Strong medical leaders: the key to high-quality care in these austere times?

I've just returned from the annual conference of medical leaders in Australasia, where I gave a keynote address on delivering high performance in austere times. The invitation to speak arose from recent work I've done with colleagues on medical leadership in the NHS, and the Fund's thinking on how to improve NHS productivity in a decade of austerity.

My message to the conference was simple. Health care systems around the world will not survive in austere times – let alone deliver high performance – without exceptional medical leadership. This is because the most important opportunities to improve productivity are to be found in unwarranted variations in clinical practice, such as prescribing, the use of diagnostic tests, and lengths of stay in hospital.

Tackling these variations cannot be done by politicians or managers. Rather, it requires every clinical team to take responsibility for reviewing its use of resources with the aim of improving the quality of care and reducing costs. I was reminded of this essential truth on a visit to Intermountain Healthcare in Utah in May, where sustained effort has been put into supporting doctors and other clinicians to do precisely this, with stunning results. One example is the reduction in deaths from sepsis from 18 per cent in 2004/05 to 10 per cent in 2008/09. The drop came three years after committing to the goal of treating more patients with a recommended 'bundle' of strategies, resulting in identification and treatment at a much earlier stage than at most hospitals .A key message is that resources are wasted when the quality of care is compromised. At Intermountain Healthcare, they tackle this by engaging clinicians in developing guidelines on best practice and reviewing performance against these guidelines. Medical leaders at all levels use performance data to challenge their peers in order to drive continuous improvements in quality and outcomes.

Visiting Intermountain Healthcare and other high-performing systems, such as Kaiser Permanente and Virginia Mason Hospital and Medical Center, underlined the central role of medical leaders in bringing about improvements in care. In all of these organisations I met many doctors who have gone into leadership roles and willingly and enthusiastically taken responsibility for the quality and cost of care. These doctors were impressively bilingual; equally comfortable talking about quality and outcomes as they were discussing productivity and efficiency.

The lesson for the NHS is to redouble efforts to involve doctors in leading work to improve performance and to do so as a matter of urgency. The Fund is playing its part in these efforts by offering a new suite of development programmes and by undertaking research into high-performing NHS foundation trusts in England. We have also invited Brent James, who has led developments at Intermountain Healthcare over many years, to speak at our annual conference in November.

A message I brought back from Australia is the need to raise the profile and status of medical leaders in the NHS. The Royal Australasian College of Medical Administrators plays a key role in doing this on the other side of the world and the recently established Faculty of Medical Leadership and Management has the opportunity to do the same here. Both myself and Vijaya Nath will be speaking at the Faculty's upcoming conference and talking to medical leaders about some of our leadership programmes, which we have recently redesigned to support the development of current and future medical leaders. The King's Fund will be contributing to the FMLM's upcoming conference and supporting future aspirations for professionalising high-quality medical leadership and management. Without a critical mass of credible and respected medical leaders equally fluent in the language of managers and clinicians, the NHS will struggle at best and fail at worst to make the changes needed to survive the decade of austerity.