ABC of Clinical Leadership (eBook)

Tim Swanwick, Judy McKimm (Autoren)

eBook Download: EPUB

2017 | 2. Auflage
John Wiley & Sons (Verlag)
978-1-119-13433-6 (ISBN)

Infos

The ABC of Clinical Leadership explores and develops the key principles of leadership and management.  It outlines the scope of clinical leadership, emphasising its importance in the clinical context, especially for improving patient care and health outcomes in rapidly changing health systems and organisations. Using short illustrative case studies, the book takes a systematic approach to leadership of clinical services, systems and organisations; working with others and developing individual leadership skills. 

This second edition has been fully updated to reflect recent developments in the field, including current thinking in leadership theory, as well as a focus throughout on workforce development and working in multidisciplinary healthcare teams.  International examples are used to reflect global practice and two new chapters on leading projects and followership have been added.

Combining theory and practical clinical examples, and written by clinical educators with a wealth of experience of leadership in the clinical and educational environment, the ABC of Clinical Leadership is an ideal resource for all healthcare professionals, both during training and for continuing professional development.

Tim Swanwick, Senior Clinical Adviser, Health Education England; Visiting Professor in Medical Education and Leadership, University of Bedfordshire; Honorary Senior Lecturer Queen Mary University of London and Imperial College.

Judy McKimm, Director of Strategic Educational Development, Swansea University; Visiting Professor Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia; Guest Professor Huazhong University of Science and Technology, Wuhan, China.

Inhalt

Contributors vii

Preface viii

1 The Importance of Clinical Leadership, 1
Sarah Jonas, Layla McCay and Sir Bruce Keogh

2 Leadership and Management, 5
Andrew Long

3 Leadership Theories and Concepts, 9
Tim Swanwick

4 Followership, 14
Hester Mannion and Judy McKimm

5 Leading Groups and Teams, 19
Lynn Markiewicz, Michael West and Judy McKimm

6 Leading and Managing Change, 24
Valerie Iles

7 Leading Organisations, 29
Stuart Anderson

8 Leading in Complex Environments, 33
David Kernick and Tim Swanwick

9 Leading and Improving Clinical Services, 38
Fiona Moss

10 Leading Projects, 43
Jonathan Gardner

11 Educational Leadership, 50
Judy McKimm and Tim Swanwick

12 Collaborative Leadership and Partnership Working, 56
Judy McKimm

13 Understanding Yourself as Leader, 61
Chris Lake and Jennifer King

14 Leading in Culturally Diverse Health Services, 66
Tracie Jolliff , Tim Swanwick and Judy McKimm

15 Gender and Clinical Leadership, 72
Celia Taylor and Judy McKimm

16 Values-Based, Authentic and Ethical Leadership, 77
Deborah Bowman and Tim Swanwick

17 Developing Leadership at All Levels, 81
Tim Swanwick and Judy Butler

Index 86

Textauszug

CHAPTER 1
The Importance of Clinical Leadership

Sarah Jonas1, Layla McCay2 and Sir Bruce Keogh3

1 Sussex Partnership NHS Trust, UK

2 University of Tokyo, Japan

3 NHS England, UK

OVERVIEW

• Clinical leadership is vital to the success of healthcare organisations.
• Strong clinical leadership is associated with high‐quality and cost‐effective care.
• Clinical leadership means healthcare professionals engaging in setting direction and implementing change.
• Effective clinical leadership is collaborative and multidisciplinary
• Clinical leadership is needed at every level.

Healthcare is a huge, important and inherently complex business; every person in the world needs it, every country spends substantial proportions of their gross domestic product (GDP) on it, governments are judged by it, populations are determined by it and almost everyone has a personal interest in how it is delivered. The USA spent 17% and the UK 9% of its GDP on healthcare in 2013. Healthcare organisations also provide employment for a substantial sector of the population; for instance, the UK’s National Health Service (NHS) employs 1.4 million people, making it the third largest civilian organisation in the world.

To enable organisations of such magnitude to deliver high‐quality healthcare, high‐quality leadership and management are vital at every level, from the national to the local, all the way down to the orchestration of individual interactions between patients and healthcare professionals. To be truly effective, this leadership must come not just from professional managers, but from across the clinical professions (Figure 1.1).

Figure 1.1 Truly effective clinical leadership is multidisciplinary.

Copyright iStockphotos.

What is clinical leadership?

The terms ‘leadership’ and ‘management’ are often used synonymously or as overlapping concepts. But as Chapter 2 describes, they are two distinct but interdependent ways in which organisations, groups or individuals set about creating change while maintaining stability. Leadership involves creating a vision, setting strategic direction and establishing organisational values. Management is more focused on directing people and resources to deliver the strategic aims established and propagated by leadership. A lack of either – leadership or management – makes it difficult for an organisation to effect change or bring about improvement.

Clinical leadership refers to the concept of healthcare professionals, as opposed to professional managers, undertaking the leadership task: setting, inspiring and promoting values and vision, and using their clinical experience and skills to ensure the needs of the patient are the central focus in their organisation’s aims and delivery. Clinical leadership is key in both promoting high‐quality care and transforming services to meet evolving population needs. And there is a role for clinical leadership at every level in healthcare organisations and systems; leadership is a process, not a position.

Why is clinical leadership important?

Globally, healthcare organisations must balance the need for financial sustainability and competitiveness with the need to deliver safe and effective care. There is mounting international evidence that good clinical engagement is associated with high organisational performance, and that strong clinical leadership leads to care of higher quality (Box 1.1). Effective leadership in healthcare occurs at distinct levels: the strategic, the organisational and the frontline. And just as multidisciplinary approaches benefit face‐to‐face patient care, drawing on diverse experience and skills can also help achieve high‐quality healthcare at these various levels.

Box 1.1 Evidence for an association between clinical leadership and quality of care.

• High‐performing organisations are more likely to have clinicians on the governing board (but the direction of this association is not clear).
• Organisations with high levels of clinical engagement tend to perform better against a range of quality metrics.
• There is an association between distributed leadership and quality of care.
• Teams with low levels of conflict and shared leadership function better and deliver better care.

Despite the strong face validity of a link between clinical leadership and quality of care, a broad evidence base in this field has been slow to develop. This is largely due to the variability of how clinical leadership is defined and the complexity of healthcare organisations. However, some conclusions can be drawn.

At the organisational level, promising correlations between medical leadership and hospital rankings have emerged in the US (Goodall, 2011), while in the UK, a large‐scale review of medical leadership models (Dickinson et al., 2013) found that organisations with high levels of engagement between doctors and managers performed comparatively better than other organisations on available measures of organisational performance. Another UK study examined annual reports, performance statistics, patient outcomes, mortality rates and national patient survey data and showed that higher proportions of clinicians sitting on a hospital’s strategic governance board were associated with better performance, patient satisfaction and morbidity rate (Veronesi et al., 2012). Across the world, studies of organisational culture find strong links between high levels of clinical engagement, the distribution of leadership perceived by clinicians working in an organisation and the quality of care achieved by that organisation.

International evidence also shows that clinical leadership is also a key variable in the effectiveness of healthcare development and change implementation in an organisation (Greenhalgh et al., 2005). Of particular importance is the presence of clinical champions who are willing to lead by example (Soo et al., 2009).

At the level of clinical and nursing teams, meta‐analyses of research consistently indicate that across sectors, shared leadership and participative management in teams predict team effectiveness, including empowerment and self‐efficacy, whereas team conflict is, not surprisingly, connected with poor performance (d’Innocenzo et al., 2014; Wang et al., 2014).

The development of clinical leadership practice

Historically, healthcare management has been described as ‘management by consensus’, where administrative, medical and nursing hierarchies co‐existed but had no power over one other. Administrators made administrative decisions, doctors made medical decisions, nurses made nursing decisions and central funding bodies, including government, made funding decisions. More recently, increases in costs and the complexity of healthcare have made this model difficult to maintain.

Globally, countries have taken different approaches to the leadership and management of healthcare, with many countries employing doctors (or, less frequently, other health professionals) in senior leadership roles. In the UK, however, the government‐commissioned Griffiths Report (1983) led to the introduction of general management in the NHS. This involved formalising management arrangements, creating boards and appointing clinical and medical directors to manage particular service areas with the intention of aligning clinicians with the objectives of the organisation; however, this was not always achieved. Throughout the 1990s, there was a growing recognition that clinicians needed to be actively engaged in the leadership and management of health services in order that change might proceed unimpeded. By the next decade, it had become apparent that clinical engagement was not only necessary to prevent the derailing of managerial initiatives, but a vital prerequisite for effective direction setting and change management. The prevailing view today is that high‐performing healthcare organisations tend to be clinically led, with strong partnerships between clinicians and professional managers, and a shared commitment to clinical quality.

Leadership and healthcare professionals

Health organisations have always experienced an inherent tension between central control and clinical autonomy. Mintzberg (1992) describes healthcare organisations as ‘professional bureaucracies’, where significant organisational decisions are made at the periphery by individuals with a relatively free rein – as opposed to a ‘machine bureaucracy’, such as a government department or a factory, where organisational decisions are made centrally, directed by a middle tier of management and enacted by a large group of workers operating under instruction.

An essential feature of the professional bureaucracy is the need for leadership to come from within in order to engage that group in enacting the vision for change. A lack of effective leadership can lead to anarchy as significant decisions involving the whole organisation can be made at the frontline without regard for overall organisational strategy, while such strategies may not be ‘heard’, paid attention to or implemented on the frontline....

Produkt-Details

• Erscheint lt. Verlag: 10.1.2017
• Reihe/Serie: ABC Series
• Reihe/Serie: ABC Series
• Reihe/Serie: ABC Series
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Allgemeines / Lexika
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Medizinethik
• Themenwelt: Medizin / Pharmazie ► Studium
• Schlagworte: Care • Change • Clinical • Clinical Skills • Clinicians • Collaboration • dentists • doctors • Environments • Followership • Health • Healthcare • Klinische Fertigkeiten • Leaders • Leadership • Management • Managers • medical education • Medical Professional Development • Medical Science • Medizin • Medizinstudium • nurses • orgainization • Organisation • outcomes • Partnership • Patient • Perspektiven in medizinischen Berufen • Policy • Projects • Service • Staff • Supervisors • Support • Teams • Trainers
• ISBN-10: 1-119-13433-1 / 1119134331
• ISBN-13: 978-1-119-13433-6 / 9781119134336