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The rise of clinical leadership: from dark side to centre stage

In this step we will explore how clinical leadership has emerged as a major priority of policy makers and is viewed as central to improving healthcare.

A notable feature of health services reform in many countries has been a concerted effort to increase the active involvement of doctors and other clinical professionals in the management of services, from ‘ward to board’. At the strategic apex of hospitals doctors, in particular, have been recruited into Core Executive (CEO) and other board level roles. In the UK, for example, clinical professionals now make up 25 percent of board roles, while in Italy, the proportion is even higher. At middle tier levels, doctors have also been recruited into roles such as clinical directors in hospitals (responsible for budgets and the operational performance of services) or given responsibilities for planning and commissioning services (as in the English NHS). As a result of this it is claimed that a significant proportion of management roles may now be occupied by people with clinical backgrounds – as high as 50% in Italy, 63% in France and 71% in Germany (Dorgan, 2010).

This involvement of clinical professionals in the running of services is not only limited to those who take on formal management roles that are full time or part time. In many countries a far larger number are also taking on leadership roles which may or may not involve the exercise of formal management authority. These forms of leadership may exist at levels, including the co-ordination of small scale improvement projects at the front line, right through to service development projects (for example, around the re-design of patient pathways), in which clinicians may work across professional and sometimes organisational boundaries. According to Denis et al. (2001), these informal leadership roles may be critical in re-shaping services and involve “processes and skills that may or may not reside in formally designated leaders”.

It is argued that there are distinctive advantages of having clinicians take on these leadership roles. An influential report by the management consulting firm, McKinsey (Mountford and Webb, 2009) argues that in order to transform health services in future “leadership must come substantially from doctors and other clinicians, whether or not they play formal management roles.” The reasons for this are obvious: “Clinicians not only make the frontline decisions that determine the quality and efficiency of care but also have the technical knowledge to help make sound strategic choices about longer-term patterns of service delivery”.

Added to this is the credibility and legitimacy that clinical leaders and their ability to engage other practicing doctors or nurses to accept and embrace change. Numerous studies of clinical leaders emphasise their deep understanding of context and ability, as prototypical professionals themselves, to bridge the gap between external policy demand and the day to day business of providing services. It is expected that clinical leaders will influence and motivate their peers through their professional knowledge and skills. At the same time they might also collaborate more effectively with managers in developing organisational strategies that are aligned with quality improvement (Fitzgerald et al., 2013).

For these reasons, policy makers in many countries have become increasingly animated by the prospect of strengthening clinical leadership as a means of accelerating the pace of healthcare improvement. Interestingly, many professional bodies themselves have also embraced this idea, with clinical leadership moving from ‘the dark side to centre stage’ (Ham et al., 2011). In the UK, for example, the Royal College of Physicians (2005) states that “a doctor’s corporate responsibility, shared as it is with managers and others, is a frequently neglected aspect of modern practice”. In future doctors need to see themselves as ‘partners’ and ‘leaders’ as well as excellent practitioners (GMC, 2009).

Consistent with this idea, in many countries, great investments have also been made in the formal training and education of clinicians to become more effective leaders. Hence, in the Netherlands medical education is based on the Canadian Model of Medical Education (CanMEDS), constructed around seven areas of expertise, one of which is management. In the UK, a ‘Medical Leadership Competency Framework’ also exists to guide doctors training, and is now incorporated into the undergraduate and all postgraduate (specialist) curricular. In these cases and more widely, finding ways to unleash the leadership potential of clinicians is viewed as being a central building block towards the improvement of healthcare.

Talking point

  • Is clinical leadership anything more than just the latest fashion?
  • Do clinical professional always make the best leaders in healthcare organisations?

References

Denis, J.L., Lamothe, L. & Langley, A. (2001) The dynamics of collective leadership and strategic change in pluralistic organisations. Academy of Management Journal, 44 (4): 809-837.

Dorgan, S., Layton, D., Bloom, N., Homkes, R., Sadun, R. & van Reenen, J. (2010) Management in Healthcare: Why Good Practice Really Matters. London: McKinsey and co. and LSE (CEP).

Fitzgerald, L. Ferlie, E., McGivern, J. & Buchanan, D. (2013) Distributed leadership patterns and service improvement: Evidence and argument from English healthcare. The Leadership Quarterly, 24 (1): 227-239.

General Medical Council (2009) Tomorrow’s Doctors: Outcomes and standards for undergraduate medical education. London, GMC.

Ham, C., J. Clark & J. Spurgeon (2011) Medical Leadership: From Dark Side to Centre Stage. London: The King’s Fund.

Mountford, J. & Webb, C. (2009) When clinicians lead. McKinsey Quarterly, February [Online] Available from: http://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/when-clinicians-lead.

Royal College of Physicians (2005) Doctors in Society: Medical Professionalism in a Changing World. London: Royal College of Physicians.

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Leadership for Healthcare Improvement and Innovation

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