200908 clinical leadership doc by mckinseyaug08

7/28/2019 200908 Clinical Leadership Doc by MckinseyAug08

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by James Mountordand Caroline Webb1

1 James Mountord is a Healthcare Expert based in McKinseys London Ofce.Caroline Webb is a Partner, also based in London.

For more inormation, please contact [email protected]

01 introduction

031. clinical leadership:

what it is,why it works

10 2. underlying barriersto clinical leadership

14

3. practical stepsto build stronger

clinical leadership

25 conclusion


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Who will heal healthcare? In this paper we arguethat the leadership needed to transorm theperormance o hospitals and health systems mustcome principally rom doctors and other clinicians whether or not they play ormal managementroles. We describe what such clinical leadershiplooks like in practice, and highlight the evidenceor its positive impact on healthcare perormance.We examine the deep-seated barriers that havemade it dicult to cultivate leadership amongstclinicians. And we set out practical steps thatorganisations and policymakers can take to

strengthen clinical leadership as a means tounlocking major perormance improvement.

introduction

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Healthcare acessome dauntingchallenges.Across developedcountries, costination continuesunchecked; theaverage UShousehold, orexample, nowspends more onhealth insurance

than on mortgagerepayments.Proound qualityand saety problemspersist there arearound 90,000avoidable deathsa year in the USalone as a resulto shortcomingsin care received.2And despite large

pay increases, manysystems ace allingrecruitment intoclinical proessions,reecting growingdissatisactionamongst doctorsand nurses.

2 Institute o Medicine (2001) Crossing the Quality Chasm

clinicalleadership:

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healer,leader andpartnerConsider the example o Kaiser Permanente,a large, integrated US payor and provider operatingin several states. In the late 1990s, KaiserColorado was struggling with declining clinical andnancial perormance, and was losing some topclinicians to private practice and rivalorganisations. A new CEO a paediatric plasticsurgeon made clinical leadership an explicitdriver o improved patient outcomes, dening therole o the clinician as healer, leader and partnerand revamping Kaisers leadership developmentprogrammes or doctors. Within ve years oadopting this new approach, Colorado had becomeKaisers highest-perorming aliate on quality ocare and a beacon o quality within US healthcare;patient satisaction grew signicantly; staturnover ell dramatically; and net income rose

rom zero to $87million.

Just as striking is the turnaround o the USVeterans Aairs administration (VA) a publicsector health system or retired servicemen which,in the mid-1990s, was perorming so poorly thatsome prominent voices suggested closing it down.A new CEO again a doctor implemented animprovement strategy in which clinical leadershipplayed a central part. The VA was reorganised into21 networks across the US, each with accountableclinical leadership. New clinically-relevantperormance measures were agreed, real rewardsand consequences or perormance wereintroduced, and bureaucracy was trimmed, with72% o all orms eliminated. The VA is now aleader in clinical quality: or example, the risk odeath or men over 65 in VA care is 40% below thenational average. Patient satisaction rose to 83%,12% above the US average, even as VAs patientnumbers doubled over a decade. Remarkably, VAscost per patient remained unchanged between1995 and 2005 despite per-patient costs climbing40% across US healthcare as a whole.

Clinical trainingand traditionsmake the notiono clinical leadershipcounterintuitiveor many clinicians.The conventionalview is that doctorsand nurses shouldlook ater patients,

while administratorslook aterorganisations.Yet severalpioneeringhealthcareinstitutionshave turned thisassumption on itshead and achievedoutstandingperormance.

1. clinicalleadership:what it is,

why it works

03clinical

leadership:unlocking highperormance in

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In the UK, pockets o clinical leadership existin some high-perorming organisations such asthe Heart Hospital at University College LondonHospital (UCLH). In 2002, the hospital wasstruggling with clinical outcomes in the lowestquartile, a recurrent annual decit o 6 million,and high levels o clinician disengagement. Thisled to an overhaul o services along the principleso Service Line Management (SLM), in whichclinicians play a key part in service design and

day-to-day operations, and share accountability orresults, both clinical and nancial. The clinically-led approach embodied by SLM helped achievesustained improvement in eciency, clinical qualityand nancial position, with the number o cardiacoperations rising 40% in our years, while thesurgical mortality rate halved.

defning

and describingclinical leadershipIt is clear that clinical leadership hascontributed to some remarkable results orthese organisations. But what, exactly, is clinicalleadership? Our reading o the cases, and our ownexperience, has led us to dene it as ollows:

Clinical leadership is putting clinicians at theheart of shaping and running clinical services, soas to deliver excellent outcomes for patients andpopulations, not as a one-off task or project, but

as a core part of clinicians professional identity.It is worth pointing out what clinical leadership,by this denition, is not. It is not an end initsel but rather a means to the end o high-perorming health systems. It should not exist ina silo, divorced rom clinical practice it shouldbe a core part o excellent patient care. And it isnot something or just a ew clinicians in ormalexecutive roles it is something all cliniciansshould believe in and demonstrate at leastto some degree.

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What does clinical leadership, thus dened,look like in the real world? A visitor to one o theorganisations cited above might observe someor all o the ollowing practices. As a startingpoint, all sta, whether clinicians or not, share thecommon aim o delivering excellent care eciently.Doctors collaborate with administrators on keyclinical decisions, ully inormed o the trade-osand resource implications. There is constantreerence to patients, not just or outcomes, but

also or patient experience. Units quality andcost perormance are tracked in real time. Anda saety near-miss, rather than being sweptunder the carpet, is put at the centre o a learningconversation which includes students andtrainees.

A key eature o such institutions is the attitude otheir clinicians. Rather than seeing the institutionsimply as a place where they come to work, theycare deeply about its eectiveness and takeownership o organisational issues. Accordingly,they regard administrative and leadership skills asa natural complement to their clinical skills.

evidenceo clinicalleadershipsimpact onperormanceMaking clinicians organisational leaders is a hugeand costly task. Is it worth it especially giventhe many competing demands on clinicians time?They and others will rightly seek evidence o thelink between clinical leadership and a healthorganisations perormance, both clinical andnancial. Proo o a direct correlation will remainelusive, thanks to the inherent complexity ohealth systems, whose perormance is aectedby multiple, overlapping variables o which clinicalleadership is only one. Nonetheless, a diverse andgrowing body o research suggests the impact o

clinical leadership.A recent study by McKinsey and the LondonSchool o Economics, involving over 170 generalmanagers and heads o clinical departments inthe UK NHS, ound that hospitals with the greatestclinician involvement in management scored some50% higher on key measures o organisationalperormance than hospitals with low clinicalleadership.3


3 McKinsey Quarterly (February 2008):A HealthierHealthcare System for the United Kingdom


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Amongst the growing base o academic evidence,an NHS study ound that in 11 examples oattempted service improvement, organisations withstronger clinical leadership were more successulin delivering change.4 Another recent study oundthat high-perorming NHS organisations weredistinguished by CEOs who had collaborative andconsultative leadership styles and who engagedclinicians in dialogue and joint problem-solving.5In the US and elsewhere, studies published in

academic journals are now establishing that high-perorming medical groups are distinguished bytheir explicit emphasis on clinical quality, by therelationships between clinicians and non-clinicians,and by the ability o the organisation to learn.6

Numerous case examples, such as those citedabove, suggest very strongly that involvingclinicians in the shaping and day-to-day runningo services leads to higher service perormance,both clinical and nancial. Indeed, we know ono high-perorming healthcare organisation whichhas low levels o clinical leadership.

4 National Co-ordinating Centre or NHS Service Deliveryand Organisation (2006) Managing Change and RoleEnactment in the Professionalised Organisation

5 Academy o Royal Medical Colleges/NHS Institute (2007)Enhancing Engagement in Clinical Leadership

6 e.g., Shortell et al (2005) Medical Care Research& Review Vol 62, no. 4; Casalino et al (2003) JAMAVol 289, no. 4

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distributedleadershipThe research just described, together withstudies o large-scale change in other industries,underlines the importance odistributed leadership that is, leadership which extends rom theexecutive team right through to the ront line.Distributed leadership allows people across the

organisation to make eective, rapid decisionslocally, guided by the organisations overall aims,without the need or excessive bureaucracy andtop-down intervention. This is particularly valuablein large healthcare systems, where complexdecision-making is required rom thousandso people hundreds o times a day. In suchan environment, distributed leadership is vitalor speedily resolving issues and makingsound tradeos.

Distributed leadership in healthcare translates intothree archetypes o clinical leadership (Exhibit 1):

Institutional Leaders are highlysophisticated clinical leaders, otenoccupying ormal executive-level leadershiproles, who steward whole organisations.They are able to communicate a powerulclinically-based vision and have deepand broad skills in both leadership andadministration. These skills are both hard(such as strategic thinking and planning)and sot (such as negotiation andinfuence). A typical Institutional Leader

would be a Medical Director who managesto rationalise services across a multi-siteorganisation, earning the support, not ire,o colleagues by demonstrating how thechange will improve quality o care.

Service Leaders are passionate leaderso their own services, within the contexto the needs o whole organisations. Theyhave detailed knowledge o the relevantclinical evidence-base and are innovative inimproving patient care, driving both qualityand eciency. They eel deep accountability

or the perormance o their service, bothclinical and nancial.



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Front-line Leaders are, rst andoremost, great clinicians, ocused ondelivering excellent direct patient care.Yet they also see it as their responsibilityto improve the way the organisation deliverscare, towards improving outcomes andeciency. For example, i clinical recordsare repeatedly missing rom consultations,or i patients have a high non-arrival rate orappointments, a Front-line Leader would takeownership in solving the problem. To do this,they need some awareness o systems andquality improvement techniques, and mustknow the basics o leadership, such asawareness o their personal style and howto work well in teams.

These archetypes suggest a hierarchy o leaders,but this is not a rigid system, nor is one role ogreater worth than the others. Indeed, cliniciansin these dierent roles are likely to be peers, withsimilar levels o remuneration and proessionalstatus, but with dierent degrees o leadershipspecialisation. And although Institutional andService Leaders have greater overall leadershipresponsibility, it is the ar more numerous Front-lineLeaders who ultimately realise the organisations

vision, by using their day-to-day experience toinorm continuous service improvement.

Bulk of time spentleading (may no longersee patients)

Clinician executivesacting as stewards ofwhole organisations

OVERALL IDENTITY

Able to communicatea clinical vision whichresonates withcolleagues

Highly credible tocolleagues bothas a clinician andas a leader

KEY SOURCESOF POWER

Corporate-level strategicthinking and planning

Able to get the best out ofmultiple clinical services

Talent management andsuccession planning

Political savvy; strong onnegotiation and soft inuenceskills

KEY LEADERSHIP SKILLS& KNOWLEDGE REQUIRED

Passionate advocatesfor own service, butbalanced with corporateneeds

Feel responsible forperformance of services,both clinical andnancialDirect patient care rolemay be reducing

Highly credible tocolleagues, primarilyas a clinician

Detailed knowledgeof evidence-base inown clinical areaInnovative, willing totake risks

Fluent service managementskills, as specic role andsetting demands, e.g., strategydevelopment, budgeting, peopledevelopment, advocacy for theservice

Have latest evidence-base forclinical area at ngertipsWell-networked tap intocentres of excellence

Great front-lineclinicians focusingon excellent, andimproving, patient careFeel responsible foroutcomes of theirpatients and forperformance of thelocal team as a whole

Clinical passionand credibilityProximity to patientsand realities at thefront line; can seewhere opportunitiesfor improvement exist

Understanding of systems andquality improvement tech-niques, including measurement,process-mapping, operationalimprovementAble to lead self and work wellin teams

ServiceLeaders

Front-lineLeaders

InstitutionalLeaders

exhibit 1 ThRee aRCheTypes o CliniCal leadeRship

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a. ormal systemshamper thedevelopmento clinicalleadership

The value o leadership isnt communicated

early in peoples careers. It doesnt matterwhether you lead well, badly or not at all, thereis no dierentiation. Leadership just isnt anattractive career path. These quotes, typical oour interviews, illustrate the chilling eect thatcurrent policies and organisational systems haveon the development o clinical leadership.

Leadership is not typically an assessedcriterion or entry into clinical proessions, noror determining promotion. There is no clearleadership model or clinicians, and no smoothprocess to nd, nurture and stretch those with

the most potential as leaders. Nor is there awell-dened career path or development track orleadership in stark contrast to well-trodden (andrelatively secure) clinical tracks. The dierencebetween leadership and research is instructive:the latter is well-systematised, its importancein clinicians careers widely recognised, and theincentives to undertake it are very clear. In the UKNHS, or doctors at least, there are real nancialdisincentives to allowing clinical leadership todivert ones ocus: these include lower pay scalesor managers than doctors, and the risk o losing

Clinical Excellence Awards, research unding andprivate practice income.

2. underlyingbarriers toclinical

leadershipDespite theevidence o clinicalleadershipsvalue, it remainsin short supply,and healthcareorganisations otenstruggle to build it.To understand thebarriers to clinical

leadership andtheir root causes,we conductedinterviews andworkshopsinvolving nearlya hundred clinicalproessionalsrom the UKs NHS.We encounteredthree main issues,outlined in Exhibit 2

opposite anddetailed in the nextthree sections:



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Clear nancial disincentives to clinical leadership risk loss of bonus payments, research fundingand private practice income

No well-dened career path, or development track

Infrastructure of leadership is poor (e.g., lack ofnetworking or mentorship)

Performance appraisals (if they happen)often box-ticking exercises

Financial burden to obtain leadership training

often falls on the individual

Key Barriers

Clinical leadership not seen asa vital contributor to patientoutcomes, so is seen as irrelevant

Lack of data to demonstratethe impact and value of clinical

leadership

Opportunity costs of leadership

seen as too high

Clinical leadership not vital to anindividuals professional success

Clinical leadership not core toclinicians professional identity

Key Barriers

As a group, clinicians notselected for leadership skillor potential

High opportunity costs forclinicians who chooseleadership focus

Leadership training notcore part of curricula

Leadership development notconnected to the day-job

Limited follow-up orevaluation of impactof training

Key Barriers

Formal systemshamper the

developmentof clinicalleadership

Leadershipcapability amongclinicians is notsystematically

nurtured

Deeply heldbeliefs paint

clinicalleadership as low

value

Barriers toclinical

leadership 32

1

exhibit 2 The undeRlying BaRRieRs To CliniCal leadeRship

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b. leadershipcapabilityamongclinicians is notsystematicallynurtured

I dont really know a single impressive clinical

leader, was one o the more discouragingquotes we heard in our interviews. But this ishardly surprising: leadership and managementtraining is generally not included as a core parto curricula or under- or post-graduate trainees,or or clinicians in substantive posts. And thoughsome clinicians have the potential to be greatleaders, compounding the lack o systematicleadership development is the act that cliniciansare not selected on the basis o leadershipskill or potential. The leadership developmentprogrammes which do exist tend not to be

properly evaluated, ollowed up, or connected toparticipants day-jobs. Their relevance is thereorelimited. Furthermore, clinicians are rightly trainedto be wary o acting with limited knowledge,which in the realm o patient care can lead toserious harm. Rather, they are taught to seekmore inormation, or to nd an expert beoreacting. Yet leadership oten demands action underuncertainty, going with instinct which cliniciansunderstandably nd uncomortable. Clinicianstypically receive only weeks or days o leadershiptraining and see others (the managers) as the

leadership proessionals.

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c. deeply heldbelies paintclinicalleadershipas low value

Clinicians deeply held belies about leadership

are perhaps an even more powerul obstaclethan the two tangible barriers just described.Fundamentally, leadership is not seen as core toclinicians proessional identity. Clinical leadershipis not seen as a vital contributor to patientoutcomes, nor to proessional success, so isoten seen as irrelevant; unsurprisingly, there islittle mainstream celebration o, or support or,todays clinical leaders. Underlying these belies isa lack o understanding o the purpose o clinicalleadership and the various orms it can take.Instead, there is too much emphasis on ormal

roles and hierarchies.Clinicians deeply held proessional values otenreinorce this barrier. For example, in patient care,clinicians rightly prize having an evidence-baseor action rom this ethic, great progress hasbeen made in ensuring patients receive the righttreatment. But medical evidence is grounded ina biomedical model with ew variables under test,while leadership is a social property, where theevidence is messy and oten anecdotal. Whilerobust evidence-based enquiry into leadershipis possible, it uses dierent methods rom those

used in the natural sciences or example, case-studies rather than randomized controlled trials.To see leadership and its study as a legitimateand useul activity requires a shit in mindset ormany clinicians.

doctor-specifcbarriersSome o these barriers such as the approach to

evidence, just cited are particularly pronouncedamongst doctors. This is important, becausedoctors have the status and authority eitherto drive or to resist change, their decisionsdetermining what happens to patients and havinggreat nancial impact. In Medicine, unlike manyother proessions, it is still possible to get tothe top o the tree or example, president o aproessional body or proessor in a prestigiousdepartment without having an interest in or evenan aptitude or leadership. This makes doctorsscepticism about the value o leadership all themore understandable and dicult to shit.

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3. practicalsteps to buildclinical

leadershipWhat, then, arethe steps thatorganisations bethey local providersor governmentsshaping wholehealth systems cantake to overcomethese barriers,build stronger

clinical leadershipand unlock higherperormance?



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Because leadership in healthcare has laggedbehind other industries, many o the steps todevelop it are quite basic. So entrenched are thelegacy systems and mindsets described abovethat healthcare organisations have struggled totake even some o the rst steps to build clinicalleadership. This is why the approach to buildingclinical leadership needs to be an integrated one,and why seemingly simple and obvious measureswill yield signicant results. We suggest combining

three main thrusts to address the three types obarrier outlined above. Each is expanded below:

a. creatingan enablingorganisationaland external

environmentor clinicalleadership

As weve seen, organisations and health systemsas currently congured can actively discouragethe development o clinical leadership. A rst andundamental step in ostering clinical leadershipis to ensure that the organisational environmentsupports it. Key elements o this include:

Creating a relatively stableexternal/policy environment:Healthcare organisations need sucientstability in their external environment todevelop and execute consistent perormanceimprovement plans. For policymakers thismeans resisting the urge to make continualadjustments to the policy context, otenseen by those on the ground as movingthe goalposts. Rather, policymakersshould choose a small number o clinicallymeaningul priorities (ideally in dialogue withclinical leaders) on which to ocus over time,and take steps to drive perormance on

them across the system. The UKs NationalService Frameworks outlining perormanceexpectations and improvement potentialin key clinical areas such as Cancer, Strokeand Heart Disease represent the sorto clinically-driven, long-term policy prioritywhich is likely to inspire clinicians and buildtheir trust.

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Building inrastructure and processesto provide the basic inormationneeded to run organisationsand systems: Healthcare lags behindother industries in the availability o goodmanagement data which is central to theability to lead eectively. Health systemsshould encourage the development ogood inormation systems, or invest inthem directly, to ensure the availability o

reliable, timely data on clinical and nancialperormance. The UKs 2000 Cancer Plangrew out o inormation which showedthat Britain lagged behind other countrieson cancer, and that unacceptable variationin treatment and outcome existed acrossgeographic areas with similar populationproles.

Correcting clear disincentives orclinicians to lead: Paying people lessis unlikely to encourage them to becomeleaders. Yet this is precisely what ClinicalExcellence Awards (CEAs) or UK doctorscurrently do. One physician wanted tobecome Medical Director or the local payor to improve population health acrosshis city and was asked to take a 50%pay cut, since he could not carry his CEAinto the new role. Correcting such cleardisincentives is important both or thedirect nancial eect, but also because othe wider signals given about the value andprestige attached to clinical leadership.Policymakers and organisations need toexamine the incentives currently in playand to consider how to re-tune them toencourage the responses they seek romclinicians. In the organisations cited above(such as Kaiser and the VA), leaders aretypically paid a small premium over clinicianswhose sole ocus is direct patient care,ensuring that leadership contributions arerecognised. Too great a nancial premium orleadership would disincentivise patient care,and damage the peer-like dynamic soughtbetween leaders and other clinicians.



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Creating an environment whereorganisational perormance matters:Organisations across all industries developleadership not as an end in itsel, but asan essential driver o high perormance.Health systems must encourage clinicalleadership indirectly by rewardingorganisations that perorm and creatingreal consequences or those that do not.This is a particular challenge or health

systems with a prominent government role.The VA operates on the principle o earnedautonomy: high-perorming regions andorganisations are given substantial reedomto operate with less central oversight andonly light-touch supervision, whereas parts othe system which do not meet perormanceobjectives are closely scrutinised.

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b. shaping worldclass leadershipdevelopmentprogrammes

While lack o leadership capability amongstclinicians is an ot-cited barrier, the good newsis that leadership skills can be learned. Drawinga parallel to surgery: while it is true that someindividuals have greater inherent aptitude orcomplex motor tasks, it is also true that otherswith less raw talent can acquire most skillsthrough structured development and consistentapplication over time. And even the most talentedrequire careul training to unlock their potential.

A second step to building clinical leadership,then, is to shape coherent and relevant leadershipdevelopment programmes. There is much to learnrom the best practitioners in this eld both in

healthcare and in other industries which mustsimilarly build leaders rom a pool o technicalsta. We developed case studies o a rangeo such organisations all considered high-perorming within their sector. The case studiesare drawn rom very dierent industries andgeographies, so it is particularly strikingthat all share our common approaches toleadership development:

Ensuring clarity on leadershipattributes required: Required skills andattitudes or leaders are made crystal clear,

by tightly dening leadership expectationsand using an explicit leadership model.This may seem an obvious thing to do,but is ar rom the norm today in healthcare.And because leadership is not seen asa natural part o career progression orclinicians, and since clinicians are usedto there being a right answer, deningexpectations or them is more importantthan in other industries.

In the US Armys West Point Leadership

Academy, or example, leaders are recruited,trained and developed around a Be-Know-Do model. This model (and only this model)is repeatedly reinorced rom the momentnew trainees arrive at West Point. Otherorganisations use quite dierent leadershipmodels equally successully. The pointor healthcare organisations particularlyregional authorities and corporate centres is less the particular model chosen,but rather to ensure they pick one model(rom the many available) and consistently

build leadership development around it.

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Creating cachet around the selectionprocess: Here we ace a tension: ouraspiration is to create distributed leadership,with everyone acquiring the skills andattitudes o a Front-line Leader. But noteveryone has the appetite or aptitude orhigher levels o leadership, nor do we wantto take large numbers o clinicians awayrom direct patient care.

Outside healthcare, organisations typicallyprovide basic leadership skills training or all,

but not everyone gets the chance to train orleadership at a high level. Careul andselective recruitment processes determineparticipation in ormal leadershipdevelopment programmes. The process ogaining a place on senior leadershipprogrammes is oten competitive, whichhelps to make leadership a prestigioustrack. It also avoids spreading leadershipdevelopment too thinly across too many,helping ensure that sucient attention andsupport is given to each individual in the

programme. For example, in SingaporesNational Institute o Education, a leadershiptrack system identies high-potential uturehead-teachers rom among the teachingworkorce as a whole. Entry into the head-teacher track is prestigious and highlycompetitive, and a series o gatesdetermine progression even once anindividual has been accepted onto theprogramme.

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Shaping ocused and tailoredinterventions: Targeted coaching andpersonalised development plans ensure thatleadership development within the overallmodel is tailored to individuals needs.At Kaiser Permanente, physicians withparticular strengths such as interpersonaleectiveness are asked to teach theseto other clinicians. Similarly, the technicalskills taught are matched to the needs

o individuals and their organisations:or example, the Chie o a Primary Careclinic would typically ocus on areas suchas clinic scheduling, fow & access,conguring care using multidisciplinaryteams, and delivery o care through groupvisits & email/telephone consultations.

Providing ongoing interventionsand support: Leaders are not sent ona single course or programme, in isolationrom their organisations and the day-to-daycontext o their roles. Instead, a series oongoing interventions and support are putin place to develop the leader over time.These oten ollow a eld-and-orummodel, which provides opportunities orindividuals to test their leadership skillsat various stages o their career throughstretching work responsibilities and rotationsinto dierent leadership roles. Brigham& Womens hospital in Boston,Massachusetts has a longitudinalprogramme or clinicians running overseveral months, consisting o classroomteaching, sel-study, group work and projectwork back in the participants owndepartment. Ongoing coaching andeedback are given. This not only createsa cohort eect, but ensures thatleadership development is integratedinto participants day-jobs.

These our cornerstones above combine toensure clarity about what each individual is tryingto achieve through leadership development;condence (through ongoing assessment) that

individuals are likely to be capable o reachingthe standard; and a supportive and receptiveorganisational environment which allows emergingleaders to apply what they learn in ormalleadership development to their day-jobs.

Leadership development along these linestaps into proessionals sense o purpose anddenition o excellence. It helps proessionalsestablish a mindset that what they themselveswant to achieve is best realised throughhigh organisational perormance. Leadingthe organisation then ceases to be alien to

proessional culture. Rather, it becomes a naturalcomplement to being a proessional.

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c. shitingcliniciansdeeply heldbelies aboutleadership

As discussed above, perhaps the toughest barrier

to clinical leadership lies in the historical habitsand belies o clinicians themselves. These areunderstandable. When healthcare was simplerand less costly, clinical leadership was lessimportant: it was tenable or clinicians to ocusonly on patients, one at a time, and to leaveadministrative matters to non-clinicians. A richerclinical evidence-base, a sharper capacity tomeasure perormance, a shit to larger institutionsand an increase in the overall complexity o carenow make clinical leadership imperative yethabits o mind, ingrained over years, are hard

to shit. A successul programme to build clinicalleadership must address these mindsets explicitly.

One way o doing this is to gather stories ogreat clinical leadership, told authentically andcompellingly by the leaders themselves somaking heroes o clinical leaders. In Boston,or example, Partners Healthcare is now doing

just this: distinctive clinical leaders are beingcelebrated by their organisations in ront otheir peers.

An additional way is to bring together clinical

leaders in a community o the like-minded wherethey can share inormation and stories, and realisethey are not alone in the world. Again, this isbeginning to happen: in the UK, the HealthFoundation is bringing together clinical (and non-clinical) leaders into a community o proessionals,all committed to innovation and organisationalimprovement in service o excellent patient care.

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conclusionFrom todays rather isolated pocketso excellence and innovation, clinicalleadership has a long road to travel i it isto ourish as a property o whole healthsystems. But it is an essential road to

ollow, or both clinicians and their patients.It will involve nothing less than refningclinicians own defnition o proessionalexcellence. Deep commitment to patientsand to direct clinical skills and knowledgewill always remain at the core, but acommitment to ongoing perormanceimprovement and to building high-perorming organisations will become anatural complement to traditional clinicalskills. It is this transition that will pave theway or clinical leadership to go orward.

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