right’ course of action. As we develop throughout our careers we are expected to lead larger teams and ultimately services, departments and even hospitals, developing and applying these skills to an increasingly diverse set of situations. Yet I am not sure we always see these as examples of leadership. Nor do we always recognise how fundamentally important these skills are to good outcomes for our patients.

There is also a growing body of evidence demonstrating the link between services with good patient outcomes and satisfaction, and good clinical engagement with leadership and management.  And conversely services that have poor outcomes, are often shown to have poor leadership and poor clinical engagement with managers. Personally, I see clinical leadership as an emerging field with similarities with the ‘evidence based medicine’ movement of about 30 years ago, which too was an emerging field itself. During this time, there were some strong proponents who felt it was key to the future of medicine, however the majority of doctors initially just didn’t understand how or why it was important to their everyday clinical practice. Yet today it’s an integrated part of every doctor’s education and the basis upon which clinicians make decisions about their patient’s care every day. I would argue clinical leadership is similar. In the future it’s set to be an integral part of all of our education and although there will be a minority who work exclusively in the field, it’ll be something we are all thinking about and taught in a much more conscious and structured manner.

A growing number of clinicians are recognising the opportunity we have to influence the way our NHS and healthcare services are organized and run. Many others also recognise that clinicians may be best placed to understand the needs of patients and that we may be best placed to understand how services can be developed to meet our patient’s needs.

At the end of the day, being a good medical leader is about inspiring others to look after patients better, not about improving doctors' CV’s. We, as doctors, need to take back and embrace our responsibility for the NHS. Our responsibility to make the NHS the best it can be; with our patients at the very heart of a safe and effective health system.

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About the author

Anna Moore's picture

Anna Moore

Anna Moore is a Psychiatric Core Trainee from the Oxford Deanery, currently seconded to Faculty as part of the Department of Health’s Clinical Fellow Scheme. She has BSc in Neuroscience with research time spent at Harvard Medical School’s Neuroregeneration Laboratories, before Fast Track Medicine at Bristol University. Anna has a number of articles published, mainly in service improvement and disease modelling.

Before medicine she worked as an accountant and financial analyst in the private sector and has experience in financial and systems audit. She has led a number of projects within the NHS, has sat on her Trust’s NICE steering committee and been a Junior Doctor & BMA representative. She currently sits as a trustee on the Board of Directors of a Psychiatric Charity. She has a keen interest in the development of leadership and management within the medical profession.

Comments

1 year 11 months ago

Yeah.........I reckon

Yeah.........I reckon clinical leadership can help patients or doctors CVs. Thanks for sharing this awesome input. :)
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2 years 4 months ago

Thank you for what is an

Thank you for what is an interesting chain of thoughts. Picking up on Bernards point I feel that a much underused role of the clinical leader is to generate and support a culture where innovation and ideas are plentiful and welcomed. Innovation when disruptive can indeed 'shake the apple cart' and as with many proposed changes meet with resistance. However, empowering teams to challenge the status quo and be confident in generating ideas for change with a positive feedback loop to reward such activity is more achievable and less disruptive. This in turn links to the power of continual improvement and small tests of change where leadership supports and encourages teams to 'try something new' safely, with minimal resource and with metrics to enlighten and support the next round of testing.

2 years 4 months ago

Clinical Leadership

A couple of observations if I may. There is strong evidence that leadership which generates engagement correlates with high performance. This is seen in many sectors and has now been shown to be the case in healthcare. That is why the approach being advocated when introducing aspects of both management and leadership into medical education is one that aims to develop a series of leadership behaviours. The model is one of distributed leadership; leadership behaviours being demonstrated by many people at different levels. It certainly embraces the concept of followership.
However, I suspect Ross was also reflecting on the way NHS organisations deal with innovation. It is uncommon to find a successful healthcare innovator who reports a wholly supportive relationship with their managerial colleagues , or for that matter with all of their clinical colleagues. Creating a climate which is more conducive to innovation is another role for leadership. Perhaps the topic of a new blog?

2 years 4 months ago

More reading!!

Another piece of literature I meant to mention is the recent CQC report
http://www.cqc.org.uk/media/cqc-calls-action-improve-care-older-people

Also the 'book of the month' being read by the FMLM member's book club is Peter Spurgeon's 'Medical Leadership: From the dark side to centre stage' and this has a good chapter (Chapter 7) that explores some of the inter-related concepts of performance, leadership and engagement, discussing the evidence suggesting that good management practice and effective leadership can have a positive impact on organisational performance.

2 years 4 months ago

Doctors need to ensure quality of care is continually improved.

Like Eamonn & Anna, I agree that clinical leadership is key to effective teamwork, improved efficiency and better patient care. 

Though there are plenty of poor examples of leadership, which no doubt in many cases lead to detrimental care, I think these emphasise the importance that should be place on training doctors to be efficient and effective leaders. Without proper training those left to dabble may well bring unintended consequences to their organisation.

The key skills necessary to manage a disparate group of healthcare workers may come easier to some, but can be taught and learned just like any professional skill. The people that Ross refers to as providing a role model without leading and managing, I would suggest are in fact leading by example within a collaborative network. 

Key to ensuring that the medical profession takes responsibility for improvements in patient safety is the tacit acceptance by all doctors that quality of care is within their remit.