What is clinical leadership?
Without clear leadership, few projects succeed. This section will provide a brief overview of what clinical leadership is and the essential roles of sponsors and clinical champions.
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.
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:
Participate visibly throughout the project. Their sustained presence is necessary to build and maintain momentum for a change.
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.
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.
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.
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 ........."
As an experienced practice nurse, Fiona has a good insight into just how much nurses can contribute to the primary care team. She has undertaken several clinical roles including outreach and home visiting. These roles required her to draw on all her clinical skills as well as gain a deeper understanding of the social and cultural influences on the health of her patients.
Fiona is passionate about supporting people to better look after themselves and believes that nurses are best placed to do this, particularly in settings where nurses manage their own caseload and where they can spend more time with patients. This model ensures continuity of care and allows for good relationship building with patients. Nurses can bridge the gap, between the clinical decision making of the medical team and the patient, enabling them to be more confident and informed.
As a leader and a manager, Fiona has responsibility for driving and coordinating practice-wide initiatives. For example, in 2017 the team at Island Bay decided that one of their priorities for the year was to implement comprehensive care planning for their enrolled population with diabetes and other long-term conditions. To learn more about what they did, read here.
Fiona is always keen to promote the role nurses and she understands that to deliver a service that adds value, nurses need to be working at the top of their scope of practice. She feels that she has benefited from the postgraduate study she is currently undertaking and she encourages and supports other members of the nursing team to do the same.
Additionally, Fiona coordinates regular nurses’ meetings ensuring that workload is shared, encourages and supports nurses with a special interest to pursue relevant professional development activities as well as organising practice-wide training sessions. To learn more about what they did, read more here.
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.