Education: Part 2
EFFECTIVE CLINICAL LEADERSHIP INVOLVES INDIVIDUALS WITH THE APPROPRIATE SKILLS AND ATTRIBUTES, AT ALL LEVELS OF AN ORGANISATION FOCUSSING ON MULTIDISCIPLINARY/ INTERDISCIPLINARY SERVICE DELIVERY.
Clinical leadership and nursing By Rajna Ogrin and Elizabeth Barrett Health systems around the world are grappling with the task of providing system-wide evidence based, personcentred, efficient and effective care. Clinical leadership, particularly of nursing staff, is proposed to be integral in reaching this goal ( NHS Leadership Academy, 2013; NHS Institute for Innovation and Improvement, 2011). Work within RDNS from the organisation’s learning development department and the RDNS Institute, is examining the issue of clinical leadership, how to define it and facilitate it in practice. There is no one clear definition of clinical leadership, with a number of definitions proposed by various organisations. We suggest that the following clinical leadership definition provides a good summary: “.... the process of developing a culture and leading a set of tasks to continually improve the quality and safety of service delivery to consumers. Effective clinical leadership involves individuals with the appropriate skills and attributes, at all levels of an organisation, focussing on multidisciplinary/ interdisciplinary service delivery.” (VHA, 2009) Up until fairly recently, clinical leadership in nursing has tended to focus on nursing leaders who are in formal leadership positions, such as nurse managers. While nurse anmf.org.au
managers may be clinical leaders, this is usually in the context of their management activities, such as the planning and organisation of services (Davidson, et al. 2006). With the increasing urgency to improve efficiency and effectiveness of care, leadership is being proposed as part of the role of every nurse (Pepin, et al. 2011). Work currently underway in the National Health Service (NHS) in the United Kingdom is focusing on empowering clinicians and front line staff to build their decision-making capabilities to encourage a broader practice of leadership by clinicians and other frontline staff, rather than by designated managers alone (West et al. 2015). The NHS extends on this concept by promoting a collective leadership approach– where leadership is shared and changes based on the needs at the time and dependent on the skill set of the available team members (West et al. 2015). So what does it take to be a clinical leader? At this stage, there is limited knowledge and understanding of clinical leadership among front line clinicians who provide direct patient care. Current work underway at RDNS is progressing the concept of collective leadership and acts of leadership at all levels to sustain and adapt to the changing healthcare landscape. In addition, research completed at RDNS has drawn on the existing literature in leadership, then asked nurses who were in a clinical leadership position what they needed to translate evidence into practice (Ogrin, et al. 2014). Nurses stated that the clinical leadership attributes they needed in their roles fell under three areas:
Personal attributes: Having confidence in your ability to provide best practice, being able to communicate effectively and emotional intelligence. Team attributes: Encouraging trust and commitment in others, team focus, valuing the skills and expertise of others. Capabilities: Building and maintaining relationships, encouraging contribution from others, creating clear direction and the ability to be a role model. Organisations are beginning to embrace clinical leadership as a way to improve quality of care. The work at RDNS adds to our understanding of what current clinical leaders attributes are, and the fundamental need for collaboration and collective action at all levels. Further work will need to build on these attributes to build a clinical leadership framework for how training programs can incorporate developing clinical leaders – an exciting time for nurses, where they can play a key role in leading the way in system-wide translation of evidence into practice. RDNS received funding from the Commonwealth and Victorian Governments under the HACC program and from the Australian Government Department of Social Services as part of Encouraging Better Practice in Aged Care (EBPAC) initiative. Dr Rajna Ogrin is Senior Research Fellow at the RDNS Institute Elizabeth Barrett is RDNS National Manager – RDNS Education and Training
FOCUS DR RAJNA OGRIN (LEFT) AND ELIZABETH BARRETT: DEFINING AND REFINING CLINICAL LEADERSHIP
References Davidson, P. M., Elliott, D., & Daly, J. (2006). Clinical leadership in contemporary clinical practice: implications for nursing in Australia. Journal of Nursing Management, 14(3), 180-187. doi: 10.1111/j.13652934.2006.00555.x NHS Institute for Innovation and Improvement. (2011). Clinical Leadership Competency Framework. Coventry: NHS Institute for Innovation and Improvement. NHS Leadership Academy. (2013). The Healthcare Leadership Model, version 1.0. Leeds: NHS Leadership Academy. Ogrin, R., Moss, C., & Willets, G. (2014). Clinical Leadership - Leading the way to translate evidence into practice. Paper presented at the National Health and Medical Research Council 3rd Annual Symposium on Research Translation, Melbourne, Australia. Pepin, J., Dubois, S., Girard, F., Tardif, J., & Ha, L. (2011). A cognitive learning model of clinical nursing leadership. Nurse Education Today, 31(3), 268-273. VHA. (2009). Clinical Leadership in Community Health Victorian Healthcare Association (pp. 1-24). West, M., Armit, K., Loewenthal, L., Eckert, R., West, T., & Lee, A. (2015). Leadership and leadership development in healthcare: the evidence base. London: The Kings Fund.
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