Prevention – An excellent seminar series by Andrew Burnett (UCL) outlines ways in which junior doctors can take simple steps – for example, ‘ask, advise, assist, arrange follow-up’ to support improved lifestyle choices and behaviours. Embedding these concepts into clinical training and working is vital. Our work (for example A vision for the public health system in England) supports the need for this enhanced preventative focus, particularly in the context of current challenges – trying to ensure quality while also coping with rising demand.
Integrated working – Clinical leadership is paramount in the wide-reaching plans to transform health and care (eg, sustainability and transformation partnerships, accountable care systems). Clinicians are needed to chair networks and new provider entities, contribute to new pathways and plans, and also to work with partners in a myriad of roles from across the system. Indeed, Don Berwick has previously warned that ‘pursuing change without the leadership of clinicians is extremely hazardous’. But to lead properly requires time and possibly also the acquisition of new skills (eg, in management or business).
Quality improvement – The role for clinical leadership in championing improvements has been demonstrated in examples such as Getting It Right First Time or the primary care improvement efforts in Tower Hamlets. However, we know it took time for clinicians to collate data, create dashboards, visit sites and enable improvement conversations.
Engagement and activation – Our work on patient experience demonstrates the need for new approaches by clinicians based on deep understanding of patients’ needs. More than just scientific knowledge, this requires expertise in motivation theories, behaviour change methods, asset-based approaches and use of this to mobilise, empower and activate individuals and communities for improved health and wellbeing. Our work into transformational change is showing that those receiving care from Buurtzorg nurses (in the Netherlands) unequivocally highlight the importance of this.
Embracing the future – Developments in a number of areas (for example technology) means that clinical leaders need greater levels of adaptability, flexibility and resilience to accommodate new ways of working. For example, colleagues from Nuka in Alaska describe the need for GPs to use text messaging and apps to provide effective, timely care for their working age patients who use these technologies. Population health systems from the USA highlight the need for clinicians to be able to access and optimally utilise sophisticated tools supporting more proactive and joined-up care.
Despite the evidence about the importance of modern clinical leadership (one that embraces the current health and care in a system-wide way), there is a seeming lack of a consistent and systematic approach to this at present. The often humbling efforts of clinicians to put into practice what they believe to be good clinical leadership are opportunistic – based on personal interest or existing relationships – and are often unpaid or minimally reimbursed. Rather than improving patient care this can pose a risk to it.
To ensure stronger clinical leadership requires a more comprehensive strategic approach – clear roles and conditions, time, tools, training and support. These are things Don Berwick has previously said are important – and yet are still relatively rare. Many of the examples of good practice given here attribute their success to a ‘clinically led, management-enabled model’. To achieve that model, we need to look again at our system-wide efforts to ensure that we are approaching clinical leadership in the right way.
Well put Durka. Agree with your observations and comments. Would like to add peer learning and reviews to the mix. In Primary Care there is scope for learning the basics of commissioing and also changing ingrained behaviours around hierarchy, small business versus wider and bigger vision, and treating non-clinical and indeed non-medical colleagues with due regard.