What is clinical leadership?

Clinical leadership has been defined by Jonas et al. (2011) as a term that encapsulates ‘the concept of clinical healthcare staff undertaking the roles of leadership: setting, inspiring and promoting values and vision, and using their clinical experience and skills to ensure the needs of the patient are the central focus to the organisation’s aims and delivery’. 

Jonas et al. emphasise the role of clinical leaders in enhancing quality and transforming clinical services for excellence.

Leadership versus management

Leadership and management are often used as overlapping concepts. However, it is important to recognise their differences.

• Leadership involves setting a vision for people, and inspiring and setting organisational values and strategic direction.
• Management involves directing people and resources to achieve organisational values and strategic direction established and propagated by leadership. 

Leadership at every level

Effective clinical leadership is needed at every level and should not be left to one person. As noted by Taylor et al. (2013), 'clinical leadership can sit within a range of roles across the interprofessional team and primary care nurses can be at the forefront of policy implementation and local innovation.'

Examples of leadership roles that sit at different levels within an organisation are sponsors (senior management) and clinical champions (primary care team). Having strong leadership from both a sponsor and a clinical champion ensures the project is being driven from multiple parts within an organisation and is not reliant on one person.

Sponsors

A sponsor is a senior leader within an organisation (such as a practice owner or business partner for a general practice team) who can provide the authority and decision-making influence necessary for successful change. 

Year-on-year research by the Prosci team has identified active and visible executive sponsorship as the most critical contributor to successful change initiatives. (Prosci Change Management) 

The following three roles are critical for a sponsor to fulfill: 

1. Participate visibly throughout the project. Their sustained presence is necessary to build and maintain momentum for a change.
2. Communicate support and promote the change. Who delivers key messages is important within a team. Studies have shown senior leaders are the preferred senders of messages about the business reasons for change, as well as the risks or costs of not changing.
3. Build a coalition of sponsorship. Participants stated the need "for the primary sponsor to take a lead role in building and maintaining a healthy coalition of leaders who support the change.'  

Read more about sponsors from the Prosci Change Management website 

Clinical champions

A clinical champion is someone within the primary care team who is enthusiastic and driven to get a project or change implemented. It may have been their idea or something they are passionate to support and they are often willing to go the extra mile to ensure the project's success.

This person could be a GP or nurse who is passionate about a particular project and is able to be the key driver for the project on a day to day basis. 

To function well as a clinical champion they will; however, need the active support of the project sponsor described above. 

Having an effective clinical champion ensures the project is integrated into everyday work for everybody. Without engaged leaders throughout the primary care team, it can be very difficult to change daily practice and achieve success. 

Common goals

A key to ensuring engaged leaders is taking the time to determine a common goal or vision. When determining a vision or goal it is also important to consider how you would measure success. The following questions may be helpful:

• "For our team to know this project has been successful, we will be doing ....... by ......." 
• "Our patients will be....." 
• "We will have improved our results for ...... by ........."

References

The importance of clinical leadership Jonas S, McCay L, Keogh B (2011)
ABC of Clinical Leadership  Swanwick T, McKimm J,. Wiley-Blackwell, Oxford. (2011) 
What is clinical leadership…and why is it important? Swanwick T, McKimm J. Clin Teach. 2011 Mar;8(1):22-6.
Clinical leadership project Health Quality & Safety Commission, NZ
Clinical leadership in primary care. Taylor R, Martindale S (2013) Primary Health Care. 23, 5, 32-38.