Impact of clinical leadership on organization performance
In ma_ny are_as of the develope_d wor_ld, contemporar_y hospital care is con_fronted by work_force c_hallenges, ch_anging co_nsumer expectation_s and demands, fi_scal constraint_s, inc_reasing deman_ds fo_r ac_cess to care, a mand_ate to imp_rove patient cen_tered care, and issue_s c_oncerned w_ith leve_ls of quality and safet_y of health care. Effect_ive g_overnance is cruci_al to e_fforts to ma_ximize effective mana_gement of care in the hospital s_etting. Emergin_g f_rom thi_s compl_ex literature is the r_ole of leadership in the clinical se_tting. The imp_ortance of effective clinical leadership in ensur_ing a hig_h-quality health care syste_m th_at consistent_ly pro_vides saf_e and e_fficient care ha_s bee_n reiterat_ed in the sch_olarly literature and in var_ious govern_ment rep_orts. Rece_nt inquirie_s, comm_issions, and re_ports ha_ve p_romoted c_linician engagemen_t and clinical leadership as criti_cal to achievi_ng and sus_taining im_provements to care quality and patient safet_y. In thi_s pape_r, we d_iscuss clinical leadership in health care, conside_r publish_ed definiti_ons of clinical leadership, synthesiz_e the literature to descr_ibe the characteristi_cs, qua_lities, o_r at_tributes requir_ed to b_e a_n effective clinical le_ader, con_sider clinical leadership in r_elation to hospital care, and d_iscuss the f_acilitators and barriers to effective clinical leadership in the hospital sec_tor. D_espite the widesprea_d reco_gnition of the import_ance of effective clinical leadership to patient outcom_es, the_re are s_ome qu_ite con_siderable barriers to part_icipation in clinical leadership. Futur_e strategie_s shou_ld a_im to ad_dress the_se barriers to enhanc_e the quality of clinical leadership in hospital care.
Table of Contents
Clinical leadership is developing an increasingly important role in hospitals, health systems and healthcare organizations. In health organizations, leadership is a process of directing, organizing, designing, optimizing and evaluating the activities of group members. Also influence them to enhance collaboration, expand and ensure communication and, ultimately, facilitate teamwork. It is about forging an action group committed to quality, willing to achieve the vision and objectives of the organization. Not to be confused with the concept of administration, whose objective is to work with people and manage processes to produce predictable results (Cook, and Leathard, 2004: 436-440). Each element i.e. leadership and administration are not superior to the other. Both are necessary to achieve good results and to increase trust and cooperation between doctors and administrators.
Health organizations are recognizing the importance of sharing responsibility for quality improvement with leaders at all levels. This also includes patients and users of the services. The incorporation of frontline professionals in these initiatives has been a net benefit in the improvement of institutions, but it clashes with several barriers, such as lack of time and / or resources, and the lack of knowledge and skills to do so (Carryer, Gardner, Dunn, and Gardner, 2007: 1818-1819). Finding ways to free staff time to participate in improvement work or to acquire skills is a challenge for institutions. Discovering and harnessing talent, identifying committed leaders capable of arousing enthusiasm, understanding what is likely to motivate professionals to change their practices, constitute disruptive elements capable of successfully modifying and increasing the value of our organizations.
For leadership to be effective, it must be based on a clear vision for the future, a system and a culture of the organization that leads to success. The mission is the reason why an organization exists. The mission of the internists in the hospital is to provide compassionate and high-quality medical care. It is about having a clear sense of mission is crucial to guide decisions and choose between alternatives. The vision is a future state and hopefully better, towards which the organization is heading (Dierckx de Casterlé, Willemse, Verschueren, and Milisen, 2008: 753-763). It must be formulated on demographic trends, scientific advances and technological innovation of the moment. Another challenge for hospitals is considering the true needs of people, setting local goals, offering a service to citizens, collaborating with other administrations, organizations and societies.
Clinica_l leadership by frontline healthcare providers are c_ritical pa_rt of health care. Clinica_l leadership is re_commended for the potenti_al imp_act on clinical pr_actice and on the clinical care env_ironment, and contribut_es to sa_fe and q_uality patient care, and to j_ob sat_isfaction and retent_ion of frontline healthcare providers. Frontlin_e healthcare providers are wel_l p_laced to identif_y w_ork inefficien_cies, motiv_ate othe_r membe_rs of the care t_eam to a_ct on patient care, and le_ad c_hange initiati_ves to c_orrect proble_ms that ar_ise in the clinical settin_g. Front_line healthcare providers can als_o identi_fy ineff_iciencies rel_ated to organizational structures and w_ork flow_s, and to po_or p_olicies and proce_dures for the deli_very of optim_al patient care.
Hosp_itals are c_omplex so_cio-po_litical e_ntities, and the abil_ity for eng_agement and leadership amon_g clinicia_ns can b_e hampere_d by p_ower dyn_amics, dis_ciplinary boundar_ies, and co_mpeting dis_courses within the organizat_ion. T_he t_ension inhe_rent b_etween clinical and administra_tive discours_es is evidence_d in the fin_dings fr_om the evaluati_on of clinical directorat_e structures in hospitals, wi_th clo_se to t_wo third_s of med_ical and nursing staff_surveyed rep_orting the p_rimary outcom_e of s_uch structures wa_s incr_eased organizational polit_ics. at the sa_me ti_me asthe_re ha_ve bee_n grow_ing cal_ls for clinical leadership, there is ev_idence that refo_rm and restr_ucture within hospitals has result_ed in a los_s of nursin_g manag_ement r_oles and funct_ions. Des_pite pol_icy ag_enda to fost_er clinical leadership, there are repo_rts that managerial imperatives can instea_d prim_arily focus upon f_iscal efficie_ncy or organizational poli_tical imperatives, wit_h variou_s factor_s c_olluding to sile_nce con_cerns of clinician_s.
Th_is transfo_rmational shift in the c_onceptualization of leadership has see_n debat_e m_ove f_rom managerial, se_nior leader, or singular leader in_terpretations of leadership to a focus upon clinical leaders and clinical leadership. In pa_rt, th_is shift has bee_n in re_sponse to growin_g recogniti_on that w_hile de_signated leaders in positio_ns of form_al au_thority within hospitals p_lay a k_ey rol_e in administration and e_spousing value_s and m_ission, su_ch leaders are limit_ed in thei_r ca_pacity to r_eshape fundame_ntal featu_res of clinical p_ractice or ensure chan_ge at the frontline.
The hospit_al s_ector, the dem_ands pl_aced upo_n lead_ers h_ave b_ecome mo_re com_plex, and the ne_ed for differe_nt for_ms of lead_ership is incre_asingly evi_dent. to der_ive c_ost efficie_ncy and i_mprove product_ivity, the_re h_as bee_n in_tense reorga_nization. Coupl_ed wi_th thes_e re_forms ha_s b_een increasin_g attenti_on upo_n i_mproving safe_ty and quality, wi_th pro_grams ins_tituted to mov_e attent_ion beyon_d singular pat_ient–clinici_an interpr_etations of s_afety towa_rd address_ing organi_zational sys_tems and iss_ues of cultu_re.
The a_im of this revie_w is to info_rm the n_ext, intervi_ew-base_d pha_se of the p_roject t_hrough summar_izing wh_at the imp_ortance of clinical leadership in impro_ving clinical govern_ance in hospital_s. The o_bjectives are to:
- Expl_ore w_hether clin_ician engageme_nt in mana_gerial decisi_on-mak_ing is nece_ssary for imp_roved public ho_spital perf_ormance;
- Desc_ribe the historical fo_rmal and in_formal leadership roles of clinicians and the_ir historical relationship_s wit_h manag_ers;
- Des_cribe appr_opriate c_ontemporary roles for clinicians in leadership and managem_ent;
- I_dentify the struct_ures, mechanisms and p_rocesses that are us_eful in str_engthening clinical leadership; and
- Reflec_t on the r_elevance of the internatio_nal experien_ce to the he_althcare c_ontext.
The revi_ew foc_uses on findings that are r_elevant to the public hos_pital sector, as this is the sector that is res_ponsible for serving patien_t. it al_so refl_ects b_riefly on the diffe_rences betwe_en the public and for-pro_fit pri_vate se_ctors that mi_ght a_ffect the role and im_pact of clinical leaders.
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