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Possibilities and pitfalls for clinical leadership in improving service quality, innovation and productivity

Funded by: NHS SDO

Led by: Professor John Storey (The Open University Business School)

Background

The NHS is in a fiscal context where budget constraints require more from less and a policy context which urges more effective clinical engagement. A new model of clinical leadership is being widely proselytised and developed. This model of change, locally-led, patient centred and clinically-driven places a new obligation on clinicians to 'step up, work with other leaders both clinical and managerial and change the system where it would benefit patients' (Darzi Final Report, page 60). The 2010 White Paper Liberating the NHS built on this theme with a strong emphasis on GP-led commissioning. This model of clinician-led reform also underpins the new Medical Leadership Competency Framework (MLCF) for undergraduate and postgraduate training of doctors.

Aims and objectives

The overall aim of this project is to clarify the nature of, and conditions for, successful clinical leadership. The focus will be upon how successful clinical leaders develop and implement service quality improvements both within micro-systems and on a larger scale across traditional boundaries of primary and acute care.

The overall research question is: What can be learned from the experience of enacting the Darzi model of clinical leadership in practice? What are the main enabling and constraining conditions for its effective realization and performance?

In the NHS context it is rare for clinicians to be able to act alone; clinical leadership normally requires enactment within an institutional framework where there are policy, managerial and governance-led initiatives. Thus, a subsidiary research aim is to explore how clinical leadership operates within such conditions. Clinicians are often required not only to lead service redesign but to respond to top-down service improvement initiatives and this may require leadership of implementation efforts.

Subsidiary research questions which feed-in to this main research question are:

  1. What general lessons about its nature and its practice can be educed from a series of examples of effective clinical leadership in introducing more integrated models of care? What variations are required when enacting the model in very different service areas?
  2. What are the enablers and the blockers of effective clinical leadership?
  3. How do effective clinical leaders both initiate and lead service improvements while also engaging constructively with other service redesign and improvements initiatives?

Methods

We have arranged to work closely with two main health economies - inner South London (comprising the boroughs of Lambeth and Southwark), and one in the North West of England. These both represent challenging inner-city health issues and they allow for comparisons and contrasts between a London context and a northern-city context. The collaborating institutions in these health economies include: the local Primary Care Trusts, the Local Authorities and the relevant NHS Hospital Trusts.

A further important aspect of the research method is that attention is being focused on two particular challenging service areas within both of these health economies. Working with clinicians and senior managers in the relevant network of trusts we have identified sexual health and dementia as presenting huge challenges and carrying the potential for huge improvements. Thus, these two service areas in two different health economies results in four 'cases'. The case study framework operates across three levels: Governance level, Leadership level and Operational level. Within PCTs this means attending respectively to the Board, the Medical and Nursing Director roles, and the GPs and community clinicians. Within acute trusts it means attending to the interface between the Board, the Medical Director(s), Clinical Business Directors and practising clinicians.

Research team

  • Dr Richard Holti (The Open University Business School)
  • Dr Mark Kinirons (Guy's & St Thomas')
  • Dr Susan Mann (Kings College Hospital NHS Foundation Trust, London)
  • Cath McDermott (BMJ Learning)
  • Professor John Storey (The Open University Business School)

Research centre: Responsibility and Regulation (R&R)