ABC of Clinical Leadership - Tim Swanwick - ebook

ABC of Clinical Leadership ebook

Tim Swanwick

122,99 zł


The ABC of Clinical Leadership explores and develops the key principles of leadership and management. It outlines the scope of clinical leadership, emphasising its importance in the clinical context, especially for improving patient care and health outcomes in rapidly changing health systems and organisations. Using short illustrative case studies, the book takes a systematic approach to leadership of clinical services, systems and organisations; working with others and developing individual leadership skills. This second edition has been fully updated to reflect recent developments in the field, including current thinking in leadership theory, as well as a focus throughout on workforce development and working in multidisciplinary healthcare teams. International examples are used to reflect global practice and two new chapters on leading projects and followership have been added. Combining theory and practical clinical examples, and written by clinical educators with a wealth of experience of leadership in the clinical and educational environment, the ABC of Clinical Leadership is an ideal resource for all healthcare professionals, both during training and for continuing professional development.

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Table of Contents


Title Page



CHAPTER 1: The Importance of Clinical Leadership

What is clinical leadership?

Why is clinical leadership important?

The development of clinical leadership practice

Leadership and healthcare professionals

Clinical leadership – the policy response

The future of clinical leadership


Further resources

CHAPTER 2: Leadership and Management


Clinicians in management

Managers in healthcare

Leadership and management – a fine balance


Further resources

CHAPTER 3: Leadership Theories and Concepts

Trait theory

Leadership styles

Contingency theories

Transformational leadership

Charismatic leadership

Servant leadership

Authentic leadership

Distributed, shared and collaborative leadership


Further resources

CHAPTER 4: Followership


What is followership?

Why does followership matter?

Theoretical perspectives

Followership in the clinical environment

Group identity in healthcare

Followership at a systems level


Further resource

CHAPTER 5: Leading Groups and Teams

The evidence for team‐based working

Why is the link so strong?

What is a team?

Key dimensions of effective clinical teams


Further resources

CHAPTER 6: Leading and Managing Change


Thinking about change

Different contexts for change

Approaches to leading change

Useful behaviours when leading change



Further resources

CHAPTER 7: Leading Organisations

The organisational landscape in healthcare

Vision, mission and strategy

Organisational culture

Power, authority and influence

Organisational structure


Reframing organisations

Leading healthcare systems


Further resources

CHAPTER 8: Leading in Complex Environments


What is a complex system?

How can a ‘complexity’ perspective help clinical leaders?

What does this mean in practice?



Further resources

CHAPTER 9: Leading and Improving Clinical Services


Skills for quality improvement

Teamworking and the quality of care

Leading for improvement

Leading for innovation

The impact of leadership on the quality of care



Further reading

CHAPTER 10: Leading Projects

Starting a project

Getting the right support in place

Stakeholder engagement

Project governance

Communications and managing the politics

Financial business case

Keeping the project on track

Measuring and celebrating success

Why projects go wrong

Tips for success


Further reading

CHAPTER 11: Educational Leadership


The education policy context

Structures in clinical education

Integration of education with service delivery

Developing the future workforce within today’s resources

Changes in professional roles and responsibilities

Interprofessional education

Accountability versus autonomy

Resource management

Leading professional colleagues

Challenges for leaders of clinical education


Further reading

CHAPTER 12: Collaborative Leadership and Partnership Working


Collaboration and partnership

Collaborative practice

Benefits of collaboration

New organisational forms and new ways of working

Collaborative leadership

Personal qualities for collaborative leadership

Power, authority and influence

Collaborative strategies


Further reading

CHAPTER 13: Understanding Yourself as Leader

Personality, attitude, behaviour and leadership


Personality ‘type’ and leadership

The emotionally intelligent leader

Leadership ‘derailers’

Self‐doubt and the imposter syndrome

Developing as a clinical leader


Further reading

CHAPTER 14: Leading in Culturally Diverse Health Services


Diversity and equality

The case for a culturally diverse workforce

Cultural competence

Cultural safety

Race, ethnicity and healthcare leadership

Legislative frameworks

Cultural competence and the clinical leader


Further reading

CHAPTER 15: Gender and Clinical Leadership


Theoretical perspectives

The benefits of female leaders

Underrepresentation of female leaders

Interventions to redress the imbalance




Further reading

CHAPTER 16: Values‐Based, Authentic and Ethical Leadership


Values‐based leadership

Authentic leadership

Ethical leadership

Discussion: the virtuous leader in practice



Further reading

CHAPTER 17: Developing Leadership at All Levels

Leadership development: for whom?

Leadership development: what?

Leadership development: where?

Leadership development: when?

Leadership development: how?


Further reading


End User License Agreement

List of Tables

Chapter 02

Table 2.1 Examples of general and clinical management and leadership activities.

Chapter 03

Table 3.1 Leadership styles and their effect on organisational climate.

Chapter 06

Table 6.1 Approaches to change.

Chapter 07

Table 7.1 Mission, strategy and vision.

Table 7.2 The dimensions of organisational climate.

Chapter 10

Table 10.1 Example financial summary.

Chapter 11

Table 11.1 Examples of structures and functions in health professions’ education.

Chapter 12

Table 12.1 Shared and collaborative leadership.

Chapter 17

Table 17.1 Sample extract from a leadership competency framework.

List of Illustrations

Chapter 01

Figure 1.1 Truly effective clinical leadership is multidisciplinary.

Figure 1.2 Evolving thinking about clinical leadership.

Chapter 02

Figure 2.1 Leadership, followership and management: essential and interrelated activities.

Chapter 03

Figure 3.1 Spectrum of leadership decision‐making styles.

Figure 3.2 Managerial grid.

Figure 3.3 Action‐centred leadership.

Figure 3.4 Situational leadership.

Figure 3.5 The nine dimensions of the NHS Healthcare Leadership Model.

Chapter 04

Figure 4.1 Leaders need followers more than followers need leaders.

Figure 4.2 A spectrum of followership.

Figure 4.3 Followers co‐create and can change leadership behaviour.

Chapter 05

Figure 5.1 Healthcare team innovation. Professionally diverse teams have been found to be more innovative than unidisciplinary teams. Innovations introduced by such teams were also found to be more radical and to have significantly more impact on patient care.

Figure 5.2 Team communities bring together a number of individual teams which rely on each other to deliver higher‐level outcomes.

Figure 5.3 Clarity of objectives has a number of positive effects.

Figure 5.4 Leadership clarity is associated with improved team effectiveness.

Chapter 06

Figure 6.1 Planned change.

Figure 6.2 Emotional responses to change.

Chapter 07

Figure 7.1 The cultural web.

Chapter 08

Figure 8.1 Certainty‐agreement matrix.

Figure 8.2 Different contexts require different approaches.

Figure 8.3 Complex systems: changes in one element alters the context for all the others.

Figure 8.4 Ways of leading in complex systems.

Chapter 09

Figure 9.1 A model for improvement.

Figure 9.2 Good teamworking is essential for quality improvement.

Figure 9.3 Tablets and smartphones: disruptive innovations in healthcare?

Chapter 10

Figure 10.1 Project planning template.

Figure 10.2 A simple process map.

Figure 10.3 A more complex process map showing the ‘as is’ and the ‘to be’.

Figure 10.4 Five ‘whys’.

Figure 10.5 Fishbone diagram.

Figure 10.6 Power versus interest grid.

Figure 10.7 Example of a project reporting tool.

Figure 10.8 A typical risk matrix.

Figure 10.9 A simple Gantt chart created in a spreadsheet program.

Chapter 11

Figure 11.1 Inclusivity, widening participation and internationalisation – just some of the many drivers in clinical education.

Figure 11.2 The professional bureaucracy.

Chapter 12

Figure 12.1 Bridging, brokering and boundary spanning: key roles for effective collaboration.

Figure 12.2 A collective approach to leadership is stronger than the sum of its parts.

Figure 12.3 The leadership ‘gap’.

Chapter 13

Figure 13.1 Psychological levels of self.

Figure 13.2 The imposter syndrome – and overcoming it.

Figure 13.3 Assimilation and accommodation.

Chapter 14

Figure 14.1 Diversity in the NHS (England) workforce.

Figure 14.2 Historical trends in leadership and management.

Figure 14.3 Impact of discrimination within health systems.

Figure 14.4 Racial discrimination in the recruitment process.

Figure 14.5 Black and minority ethnic representation in the boardroom.

Figure 14.6 Black and minority ethnic and white staff experiences of discrimination.

Chapter 15

Figure 15.1 A model of ‘engaging’ leadership.

Figure 15.2 Recent developments in the leadership required by healthcare organisations.

Figure 15.3 Women as leaders and improved organisational performance.

Figure 15.4 Feminine leadership improves staff morale, job satisfaction and performance.

Figure 15.5 Explanations for the continued underrepresentation of women in clinical leadership.

Chapter 16

Figure 16.1 Organisational values: visible, clear and owned by all.

Figure 16.2 Caring and compassion: core values for all healthcare organisations.

Chapter 17

Figure 17.1 Leadership development, capability and organisational performance.

Figure 17.2 The 70:20:10 rule of leadership development.

Figure 17.3 Timely development.

Figure 17.4 Talent management matrix.

Figure 17.5 Commonly used leadership development interventions.

Figure 17.6 Characteristics of an effective leadership development programme.



Table of Contents

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Clinical Leadership

Second Edition



Tim Swanwick

Senior Clinical Adviser and Postgraduate Dean, Health Education, EnglandVisiting Professor in Medical Education and Leadership, University of BedfordshireHonorary Senior Lecturer, Queen Mary University of London and Imperial College, London, UK

Judy McKimm

Director of Strategic Educational Development, Swansea University UKVisiting Professor, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi ArabiaGuest Professor, Huazhong University of Science and Technology, Wuhan, China






This edition first published 2017 © 2017 John Wiley & Sons, Inc.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at

The right of Tim Swanwick and Judy McKimm to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.

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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the authors make no representations or warranties with respect to the accuracy and completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or website is referred to in this work as a citation and/or potential source of further information does not mean that the author or the publisher endorses the information the organization or website may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this works was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging‐in‐Publication data applied for

9781119134312 [Paperback]

Cover image: sturti/ gettyimagesCover design: Wiley


Stuart AndersonAssociate Dean of Studies, London School of Hygiene and Tropical Medicine, London, UK

Deborah BowmanProfessor of Ethics and Law, St George’s, University of London, London, UK

Judy ButlerSenior Consultant, Coalescence Consulting Ltd, Bath, UK

Jonathan GardnerCancer Programme Director, University College London Hospitals NHS Foundation Trust, UK

Valerie IlesHonorary Professor, London School of Hygiene and Tropical Medicine, London, UK

Tracie JolliffHead of Inclusion and Systems Leadership, NHS Leadership Academy, Leeds, UK

Sarah JonasConsultant Child and Adolescent Psychiatrist, Sussex Partnership NHS Trust, UK

Sir Bruce KeoghMedical Director, NHS England, London, UK

David KernickGeneral Practitioner, St Thomas Medical Group, NICE Fellow, Exeter, UK

Jennifer KingManaging Director, Edgecumbe Consulting Group Ltd, Bristol, UK

Chris LakeHead of Professional Development, NHS Leadership Academy, Leeds, UK

Andrew LongConsultant Paediatrician, Great Ormond Street Hospital for Children, London, UK

Hester MannionFinal Year Medical Student, Swansea University, UK

Lynn MarkiewiczManaging Director, Aston Organisation Development Ltd, Farnham, UK

Layla McCayInternational Researcher, Department of Global Health Entrepreneurship, University of Tokyo, Japan and Director of Centre for Urban Design and Mental Health

Judy McKimmDirector of Strategic Educational Development, Swansea University, UKVisiting Professor, Princess Nourah bint Abdulrahman University, Riyadh, Kingdom of Saudi ArabiaGuest Professor, Huazhong University of Science and Technology, Wuhan, China

Fiona MossDean, Royal Society of Medicine, London, UK

Tim SwanwickSenior Clinical Adviser and Postgraduate Dean, Health Education, England Visiting Professor in Medical Education and Leadership, University of Bedfordshire Honorary Senior Lecturer, Queen Mary University of London and Imperial College, London, UK

Celia TaylorAssociate Professor, Warwick Medical School, University of Warwick, UK

Michael WestHead of Thought Leadership, The King’s Fund, London, UKProfessor of Organizational Psychology, Lancaster University Management School, Lancaster, UKCo‐Director, Aston Organisation Development Ltd, Farnham, UK


Welcome to the second edition of ABC of Clinical Leadership. Since the first edition, theories and concepts, research and the practice of clinical leadership have shifted considerably. Reflecting this, our book has been extensively revised with a wealth of new material, including two completely new chapters. Everything has been brought up to date and in the course of preparing this edition, several new authors have joined the team.

ABC of Clinical Leadership is designed for clinicians new to leadership and management as well as for experienced leaders. It will be relevant to doctors, dentists, nurses and other healthcare professionals at various levels, as well as to health service managers and support staff. The book is particularly appropriate for guiding doctors in training and their supervisors and trainers.

ABC of Clinical Leadership has been written in the context of an increasing awareness that effective leadership is vitally important to patient care and health outcomes. Patient care is delivered by clinicians working in systems, not by individual practitioners working in isolation. To deliver healthcare effectively requires not only an understanding of those systems but also an appreciation of how to influence and improve them for the benefit of patients. This in turn requires the active participation of clinicians in leading change and improvement at all levels, from the clinical team to the department, the whole organisation and out into the wider community.

This book aims to inform and encourage those engaged in improving clinical care, and we have been fortunate in attracting a team of authors with huge expertise and knowledge about leadership in the clinical environment. We thank them all for their contributions. What we have aimed to do is provide an introduction to some key leadership and organisational concepts as they relate to clinical practice, linking these to real‐life examples and contemporary health systems. Each chapter is free‐standing, although reading the whole book will provide a good grounding in clinical and healthcare leadership theory and practice. Along the way, we have provided pointers to additional resources for those who want to find out more or explore additional aspects of leadership.

The book begins with an introduction to clinical leadership, through contextualising this in key policy drivers and leadership, management and followership theory. We move on to consider key aspects of leadership: leading teams, change, projects, organisations and complex environments. Then we look at the specific contexts of leading clinical services and education. The later chapters consider the broad contexts of collaboration and partnership working, how gender, culture and ethical issues influence leadership, and finally how leadership development may best be carried out. We hope that you enjoy the book, and that it stimulates you to reflect on and develop your own leadership practice and that of others.

Tim SwanwickJudy McKimm

CHAPTER 1The Importance of Clinical Leadership

Sarah Jonas1, Layla McCay2 and Sir Bruce Keogh3

1 Sussex Partnership NHS Trust, UK

2 University of Tokyo, Japan

3 NHS England, UK


Clinical leadership is vital to the success of healthcare organisations.

Strong clinical leadership is associated with high‐quality and cost‐effective care.

Clinical leadership means healthcare professionals engaging in setting direction and implementing change.

Effective clinical leadership is collaborative and multidisciplinary

Clinical leadership is needed at every level.

Healthcare is a huge, important and inherently complex business; every person in the world needs it, every country spends substantial proportions of their gross domestic product (GDP) on it, governments are judged by it, populations are determined by it and almost everyone has a personal interest in how it is delivered. The USA spent 17% and the UK 9% of its GDP on healthcare in 2013. Healthcare organisations also provide employment for a substantial sector of the population; for instance, the UK’s National Health Service (NHS) employs 1.4 million people, making it the third largest civilian organisation in the world.

To enable organisations of such magnitude to deliver high‐quality healthcare, high‐quality leadership and management are vital at every level, from the national to the local, all the way down to the orchestration of individual interactions between patients and healthcare professionals. To be truly effective, this leadership must come not just from professional managers, but from across the clinical professions (Figure 1.1).

Figure 1.1 Truly effective clinical leadership is multidisciplinary.

Copyright iStockphotos.

What is clinical leadership?

The terms ‘leadership’ and ‘management’ are often used synonymously or as overlapping concepts. But as Chapter 2 describes, they are two distinct but interdependent ways in which organisations, groups or individuals set about creating change while maintaining stability. Leadership involves creating a vision, setting strategic direction and establishing organisational values. Management is more focused on directing people and resources to deliver the strategic aims established and propagated by leadership. A lack of either – leadership or management – makes it difficult for an organisation to effect change or bring about improvement.

Clinical leadership refers to the concept of healthcare professionals, as opposed to professional managers, undertaking the leadership task: 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 in their organisation’s aims and delivery. Clinical leadership is key in both promoting high‐quality care and transforming services to meet evolving population needs. And there is a role for clinical leadership at every level in healthcare organisations and systems; leadership is a process, not a position.

Why is clinical leadership important?

Globally, healthcare organisations must balance the need for financial sustainability and competitiveness with the need to deliver safe and effective care. There is mounting international evidence that good clinical engagement is associated with high organisational performance, and that strong clinical leadership leads to care of higher quality (Box 1.1). Effective leadership in healthcare occurs at distinct levels: the strategic, the organisational and the frontline. And just as multidisciplinary approaches benefit face‐to‐face patient care, drawing on diverse experience and skills can also help achieve high‐quality healthcare at these various levels.

Box 1.1 Evidence for an association between clinical leadership and quality of care.

High‐performing organisations are more likely to have clinicians on the governing board (but the direction of this association is not clear).

Organisations with high levels of clinical engagement tend to perform better against a range of quality metrics.

There is an association between distributed leadership and quality of care.

Teams with low levels of conflict and shared leadership function better and deliver better care.

Despite the strong face validity of a link between clinical leadership and quality of care, a broad evidence base in this field has been slow to develop. This is largely due to the variability of how clinical leadership is defined and the complexity of healthcare organisations. However, some conclusions can be drawn.

At the organisational level, promising correlations between medical leadership and hospital rankings have emerged in the US (Goodall, 2011), while in the UK, a large‐scale review of medical leadership models (Dickinson et al., 2013) found that organisations with high levels of engagement between doctors and managers performed comparatively better than other organisations on available measures of organisational performance. Another UK study examined annual reports, performance statistics, patient outcomes, mortality rates and national patient survey data and showed that higher proportions of clinicians sitting on a hospital’s strategic governance board were associated with better performance, patient satisfaction and morbidity rate (Veronesi et al., 2012). Across the world, studies of organisational culture find strong links between high levels of clinical engagement, the distribution of leadership perceived by clinicians working in an organisation and the quality of care achieved by that organisation.

International evidence also shows that clinical leadership is also a key variable in the effectiveness of healthcare development and change implementation in an organisation (Greenhalgh et al., 2005). Of particular importance is the presence of clinical champions who are willing to lead by example (Soo et al., 2009).

At the level of clinical and nursing teams, meta‐analyses of research consistently indicate that across sectors, shared leadership and participative management in teams predict team effectiveness, including empowerment and self‐efficacy, whereas team conflict is, not surprisingly, connected with poor performance (d’Innocenzo et al., 2014; Wang et al., 2014).

The development of clinical leadership practice

Historically, healthcare management has been described as ‘management by consensus’, where administrative, medical and nursing hierarchies co‐existed but had no power over one other. Administrators made administrative decisions, doctors made medical decisions, nurses made nursing decisions and central funding bodies, including government, made funding decisions. More recently, increases in costs and the complexity of healthcare have made this model difficult to maintain.

Globally, countries have taken different approaches to the leadership and management of healthcare, with many countries employing doctors (or, less frequently, other health professionals) in senior leadership roles. In the UK, however, the government‐commissioned Griffiths Report (1983) led to the introduction of general management in the NHS. This involved formalising management arrangements, creating boards and appointing clinical and medical directors to manage particular service areas with the intention of aligning clinicians with the objectives of the organisation; however, this was not always achieved. Throughout the 1990s, there was a growing recognition that clinicians needed to be actively engaged in the leadership and management of health services in order that change might proceed unimpeded. By the next decade, it had become apparent that clinical engagement was not only necessary to prevent the derailing of managerial initiatives, but a vital prerequisite for effective direction setting and change management. The prevailing view today is that high‐performing healthcare organisations tend to be clinically led, with strong partnerships between clinicians and professional managers, and a shared commitment to clinical quality.

Leadership and healthcare professionals

Health organisations have always experienced an inherent tension between central control and clinical autonomy. Mintzberg (1992) describes healthcare organisations as ‘professional bureaucracies’, where significant organisational decisions are made at the periphery by individuals with a relatively free rein – as opposed to a ‘machine bureaucracy’, such as a government department or a factory, where organisational decisions are made centrally, directed by a middle tier of management and enacted by a large group of workers operating under instruction.

An essential feature of the professional bureaucracy is the need for leadership to come from within in order to engage that group in enacting the vision for change. A lack of effective leadership can lead to anarchy as significant decisions involving the whole organisation can be made at the frontline without regard for overall organisational strategy, while such strategies may not be ‘heard’, paid attention to or implemented on the frontline. However, activated successfully, the professional bureaucracy can drive excellence in a way that a machine bureaucracy cannot. Embedding clinical leadership at every level is important to ensuring that the multitude of decisions made at the frontline in large healthcare systems on a daily basis add up to concerted action aligned with the organisation’s goals.

Today’s growing interest in a joined‐up strategic approach in healthcare organisations, incorporating clinical leadership at every level, derives from a number of success stories from around the world where clinicians are already actively engaged in the running of health services to achieve significant quality improvement (Box 1.2).

Box 1.2 Case studies: Clinical leadership in action.

Kaiser Permanente, USA

Clinical leadership is central to the structure and function of Kaiser Permanente, a US health management organisation. Its doctors are essentially partners in the business, transcending the traditional barriers between clinicians and managers, and closely aligning priorities and strategies to create a joint mission. Clinicians are actively encouraged to take on senior management roles, and quality improvement projects are seen as internally generated rather than externally imposed.

Veterans Association, USA

The Veterans Association (VA) is a public sector healthcare provider for US military personnel. In the 1990s, its reputation for quality care was low; it has since transformed itself into an organisation esteemed worldwide for the success of its quality improvement initiatives. These changes were led by a medical chief executive and included clinical leadership as a central premise. Today, the VA is a leader in clinical quality and has shown that clinical leadership is associated with high‐quality care, and with lower‐cost care.

Orygen, Australia

Orygen, based in Melbourne Australia, is a clinically led, not‐for‐profit centre of excellence for youth mental health. Offering a combination of clinical services, research and policy analysis with strong clinical leadership, Orygen has been a global leader in generating interest in early intervention in psychosis.

Clinical leadership – the policy response

Perhaps the most systematic interest in clinical leadership from a national perspective has taken place in England. Government policy, detailed in High Quality Care for All (Darzi, 2008), placed quality improvement at the heart of the NHS and, importantly, highlighted clinical leadership as a key factor to achieve this. A number of national leadership competency frameworks followed, articulating the detail of what was required of clinical leadership (Academy of Medical Royal Colleges and NHS Institute for Innovation and Improvement, 2008; General Medical Council, 2012). A Faculty of Medical Leadership and Management was founded in 2011, followed by an NHS Leadership Academy in 2012. Subsequently, serial public inquiries, reports and reviews of service failures in England have continued to emphasise the importance of clinical leadership in the delivery of high‐quality care, and have embedded clinical leadership as a principle for healthcare delivery. The evolving thinking about the role of clinical leadership in healthcare is summarised in an excellent series of internationally relevant publications by the UK health policy think‐tank, the King’s Fund (Fig 1.2).

Figure 1.2 Evolving thinking about clinical leadership.

Source: King’s Fund, 2011–2015.

The future of clinical leadership

Clinicians have often been deterred from taking up leadership roles due to a lack of remuneration, professional recognition and respect, formal training or career pathways for these roles. In particular, a culture of antimanagerialism has arisen in some organisations, where clinicians may unhelpfully refer to their colleagues who participate in clinical leadership as ‘going over to the dark side’. Leadership can also be perceived as a somewhat nebulous concept, and in a world of evidence‐based practice, the study of leadership can be seen as non‐rigorous and unscientific. It is up to clinicians to further develop the study of this vital discipline and recognise and reward the true importance and power of clinical leadership.

Throughout the world, healthcare systems are increasingly expensive and complex, and the imperative to continuously improve care quality has taken centre stage. The impetus for clinical leadership to align forthcoming healthcare reforms with the needs of the patient has never been greater. The task for clinicians will be to grasp the opportunity and help lead future change through effective clinical leadership.


Academy of Medical Royal Colleges and NHS Institute for Innovation and Improvement (2008)

Medical Leadership Competency Framework

, NHS Institute for Innovation and Improvement, London.

Darzi A. (2008)

A High Quality Workforce: NHS Next Stage Review

, Department of Health, London.

Dickinson H, Ham C, Snelling I and Spurgeon P. (2013)

Are We There Yet? Models of Medical Leadership and Their Effectiveness: An Exploratory Study

. Available at:‐1808‐236_V07.pdf

(accessed 29 September 2016).

D’Innocenzo L, Mathieu JE, Kukenberger MR. (2014) A meta‐analysis of different forms of shared leadership – team performance relations.

Journal of Management



(10), 1–28.

General Medical Council (2012)

Leadership and Management for All Doctors

, General Medical Council, London.

Goodall AH. (2011) Physician‐leaders and hospital performance: is there an association?

Social Science and Medicine



, 535–539.

Greenhalgh T, Robert G, Bate P

et al

. (2005)

Diffusion of Innovations in Health Service Organisations: A Systematic Literature Review

, Blackwell, Oxford.

Griffiths Report (1983)

NHS Management Inquiry

, Department of Health and Social Security, London.

Mintzberg H. (1992)

Structure in Fives: Designing Effective Organisations

, Prentice Hall, Harlow.

Soo S, Berta W, Baker GR. (2009) Role of champions in the implementation of patient safety practice change.

Healthcare Quarterly



, 123–128.

Veronesi G, Kirkpatrick I. Vallascas F. (2013) Clinicians in management: does it make a difference?

Social Science and Medicine



, 147–155.

Wang D, Waldman DA and Zhang Z. (2014) A meta‐analysis of shared leadership and team effectiveness.

Journal of Applied Psychology



(2), 181–198.

Further resources

Dickinson H, Ham C. (2008)

Engaging Doctors in Clinical Leadership: What Can We Learn from the International Experience and Research Evidence?

University of Birmingham, Birmingham.

Hamilton P, Spurgeon P, Clark J

et al

. (2008)

Engaging Doctors: Can Doctors Influence Organisational Performance? Enhancing Engagement in Medical Leadership

, Academy of Medical Royal Colleges and NHS Institute for Innovation and Improvement, London.

King’s Fund Leadership Development. Available at:

(accessed 29 September 2016).

Mountford J, Webb C. (2009)

When Clinicians Lead

. McKinsey Quarterly. Available at:‐systems‐and‐services/our‐insights/when‐clinicians‐lead

(accessed 29 September 2016).

CHAPTER 2Leadership and Management

Andrew Long

Great Ormond Street Hospital for Children, London, UK


Management and leadership are interrelated, complementary activities, both essential for organisational success.

Complex organisations require both wise leadership and consistent management.

Management helps provide order and consistency; leadership is about change and movement.

Many healthcare organisations are overmanaged and underled.

Both leadership and management skills can be learned.


Until fairly recently, intense debate raged about the difference between managers and leaders, or indeed whether a difference existed at all. Bennis and Nanus (1985), for instance, suggested that ‘managers are people who do things right and leaders are people who do the right thing’ (p.21). A more contemporary view is that categorising individuals as either a leader or a manager is unhelpful as in day‐to‐day life, most people carry out both sets of activities and even very senior leaders do a lot of ‘management’. There is some consensus, though, that management activities are those that provide order and consistency, whilst leadership tasks produce change and movement (Northouse, 2015). Think of a ship setting out on a journey; while it is vital to set direction and motivate the sailors to cope with challenging conditions (the leadership aspects), the ship will not reach its destination if it is not watertight and doesn’t have enough fuel, provisions or people to sail it (the management activities) (Table 2.1).

Table 2.1 Examples of general and clinical management and leadership activities.


Management activities

Leadership activities

Working with people

Recruitment, selection, performance monitoring and review, disciplinary procedures

Motivating, inspiring, supporting, collaborating, building networks

Physical resources and facilities

Planning and maintenance, remediation of deficiencies

Scanning the horizon to see what is possible, seeking opportunities