Definitional issues in clinical leadership

Definitional issues in clinical leadership

Within the health care system, it has been acknowledged that clinical leadership is not the exclusive domain of any particular professional group.15 Rather, all members of the health care team are identified as potential leaders.16 Like “leadership,” the concept of clinical leadership can be defined in a range of ways; and while a standard definition of clinical leadership providing absolute agreement on meaning is not crucial to progress and is likely to prove difficult,17 it is useful to consider the various ways clinical leadership is conceptualized and presented in the literature. While effective clinical leadership has been offered up as a way of ensuring optimal care and overcoming the problems of the clinical workplace, a standard definition of what defines effective clinical leadership remains elusive.15,18 Indeed, in some ways it is easier to consider what constitutes poor or ineffective clinical leadership.Nursing Leadership Essay

A secondary analysis of studies exploring organizational wrongdoing in hospitals highlighted the nature of ineffectual leadership in the clinical environment. The focus of the analysis was on clinical nurse leader responses to nurses raising concerns. Three forms of avoidant leadership were identified:

placating avoidance, where leaders affirmed concerns but abstained from action; equivocal avoidance, where leaders were ambivalent in their response; and hostile avoidance, where the failure of leaders to address concerns escalated hostility towards the complainant.14

These forms of leadership failure were all associated with negative organizational outcomes. Similarly, McKee et al employed interviews, surveys, and ethnographic case studies to assess the state of quality practice in the National Health Service (NHS); they report that one of the most important insurances against failures such as those seen in the Mid-Staffordshire NHS Trust Foundation is active and engaged leaders at all levels in the system.Nursing Leadership Essay

Despite the definitional uncertainty, a number of writers have sought to describe the characteristics, qualities, or attributes required to be an effective clinical leader. Synthesis of the literature suggests clinical leadership may be framed variously – as situational, as skill driven, as value driven, as vision driven, as collective, co-produced, involving exchange relationships, and as boundary spanning (see Table 1). Effective clinical leaders have been characterized as having advocacy skills and the ability to affect change.20,21 As well, effective clinical leaders have been linked to facilitating and maintaining healthier workplaces,22,23 by driving cultural change among all health professionals in the workplace.24 To achieve these positive outcomes, clinical leaders need to be seen as credible – that is, be recognized by colleagues as having clinical competence18,25–27 and have the skills and capacity to effectively support and communicate with members of multidisciplinary clinical teams.18,25 Taking an individual perspective, effective clinical leaders require personal qualities that reflect positive attitudes toward their own profession, have the courage and capacity to challenge the status quo, effectively address care quality issues, and engage in reflective practice.18,14 Pepin et al found that clinical competence, the capacity to lead a team, and being prepared to challenge the status quo were necessary skills for clinical leaders in one Canadian study.28 In an Australian study, findings indicated that student nurses want clinical leadership attributes from their clinical preceptors to include being supportive, approachable, and motivating, while being effective communicators.29 Table 1 summarizes the characteristics of clinical leadership and the attributes of clinical leaders distilled from the literature.Nursing Leadership Essay

Table 1 The characteristics of clinical leadership and the attributes of clinical leaders
Notes: Table distilled from: Clark 2012;31 De Casterle et al 2008;47 Edmonton 2009;11 McKeon et al 2009;73 Stanley 2012;32 Patrick et al 2011;34 McKee et al 2013.19

Despite acknowledging the lack of a standard definition of clinical leadership, the authors in one literature review identified common themes:

[…] the ability to influence peers to act and enable clinical performance; provide peers with support and motivation; play a role in enacting organizational strategic direction; challenge processes; and to possess the ability to drive and implement the vision of delivering safety in healthcare.30

Many articles assert that clinical leadership is leadership provided by clinicians often recognized as clinical leaders. Indeed, an important driver of the move toward models of clinical leadership is the notion that clinical leaders “are the custodians of the processes and