Don Berwick: the importance and challenge of clinical leadership

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  • Posted:Friday 17 May 2013

Richard Bohmer, Professor of Management Practice, Harvard Business School and International Fellow at The King's Fund, speaks with Don Berwick, Founder and former President, IHI, about the role of clinicians in leadership.

You can download the full transcript from Don Berwick's chat with Richard Bohmer:   Don Berwick: the importance and challenge of clinical leadership

About this interview

Clinical leadership has been recognised as an increasingly important component of effective, efficient, safe and high-quality health care.

In this interview, Don Berwick discusses the rationale for an increased role for clinicians of all levels in leadership, and what it takes to prepare clinicians for, and engage them in leadership roles.


Leslie Hamilton

Cardiac surgeon,
Safe and Sustainable clinical steering group
Comment date
20 May 2013
Leadership is about change (for the better) but change is always difficult for those involved. It is one thing to call for clinical leadership but when that is given there has to be not only a process within the system but also the political courage to see changes through. A complex organisation like the NHS needs clear (clinical) leadership prepared to take decisive strategic decisions - it cannot be run as a local democracy or by the courts.

The case for change in the ongoing national review of paediatric cardiac surgery ("Safe and Sustainable") had unanimous support from all the current units and all the professional bodies (Royal Colleges, Speciality Associations and parent groups). Yet a process which began with the Bristol Inquiry in 2001 and more formally with the current review established in 2008, is being regularly delayed by interventions in the courts and the political arena. If a review which begins with a group of 30 surgeons cannot be delivered, what hope is there for getting other major changes, so necessary in the NHS, through the system?

Hugh McIntyre

Consultant Physician,
Comment date
31 May 2013
If "value" is "excellence through the person you serve", and the point of traction in healthcare is the clinician/"user" interface, then when that interface becomes disengaged contact, care and compassion may be lost.
Mid Staffs seems to embody such "disengagement" for which the current remedy is the “ground-up” re-engagement of clinicians through leadership development and training. But, as Don Berwick argues in this simple, brilliant piece, the disengagement at the clinical interface is a by-product of a hierarchical organisational culture.
Surely true clinician leadership in the NHS can only occur when the system is aligned to clinician leaders. Such a system, where "management" acts as a conduit (encompassing clinical and financial governance) for clinician led care, centred on the person you “serve”, does exist - for example in Kaiser – yet it appears to be the polar opposite of much of current NHS operation. Do we not also need to realign the person – system relationship in the NHS?

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