‘The importance of effective clinical leadership to ensure a high-quality healthcare system that consistently provides safe and efficient care has been reiterated in scholarly literature and in various government reports.’

(Xu 2017)

What is Leadership?

Leadership is both the position or fact of being the leader and a set of characteristics that make a good leader (Cambridge Dictionary 2024).

Leadership also encompasses the task of facilitating individual and combined efforts to fulfil shared objectives (Schyve 2009). This definition makes clear that leadership is not purely based on rank but is a practised skill.

This article relates to the National Safety and Quality Health Service Standards: Standard 1 Clinical Governance.

‘Leaders of a health service organisation have a responsibility to the community for continuous improvement of the safety and quality of their services, and ensuring that they are person-centred, safe and effective.’

(ACSQHC 2021)

What is Clinical Leadership?

The rise of clinical leadership in recent years can be thought of as a response to the invitation (from organisations) for clinicians to engage in leadership practices, traditionally thought of as roles reserved for administrators and/or professional health service managers only.

Literature has argued that clinical leadership could be the solution to current problems faced by health service organisations locally and globally (Gauld 2017; Swanwick & McKimm 2011; Mountford & Webb 2009). These challenges include but are not limited to financial tensions, changing consumer expectations, higher demands in terms of access to care, directives to improve patient care, and new measures pertaining to the quality and safety of healthcare.

The Case for Clinical Leadership

Clinicians should be able to take on leadership posts from a position of authority gained through evidence-based practice, ideally positioned for meaningful patient advocacy.

Patients often want their clinicians, who play the most active role in their care, to be involved in making major decisions within an organisation (Mountford & Webb 2009).

After all, clinicians are at the forefront when it comes to the quality and efficiency of care provided to patients. Clinicians also have the technical knowledge to make well-reasoned decisions around long-term care provision (Mountford & Webb 2009).

The UK’s National Health Service: A Case Study

Swanwick and McKimm (2011) demonstrated the success of clinical leadership through a British case study in which the UK’s National Health Service (NHS) appointed a London doctor, Ara Darzi, to take on the role as Health Minister in 2007.

Darzi’s vision was to secure quality as the core of health service provision. In his view, clinicians should take on three key roles: ‘practitioner, partner and leader’ (Swanwick & McKimm 2011).

Darzi’s policies helped to raise the profile of clinical leadership and affix it to the UK’s national consciousness (Swanwick & McKimm 2011).

A study conducted by the NHS found that in 11 cases in which improving services was the primary aim, organisations with stronger clinical leadership achieved more success (Mountford & Webb 2009).

Effective healthcare is not achieved by an individual alone; it is the result of large, complex systems working in harmony, engaging with multiple individuals and organisations. A successful clinician needs to understand those pathways and systems of care, and if they are to lead effectively in the 21st century, must be comfortable collaborating with those systems for the benefit of their patients (Swanwick & McKimm 2011).

What is the Case Against Clinical Leadership?

An American study unearthed the following barriers to implementing this leadership shift:

• There is persistent doubt as to the value of experienced clinicians allocating time to leadership rather than treating patients
• Playing an organisational-leadership role may not be seen as vital for providing patient care or the professional success of the clinician
• The impact of clinical leadership is often hard to measure or prove
• There are weak or, in some cases, negative incentives for clinicians to take on service leadership roles
• Leadership potential generally is not a requirement for entry into the clinical professions and often isn’t a major factor in promotion
• There is not a well-defined career path for those in leadership roles - in stark contrast with well-known clinical and academic routes
• Peer recognition is low or nonexistent.

(Mountford & Webb 2009)

Overall, Mountford and Webb’s study makes it clear that systemic change is necessary, as it is the overarching barrier to clinicians moving into leadership roles.

What Should Organisational/Clinical Leadership Strive to Achieve?

Recommendations from the NSQHS Standards

Organisational Leadership

The health service should create a clinical governance framework and use this to improve the safety and quality of healthcare provided to patients. The organisation should also create strategies to meet the safety and quality needs of Aboriginal and Torres Strait Islander people. Safety and quality must be key considerations in every business decision (ACSQHC 2021).

Clinical Leadership

Leaders should assist all healthcare staff in performing their safety and quality roles and responsibilities. They should also support clinicians in improving the safety and quality of healthcare, guided by the organisation’s clinical governance framework (ACSQHC 2021).

Conclusion

Clinical leadership is still not implemented widely across healthcare; at present, it exists mainly in isolated pockets of excellence and innovation (Gauld 2017; Mountford & Webb 2009). However, the long-term benefits for both clinicians and their patients have been well demonstrated in practice and reiterated in literature.