What is clinical leadership and how can we embed a clinical?

What is clinical leadership?

Leadership is a complex topic which we observe all around us in every day settings but can be challenging to precisely define. It broadly encompasses a set of behaviours to help collectively align and guide people and organisations to deliver a strategic vision or plan. Within healthcare settings, clinical leadership involves ensuring that doctors and their multi-professional colleagues can efficiently and effectively deliver high quality healthcare to their patients both at an individual level as well as at an organisational level. This can be delivered from formal leadership roles such as Hospital Director or Head of Department but equally importantly, it can also be delivered individually by doctors of all grades both formally and informally as they go about their daily clinical practice activities and related duties.

Why is clinical leadership important?

In general, healthcare organisations that are well run with a good clinical leadership culture deliver better results, for example achieving lower complication rates from surgery, having shorter duration of in-patient stays and demonstrating higher levels of staff satisfaction. The converse is also true in that organisations which are less well run with poorer clinical leadership generally have worse outcomes including morbidity and mortality rates. These organisations also have poorer working environments, for example experiencing challenges such as high rates of bullying, higher levels of sickness absence and higher staff turnover. Ultimately, proficient clinical leadership in healthcare improves working practices and has a direct positive impact on patient safety including through reducing the chances of causing harm to patients.

Who is a clinical leader?

It is important to appreciate that every doctor from House Officer to Senior Consultant is a clinical leader within their immediate professional working environment. This is true from a House Officer leading an emergency on-call team to successfully perform CPR at 2am at night to save the life of a critically unwell patient to the Hospital Director who successfully secures funding to expand a busy Emergency Department. As such, context and situation are important aspects of clinical leadership and all doctors will at times be required to step into the role of clinical leader.

What are the key attributes to being a clinical leader?

Whilst, all doctors need to perform the role of clinical leader at certain times, it is important to recognise that experience, and often the hierarchy and seniority associated with this experience, is of high importance. Clinical leaders understand how healthcare systems work, appreciate the complexities of how to deliver high quality care and are able to proficiently navigate the healthcare environment to deliver desired results both individually and collectively as a team. This experience includes subject specific knowledge of how to practice medicine or surgery and how to best deliver this healthcare, as well as general leadership skills and attributes. These general leadership skills include effective team working, communication, interpersonal skills, compassion, time management, conscientiousness, openness and collaboration.

What are the different styles and models of clinical leadership?

Just as no two individuals are the same, no two leaders are the same. Indeed, successful leaders may take very contrasting approaches to leadership. For example, a naturally extrovert leader who enjoys public speaking may use high profile talks to deliver their vision, engage and to motivate staff, whilst a more introvert leader may prefer to communicate through smaller group discussions and written material. Approaches will also differ based on the circumstances and needs of the service. For example, if an organisation is split over different geographical areas and sites, a hospital director may at times delegate leadership responsibility to trusted colleagues. Importantly, a successful leader will be aware that in order to achieve their leadership vision, they will need to create an appropriate workforce and workplace culture. As part of this, they will need to assemble a reliable, motivated team who jointly share and own this vision and who are able to work together collectively to deliver it. Furthermore, a clinical leader will be self-aware of their personal strengths and weakness and ensure that their senior leadership team is composed of a range of individuals who collectively between them have the necessary skills and attributes to achieve their vision.

How do you develop clinical leadership skills?

Leadership skills are accrued over time and through experience, starting early on in life during childhood well before commencing medical school. Indeed some people appear to innately and effortlessly possess certain leadership qualities! Leadership skills can however be taught, learnt and refined with appropriate supervision, guidance and practice. With support, most doctors are capable of becoming a clinical leader. The support and guidance they need however must be clearly defined as well as delivered within authentic contexts. Explicit clinical leadership learning objectives should be included in all undergraduate medicine curricula as well as incorporated into postgraduate medical education curricula for higher specialist training. These objectives need to be developed and overseen collaboratively by medical schools, the Malaysian Medical Council, the Ministry of Health as well as learned societies such as the College of Surgeons, College of Physicians and Academy of Medicine. Furthermore, doctors need to be given the time and space to appreciate and reflect on the relevance of clinical leadership to their everyday professional practice. As such, clinical leadership training should be viewed by trainers as a core part of undergraduate and postgraduate training and not as an addition to the core syllabus. 

Finally, it is vital that trainers appreciate the importance of positive role modelling in education when supervising trainees. Human beings learn through role modelling and generally conform to community norms. This means that both positive behaviours and negative behaviours from supervisors and current clinical leaders will directly influence how the future generation of clinical leaders will behave.

Where can you practice being a clinical leader?

One can practice being a clinical leader through a variety of methods and in various contexts. At both undergraduate and postgraduate level, this can include formal teaching and case studies to showcase examples of good clinical leadership. For example, simulation training with case studies on how to assess the critically unwell patient or how to respond to a patient complaint or clinical error all involve elements of clinical leadership training. There are also a variety of courses regionally, nationally and internationally that provide in depth clinical leadership training, such as the clinical leadership workshop run by the College of Physicians of Malaysia. Most importantly however, it is the situated learning experience – that of learning to be a clinical leader through practicing it on the job – which will allow postgraduate trainees the most authentic experience of learning to be a clinical leader. This however requires proficient, active supervision and mentoring from trainers so that learning opportunities are made explicit, reflected upon and refined over time to support development. One such example may include a Specialist swapping roles with a registrar once a week to allow the registrar to lead a ward round. Importantly, the Specialist will still participate in the ward round and provide specific feedback and guidance at the end of the round. 

Finally, for those trainees who are keen to develop a subspecialist interest in clinical leadership, Clinical Leadership Fellowship programmes, similar to the model used by trainees completing Research Fellowship programmes, have been shown to work well. During these programmes, trainees apply to take a period of time out of their core postgraduate specialist training to develop their leadership experience. For example, trainees may work with senior leaders such as Hospital Directors to develop new clinical services at their hospital or at higher levels, such as working with senior leaders from the Ministry of Health to develop national clinical policy. Ultimately, no one method will work for all, but a range of opportunities along with a general recognition amongst current leaders of the importance of developing clinical leadership skills will be required to continue help improve health outcomes for the people of Malaysia.