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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](/audio-video/alison-cameron-patients-as-partners "Alison Cameron: Patients as partners - bridging the gap between "them" and "us""). 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.