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Literature summary week 2
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W2 Literature – OBDaly et al. (2014) The importance of clinical leadership in the
hospital setting
HC systems in the developed world continue to struggle with escalating demands for
services and escalating costs. The transformation which is needed to progress the quality of
HC around the world requires leadership. This must come from doctors and other clinicians.
They make frontline decisions that determine the quality and efficiency of care, and have
the technical knowledge to help make sound strategic choice about long-term service
delivery.
Effective clinical leadership includes system performance, achievement of health reform
objectives, timely care delivery, system integrity and efficiency.
Services provided by individual hospitals are determined and driven by a number of things,
like government policy, population demographics and politics of service providers.
Regardless of these differences, the clinical areas of the hospital are critical to all HC
organizations, since this is the level where consumers principally engage with the hospital
system. For consumers of health care to achieve optimal health outcomes and experience
optimal hospital care, many believe effective clinical leadership is essential.
The governing body, chief executive and senior managers, and leaders of medical staff need
to collaborate to achieve high quality of care, ethics, community service and financial
sustainability.
All members of the health care team are identified as potential leaders. Not one clear
definition on what effective leadership in HC is.
Three types of avoidant leadership (associated with negative organizational outcomes):
- Placating avoidance; leaders affirmed concerns but didn’t act on it
- Equivocal avoidance; leaders were ambivalent in their response
- Hostile avoidance; failure of leaders to address concerns escalated hostility towards
the complainant
To avoid negative organizational outcomes, active and engaged leadership is necessary at all
levels in the system. Effective leaders have: advocacy skills and ability to affect change. They
facilitate and maintain healthier workplaces by driving cultural change among all health
professionals in the workplace. They need to be recognized by their colleagues and have
skills & capacity to effectively support and communicate. They need to be positive about
their job, courage and capacity to challenge the status quo and address quality issues.
Clinical competence important too (capacity to lead a team). Influencing peers, providing
support and motivation, challenge processes. Stanley has contributed a summary of seven
clinical leadership characteristics which includes factors such as expertise, direct
involvement in patient care, high level interpersonal and motivational skills, commitment to
high quality practice, and empowerment of others. In contrast to managerial leadership,
which operates through hierarchical superior–subordinate organizational relationships,
clinical leadership has a collegiate orientation and a focus upon the patient or service
interface.
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, Clinical leadership is more patient-centered and focuses on collective and collaborative
behaviors. Nurses might be good leaders in HC.
The scrutiny on hospitals has increased the emphasis on the role of health professionals,
including nurses, in monitoring standards, developing and evaluating better ways of working
as well as advocating for patients and their families; and led to a substantial momentum in
the quality and safety agenda, including the promotion of various strategies such as
promoting evidence-based practice.
There’s been a transformational shift in the conceptualization of leadership, and it has seen
debate move from managerial, senior leader, or singular leader interpretations of leadership
to a focus upon clinical leaders and clinical leadership. This shift is taking place because
formal leaders are limited in their capacity to reshape fundamental features of clinical
practice or ensure change at the frontline (too focused on administration and espousing
values and mission?).
Edmonstone cautions that without structural and cultural change within institutions, the
move toward clinical leadership can result in devolution of responsibility to clinicians who
are unprepared and under resourced for these roles. This is trying to be solved by leadership
development programs. But lack of evidence that patient outcomes improve due to these
efforts.
Some barriers to participation in clinical leadership. Such barriers are noted extensively in
the literature and can include lack of incentives, lack of confidence, clinician cynicism, poor
communication, poor preparation for leadership roles, curriculum deficiencies at
undergraduate level in medicine and health professional courses, experience as participants
in poorly constructed clinical leadership programs, inadequate resourcing of development
programs, poor leadership, lack of vision and commitment at the higher levels, perceptions
of leadership as “other” and not core to a clinical practice role, poor interdisciplinary
relationships, role conflict, and at times rejection of the “leader” role as unacceptable
impost, resistance to change, and poor team work.
Characteristics of clinical leaderships and the attributes of them:
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