South Thames Foundation South Thames Foundation SchoolSchool

Faculty BriefingFaculty Briefing

2929thth January 2010 January 2010

Clinical Leadership in Clinical Leadership in FoundationFoundation

“ The doctor's frequent role as head of the healthcare team and commander of considerable clinical resource requires that greater attention is paid to management and leadership skills regardless of specialism. An acknowledgement of the leadership role of medicine is increasingly evident. "

Aspiring to Excellence, Prof John Tooke, 2008

Hospitals where clinicians are engaged in strategic planning and decision making are better performers than those where

clinicians are alienated from the strategic processes of the hospital

(Goldstein and Ward 2004).

‘Significant change in clinical domains cannot be achieved without the cooperation and support of clinicians. . .

(Bowns and McNulty, 1999, 66–7)

A Staffordshire NHS trust whose standard of emergency care led to patients dying needlessly showed a "lamentable failure of clinical leadership"

There is a need for clear and visible leadership at the top but this has to be linked with the development of leadership at all levels, especially clinical leadership in both primary care and hospitals.

Chris Ham - Professor of Health Policy and Management 2003

Doctors in society: medicalDoctors in society: medicalprofessionalism in a changing worldprofessionalism in a changing world

We recommend that the General Medical We recommend that the General Medical Council revises its important document, Council revises its important document, Tomorrow’s doctors, Tomorrow’s doctors, to strengthen to strengthen leadership and managerial skills as key leadership and managerial skills as key competencies of professional practice. competencies of professional practice.

Report of a Working Party of the Royal College Report of a Working Party of the Royal College of Physicians of London. London: RCP, 2005of Physicians of London. London: RCP, 2005

Doctors in society: medicalDoctors in society: medicalprofessionalism in a changing worldprofessionalism in a changing world

Report of a Working Party of the Royal College of Report of a Working Party of the Royal College of Physicians of London. London: RCP, 2005.Physicians of London. London: RCP, 2005.

    CHMS particularly welcomes the recommendations to CHMS particularly welcomes the recommendations to strengthen clinical leadership.  Medical Schools firmly strengthen clinical leadership.  Medical Schools firmly believe that good leadership is fundamental to the rolebelieve that good leadership is fundamental to the role

of each and every doctor and that all doctors should of each and every doctor and that all doctors should demonstrate the potential to act as leaders when demonstrate the potential to act as leaders when required. required. 

Professor David GordonProfessor David Gordon, Chair of The Council of Heads , Chair of The Council of Heads

of Medical Schools of Medical Schools

Next stage review -2008Next stage review -2008

For those at a postgraduate or equivalent stage in their careers, we will explore ways to ensure that both the curricula and appraisal processes reflect the importance of learning leadership skills.

Ara Darzi

Defining clinical leadershipDefining clinical leadership

“ “The essence of clinical leadership is to motivate, The essence of clinical leadership is to motivate, to inspire, to promote the values of the NHS, to to inspire, to promote the values of the NHS, to empower and to create a consistent focus on the empower and to create a consistent focus on the needs of the patients being served. Leadership needs of the patients being served. Leadership is necessary not just to maintain high standards is necessary not just to maintain high standards of care but to transform services to achieve even of care but to transform services to achieve even higher levels of excellence.”higher levels of excellence.”

(Department of Health, 2007)(Department of Health, 2007)

Defining clinical leadershipDefining clinical leadership

“ “ Driving service improvement and the Driving service improvement and the effective management of teams to provide effective management of teams to provide excellence in patient / client care”excellence in patient / client care”

Scottish Executive, 2005, p4Scottish Executive, 2005, p4

‘‘Teaching leadership in clinical Teaching leadership in clinical settingssettings

Curricula will have leadership Curricula will have leadership competencies embedded competencies embedded

Local clinical and managerial champions Local clinical and managerial champions to set up teaching leadership initiativesto set up teaching leadership initiatives

Use of Local faculty structuresUse of Local faculty structures Development of local resourcesDevelopment of local resources Development of ES and CS in teaching Development of ES and CS in teaching

and assessing leadership competencies.and assessing leadership competencies.

Leadership FrameworksLeadership Frameworks

BAMMBAMM NHSIINHSII AMRoC Medical Leadership Competency AMRoC Medical Leadership Competency

Framework April 2008Framework April 2008 AMRoC common competency framework AMRoC common competency framework

based on good medical practice based on good medical practice May 2009 specialty curriculaMay 2009 specialty curricula

KSS leadershipKSS leadershipSt Richard’s HospitalSt Richard’s Hospital

Western Sussex Western Sussex Hospitals Trust Hospitals Trust December 2009December 2009

Current leadership activityCurrent leadership activity

Trainees encouraged toTrainees encouraged to

Engage in AuditEngage in Audit ResearchResearch Represent their peersRepresent their peers Take on roles of responsibilityTake on roles of responsibility Teach Teach

More recently…More recently…

Expose trainees to variety of leadership Expose trainees to variety of leadership learning opportunitieslearning opportunities Taster daysTaster days HImP (Health Improvement Projects)HImP (Health Improvement Projects) Provision of medical Student OSCEProvision of medical Student OSCE Highlight influence of external drivers eg Highlight influence of external drivers eg

NICE, CNST and NPSANICE, CNST and NPSA

Taster DaysTaster Days

Obtain consent from Trust LeadersObtain consent from Trust Leaders Explain aims to CEO etcExplain aims to CEO etc Provide feedback form Provide feedback form Highlight opportunities to trainees via Highlight opportunities to trainees via

Educational SupervisorsEducational Supervisors Trainee to impart experience to peers at Trainee to impart experience to peers at

later datelater date

HImPHImP

Open forum to highlight areas for Open forum to highlight areas for improvementimprovement

Identify most significant issuesIdentify most significant issues Summarise Summarise Feedback actions requiredFeedback actions required Facilitate project managementFacilitate project management Present findings/solutionsPresent findings/solutions

Medical Student OSCEMedical Student OSCE

Familiar to all junior doctorsFamiliar to all junior doctors Encourages overall leadership to Encourages overall leadership to

coordinate the whole sessioncoordinate the whole session Encourages “micro” leadership to set up Encourages “micro” leadership to set up

and design individual stationsand design individual stations Encourages need for professionalism, time Encourages need for professionalism, time

management, assessment and feedbackmanagement, assessment and feedback

Leaders in the NHSLeaders in the NHS

NICENICE CNSTCNST NPSANPSA KSSKSS

Highlight the influence of agencies and Highlight the influence of agencies and how they effect Junior Doctors working how they effect Junior Doctors working lives lives

Opportunities to corroborate or refute Opportunities to corroborate or refute guidelines and policiesguidelines and policies

SummarySummary

Are there better ways?Are there better ways? Does everyone have to “do” Leadership or Does everyone have to “do” Leadership or

just be exposed?just be exposed? Leadership in bite sized bits (OSCE)Leadership in bite sized bits (OSCE) Leadership in context/relevant to NHS Leadership in context/relevant to NHS

agenciesagencies