Skip to 0 minutes and 4 seconds RICK IEDEMA: When we think about leadership in health care improvement, very often the terms of reference that we apply to leadership have to do with people who are able to inspire others and create followership. Aside from that, we think about leaders who are people, who are able to mobilise data and evidence to get people to pay attention to aspects of practise and imperatives for change, but, very often the problem there is that leaders omit the very issue of looking at processes as they unfold for patients and I think that is a basic problem.
Skip to 0 minutes and 45 seconds And the paradox here is that medicine will insist on very empirical engagement with the body, so that we have to have seen a particular disease to really know it. We have to have seen it in particular patients to really know it. But when it comes to analysing processes, we will satisfy ourselves with data that are obviously putting processes at a distance. And for that reason, I’ve started to toy with the notion of the ‘clinalyst’. The clinalyst is a clinician who’s an analyst and a catalyst, and these are people who are able to focus front-line people’s attention and manages attention on how stuff actually happens for patients in real time.
Skip to 1 minute and 26 seconds Because that, I feel, is a big black hole in how we think about health care improvement and health care leadership in actual practise. So the clinalyst is a person who may use narratives, but also footage about how things happen with and around patients to get front-line practitioners to reflect on their taken as given practises and their ways of operating with one another and around patients. So, most typically, our attitude is to distance ourselves and that is portrayed in this little cartoon called “The Understandascope.” “The Understandascope” is a metaphor for the scientific approach to analysing processes.
Skip to 2 minutes and 12 seconds But as you can see in the cartoon, the people in the street, the melee, where the mess happens and the chaos, we don’t really want to have very much to do with that. We prefer to see numbers rather than the mess. The clinalyst is someone who will engage people with the mess and says, we really need to get our hands dirty to be able to really begin to impact on how care happens for patients.
Skip to 2 minutes and 37 seconds And so clinalysts are people who will look at where care happens in such confused ways that patients really don’t know what’s going on, and front-line people are not really sure about what’s happening, and to work out from there rather than start with pre-prepared solutions based on data and analyses that occurs somewhere else. So, I offer the clinalyst as an alternative to how we think about healthcare leadership in general.
Alternative leadership roles: the ‘clinalyst’
In the final video this week we explore the possibility of alternative leadership roles that are not concerned with management and directing operations, but are more about brokering and facilitating change. This short lecture by Professor Rick Iedema, Monash University, describes his recent work on emerging new forms of leadership that support healthcare improvement.
As we saw in Week one, new policies and guidelines in healthcare are never simply translated into practice, even when they are strongly informed by evidence. In practice, clinical professionals always need to engage in learning and “articulation work” to make new policies or resources fit their own situation. This, in turn, depends on the ability of individuals or teams of clinicians to reflect on their own practice in creative ways.
As Professor Iedema explains, this type of creative thinking and the ability to understand complexity does not always come naturally. Partly, this is because clinicians are not trained to consider the organisational or systems dimensions of their work. It may also be because clinicians are often too busy treating individual patients or dealing with emergencies to step aside and engage in this kind of reflection.
It is in this context, according to Professor Iedema, that an alternative kind of leadership role emerges - what he describes as “the clinalyst”. This is shorthand for “outsider-analyst-catalyst”, or a role that is all about enabling frontline clinicians to engage in the kind of critical reflection and learning described above. Clinalysts may straddle specialities and professions with the ability to work across disciplinary boundaries and understand the priorities of management. They display experience with quantitative and qualitative data collection, data analysis and the skills to present such data and make it meaningful and relevant. Most importantly, clinalysts have facilitation and mediation skills, enabling them to act as catalysts in situations where change is necessary, and create forums where clinicians and patients can engage in articulating and renegotiating the complexities inherent in their work. By initiating a role such as the clinalyst, health-policy makers and managers acknowledge the importance of frontline staff taking the lead in creatively adapting and translating rules, procedures and guidelines to fit their own practices and ensure that they are more sustainable.
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