Three challenges for clinical leaders in 2016

It’s been a turbulent start to 2016 for clinical leaders, with industrial disputes and increasing pressure to deliver high-quality care alongside the ‘eye-watering productivity improvements required under the NHS five year forward view’.

Involving clinicians in decision-making and leadership will be vital if the NHS is to bring about long-term, sustainable changes in clinical care and services and get the best value for every pound spent.

Through our work supporting clinical leaders – including doctors, nurses and allied health professionals – at all stages in their careers, we hear first-hand about the issues they’re facing, and some of those we’ve worked with have shared their perspectives on our blog. Three main challenges emerge for clinical leaders in 2016.

The first is ensuring a renewed focus on quality improvement. The exemplars of quality improvement in the United States include Virginia Mason, Intermountain Healthcare, Kaiser Permanente and Mayo Clinic, and those closer to home include NHS Highland, Salford Royal NHS Foundation Trust and Wrightington, Wigan and Leigh NHS Foundation Trust. These organisations have strategies that are focused on continuous quality improvement and identifying, developing and nurturing leadership talent. For example all have invested in data systems (identified by clinicians) that link their outcomes to systems for delivering care. Early successes in the vanguard sites in the United Kingdom have come from clinicians’ desire to have better data on which to base their clinical decisions. To achieve better quality, data-driven outcomes, clinicians will require more development, support and resources. Leaders across the NHS, including arm’s length bodies and regulators, will need to encourage quality improvement as the central strategy (look out for our upcoming report on this by Chris Ham and colleagues, due to be published later in February).

A recent pilot quality improvement programme in a large community mental health provider has shown how investing in a strategic approach to quality improvement can help re-focus resources on those vital few projects that have the most measureable impact on the quality of patient/user care. Giving quality improvement primacy can reduce waste, duplication of resource, avoidable variation in patient outcomes and, in some cases, reduce costs. The engagement of doctors in this pilot was critical to its success, reinforcing the importance of medical engagement in achieving improvements in the quality of care and ultimately contributing to creating a culture where continuous improvement and safety are valued.

The second challenge is for clinical leaders to remain focused on their values, passion and purpose. For example we are often reminded by doctors in primary care, secondary care and mental health settings that their first and foremost priority is to act in the best interest of patients – to ‘first do no harm’ and that in tough times it is their core values that help them to maintain focus and to lead effectively. These values enable clinicians to lead and manage services that are truly patient-centred, and they go some way towards increasing levels of trust in our culture of care. This is another reason why more needs to be done to attract clinicians into leading continuous quality improvement, and to harness their talents in supporting local innovation.

Third and finally, clinical leaders need to appraise traditional power relationships with patients, using their specialist knowledge in ways that take account of the needs, wants and beliefs of patients. As patients we are much better informed and demanding consumers, and are moving towards becoming ‘partners’ in designing our health care. It’s an area we’re actively exploring at the Fund and supporting through our work with patient leaders.

Over the next year and beyond, we’ll work with clinical leaders to support them to face these challenges – a continuation of a journey we began with organisations and individuals through our leadership development work many years ago. We are working with NHS Improvement to provide support for trusts in ensuring that they have the leadership across their organisations in the future to deliver cultures that are unwaveringly focused on the delivery of high-quality and continually improving care.

We will continue to promote the growth of healthy cultures in which organisations place value on looking after the health and well-being of their workforce. By helping medical professionals and the organisations in which they work to harness their collective potential, we aim to carry the NHS further forward in delivering the health and care that we and our families deserve.

Keep up to date

Subscribe to our email newsletters and follow @TheKingsFund on Twitter to see our latest news and content.


#545741 Claire Dow
Consultant Geriatrician and Clinical Director Community Health Services
Barts Health NHS Trust

Empowering our staff to be able to "be the change" in these times for uncertainty is another challenge. They have the skills and the knowledge so easy need to ensure that they are able to co produce services for the people we care for. However I think it is a challenge that we can embrace.

#545742 Vijaya Nath
Director Leadership Development
The King's Fund

Claire the talent,skills & passion that resides in our clinicians is one of the NHS's greatest assets .
National leaders and those at system and organisation level need to make it possible for your cohort's skills , knowledge and behaviours to be utilised in these challenging times .
Thank you for adding to this piece .

#545744 Sarah Mundy
Aquarius Management Consultants

The ability of these clinicians to role model the key qualities and behaviours is key. This ability to help enable others to recognise how to remain focusd on their values and passions and to be able to fully engaged with patients shows true leadership.

#545746 Peter Buckley
Development Director
Entrusted Consulting Ltd.

Without hesitation I would agree with these linked challenges for clinical leaders. Leadership is about setting an example, but also coming to the table in the first place.

At the heart of change for good and effectively addressing these challenges has to be the rebuilding of trust between individuals and trust between clinical and non-clinical leaders. Silos arise when individuals loose trust in the motives, values, passion and purpose of others.

Addressing this route cause goes a long way towards enabling success by whatever criteria it is measured. This can be done, with care, focus support, honesty and time.

#545752 Michael Bergstrom
Senior Advisor
Swedish Association of Local Authorities and Regions

I think that doctors need to face the challenge of increasing multimorbidity. Traditional organisation, education, research, measurenent and financial modells are not fit for purpose. This needs to be adressed in order to stick to the core idea of healthcarw eg decrease the burdon of illbess and support health.

#545753 Vijaya Nath
Director Leadership Development
The King's Fund

Agree Michael,
Healthcare demographics are stark we do need to redesign our ways of working , educating , measuring , financing . Clinicians best place to lead this in concert with Patients and inter related agencies .

#545755 Dr Kadiyali M S...
Innovation Integration Consultant
7iMed Ltd

I have been struggling to come to terms for more than a decade addressing the second challenge is for clinical leaders. I can comfortably say, the reason healthcare is failing is because the clinical leaders have not remained focused on their values, passion and purpose.

I assumed doctors in primary care need not be reminded that their first and foremost priority is to act in the best interest of patients – to ‘first do no harm’ and that in tough times it is their core values that help them to maintain focus and to lead effectively.

UCH in London in 1996, introduced pre-printed assessment sheet, the result of this this approach created a new breed of doctors who are not looking, listening or acting in the best interest of patients but believe evidence based approach, guidelines and protocols are more important than listening carefully to the story of patients. As Jerome Groopman, wrote in his "How Doctors Think", the next generation of doctors will be computers if we give more importance to statistics and numbers and I certainly will do all that I can to create "Dr Maya Doll" with the help of my friends in China.

The primary role of a doctor is not saving lives nor alleviating pain and suffering using drugs but to identify the problem offer the best solution to be happy (physical and mental wellbeing). I must tell you we doctors have not been fortunate to have developed any drug that cure any illness and been callous to loose the one and only drug that cured any illness "The Antibiotic".

Unfortunately we are now in a junction when humanity and our profession is threatened by the very micro-organisms that once we thought we had conquered and yet the leaders are talking about cost, method to sustain NHS and offering advice to doctors based on theoretical idealism and not based on practical reality.

It is we doctor who sit and consult, manage acute illness in the community who are in danger and not the leaders who have occupied the seat of power. So please stop thinking of "Challenges for leaders", and start thinking of "Challenges to doctors and nurses in the community" and threat to humanity.

I have endowed pain, suffered, humiliated, lost all that I had and now ready to bring in changes that need no money nor help from institution or people in power. I have done all that I can only to make sure my colleagues (doctors), nurses, staff and their family who are spending time, effort and working in the community knowing their life is now in danger due to emerging infections and antibiotic resistant bacteria spreading all over the world.

Knowing more healthcare workers than general population died in ebola infected area, please stop talking about the challenges faced by self proclaimed leaders who have lost touch with the reality.

My contribution is to help fellow human and the doctors who manage their illness and not patronise institutions that claim to act in the interest of our profession and patient care.

#545765 Dr Umesh Prabhu
Medical Director
Wrightington, Wigan and Leigh FT

Fundamental problem in our NHS is Board has 80% non-clinical leaders and only 20% clinical leaders. In such a culture finance and targets dominate. Sadly clinical leaders are not trained in leadership and many do not get feedback about their own leadership and been in such position for a very long time. Many Board leaders are good people trying to do their best. But with targets, financial challenges NEDs put pressure on Execs who put pressure on staff and hence in such a culture patients and staff suffer.

In Wrightington, Wigan and Leigh we have transformed the Trust by working with our staff we defined our values, culture, appointed values based leaders and managers, put robust governance and staff and patient engagement as the way we do things. We have 4 doctors on the Trust Board and today we have been a successful Trust.

Challenges in 2016 is not simply for clinical leaders but for the NHS. Challenge is how do we appoint right leaders to do the right job so that patients are safe and get better care and staff are happy at work place. How do we remove the culture of bullying, naming, shaming disciplining and promote a culture of safety, staff engagement and patient engagement. How do we hold Board leaders to account for appointing poor leaders and poor governance.

#545780 dee narga
Northern lake

Excellent article.

#545781 dee narga

So well said DR.P...your voice is the hope to many

Add new comment