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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.

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Comments

12 years 4 months ago

Thanks Ross & Eamonn

Ross – I agree to some extent, in that we can’t all lead all situations all of the time. But I’m not sure that would be appropriate anyway. For me, the nature of leadership varies depending on the context the clinician is in, so the skills required would depend on this context too.

Regarding setting direction I agree that although all Docs are required to be leaders in different situations, all are followers too and it’s a requirement to be both in reality! As Eamonn says, we can’t all be Sir Bruce (and I bet he even has a role as ‘follower’ in some contexts). Perhaps one of the skills of a good leader is to understand the situations in which they need to ‘follow’? I think that as a team leader it would be inappropriate if I believed that just because I held that role that I always knew the ‘right’ direction. Part of my job would be to understand when I did need help in determining direction from others. I imagine the full time MD spends quite a lot of his time being ‘directed’ by the clinicians on the front line, or from those in specialties he has little experience of. And rightly so.

With respect to the evidence – in part, you may be right and I also agree with Eamonn in that there are no RCT trials demonstrating this link. Although I’m not sure how easy or ethical one would be. When I was looking into the area, I found some of the NHS Institution for Innovation and Improvement publications really useful. It sounds like you’ve done a lot of reading in the area. In particular, I found a couple entitled: ‘Engaging Doctors: What can we learn from trusts with high levels of medical engagement?’ and ‘Engaging Doctors in Leadership: What we can learn from international experience and research evidence.’ to be useful – what do you think?

The King’s Fund Leadership reading lists were also really useful to me http://www.kingsfund.org.uk/topics/leadership_and_management/index.html#... and as Eamonn says, there is a recent Health Foundation Publication exploring the links too. http://www.health.org.uk/public/cms/75/76/313/2119/What's%20leadership%2... 20with%20it.pdf?realName=JTGpo2.pdf
I also like the following authors: Michael West, Peter Spurgeon and Chis Ham. Ross - I’d be grateful for further recommendations as it sounds like you’ve done a lot of reading into this!

I think that in terms of an emerging field, as you indicate there is a continuing need to turn our attention to clinical leadership from an academic point of view, as you rightly point out there is still work to be done! I also get a sense that medical management and/or leadership is not an entirely accepted career path amongst all our colleagues quite yet.

Regarding management and leadership, I agree that the terms are not synonymous. Personally, I think that good leaders tend to have had a pretty solid understanding of management. However, I don’t think all managers need to be good leaders, nor would they all want to be. Obviously anyone can demonstrate excellent leadership skills, whatever their title. I suppose that in ‘life before medicine’ (as an accountant & in industry) I was developing a range of management skills that I am now able to apply to the healthcare system in the small projects I’ve led. These management skills have been invaluable to me and have certainly enabled me to understand better what is required of a good leader – something I can’t claim to have achieved, but continue to aspire to!

I certainly didn’t aim to claim a monopoly for clinical leaders on ‘aspiring others to look after patients better’, but was merely making the point that working to be a good clinical leader and/or manager is not just ‘CV polishing’. In my experience the clinical managers/leaders I have met are motivated by a genuine desire to help to improve the lot of their patients and no less so than the clinicians working on the front line.

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12 years 5 months ago

Leadership again

I agree with Anna, leadership is a skill we all posess and must nurture. I would argue with Mr Fisher's view of leadership. Not all doctors want to be the next Bruce Keogh. But we all want to be the best clinician possible for our patients. In order to do this we must lead patients, fellow doctors and other healthcare staff on the patient journey. The skills are engrained in us from an early stage, we very often don't realise we are using them. To be a better doctor I would argue that they should have the same importance as postgraduate exams and CPR training.
Secondly, I challenge Mr Fisher's view that the link between leadership and outcome is only theoretical. Whilst I agree that there are no peer reviewed original papers published on the topic, there are a mass of observational studies and expert opinions. In 2000, the government's performance and innovation unit reported on public sector leadership. It showed that the climate a team works in has up to 30% effect on the performance of said team. It also showed that leadership of the team had a 70% effect on the climate the team works in. I therefore do not have to offer great inference that leadership and performance are directly proportional.
Mr Fisher correctly points out that thereare many examples of good leadership in failing units. However, this is not a arguement that leadership has not effect on quality. Rather it shows that leadership is a (arguably large) component of the complex equation that is quality in healthcare.

Competing interest: I am on the NHS medical director's clinical fellow's scheme, on secondment to the health foundation. These views here are my own. Further evidence of the link between leadership and quality can be found on the health foundations website www.health.org.uk

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12 years 5 months ago

Leadership

Unfortunately I think this is a rather simplistic view.

We cannot, as you suggest, all be clinical leaders, else who will be followers and in what direction will we go if we all lead?

I would actually challenge the evidence that demonstrates the direct link between "services with good patient outcomes and satisfaction, and good clinical engagement with leadership and management." This has long been aspirational and perceived to be self evident but it is not actually reflected in academic practice. Conversely there are many reports of poor engagement with management and yet good clinical outcomes. The strong link is not proven.

I am unsure how "clinical leadership" can be all these things and then develop as an "emerging field" within all the different specialities unless you are simply referring to management. Leadership afterall has implicit qualities of followership and, my origonal point in my tweet was that management roles are not recognised by the profession as leadership. There are many who "inspiring others to look after patients better" who would neither lead nor manage.

In summary, the terms are not synonymous and their effects remain "a consummation devoutly to be wished."

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