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added:
09 January 2009
Clinical Leadership are we asking the right questions? Attempts to improve ‘clinical engagement’ and ‘clinical leadership’ have been made intermittently over the last decade with varying success and an extensive literature has developed on the subject. Lord Darzi’s Next Stage Review1 again emphasises the need for clinical leadership, ‘fostering leadership for quality’ and suggests a new professionalism with ‘clinicians as practitioners, partners and leaders’.
This latest and laudable attempt to involve clinicians in formal leadership roles also comes at a time when the evidence that doctors can influence organisational performance is growing2. But are clinicians, in fact, difficult to engage and reluctant to lead? There sometimes seems no shortage of candidates for senior positions in professional societies, the Royal Colleges and the BMA.
Whether these individuals turn out to be good leaders is neither here nor there, they are clearly not reluctant to lead, and do get engaged in agendas that they find interesting or important to them. This raises an interesting set of questions about why professional leadership may be attractive to some clinicians but clinical leadership of a health organization or of the broader NHS may be less so.
What do we mean by clinical leadership?Are the skills and competencies of clinical leaders any different to those of non-clinical leaders in NHS organizations?
Is the context in which those skills and competencies are displayed different for clinicians?
Are the barriers to clinicians displaying leadership or developing leadership skills different to non-clinicians and, if so, what can be done to overcome them?
To help answer these and similar questions, Dearden have been engaged by the NHS North West Leadership Academy to conduct a detailed and comprehensive study of the current state of and attitudes towards clinical leadership development in all the NHS organisations in the North West of England. Through a series of interviews, group meetings, questionnaires and large, multi-disciplinary open-space events, we are examining not only the ‘transactional’ aspects of leadership (skills, competencies, training and education, career development opportunities, etc) but also the broader organizational development factors underpinning it. Our hypothesis is that skilled clinical leadership is a necessary part of a successful organization but alone is insufficient. It must be practised in the correct receptive context, have a clear purpose linked to a proper understanding of the organization’s (and wider NHS) goals and be backed up by professional managers that are not afraid to let clinicians into their world.
The implications of this are simple in concept but may require a fundamental shift in culture in some organizations.
Clinicians will need...
to align their professional priorities and ambitions to organizational and service goals.
help to overcome their previous reductive training to see the broader health picture beyond their specialist areas.
help to change their perception of risk-management away from a perfectionist approach of wanting to do the very best for the individual patient before them to accepting that prioritization and compromise may be necessary.
to accept financial responsibility for clinical decisions.
Managers will need to acknowledge...
that the different knowledge base of clinicians may change organizational priorities.
that clinicians will not be as influenced by central DH and political directives as career managers.
that clinicians by and large will not have the basic managerial skills acquired by professional managers and will need significant support.
This agenda therefore is as much about engaging managers as it is about engaging clinicians. This could be challenging for a generation of managers, especially at Chief Executive level, who have become used to a different environment. It will require both professional groups to develop new behaviours, attitudes and possibly a new language to bridge the gap between existing cultures.
For all this to succeed, it follows that clinical leadership development must take place firmly in the context of the wider development of the organization; a message that Dearden have been promoting since its inception in 1989.
If you would like to learn more about the work Dearden are doing with the NHS North West Leadership Academy, or about other ways in which Dearden can help your organization develop its clinical leaders, please contact Dr David Dawson on telephone 07940 438988 or by email on david.dawson@dearden.co.uk
1Department of Health (2008) High Quality Care for All: NHS Next Stage Review Final Report, TSO: London. 2Hamilton P, Spurgeon P, Clark J, Dent J, Armit K (2008) Engaging Doctors: Can doctors influence organisational performance? NHS Institute for Innovation and Improvement: Coventry.
