04 Jan 2013

Research reveals the clinical leadership behaviours required to make the NHS reforms work

From April 2013, the Prime Minster wants to see ‘doctors in charge’, with new Clinical Commissioning Groups paving the way. But there has been widespread scepticism about whether GPs and other clinicians are ready for this root-and-branch challenge.

New research results from The Open University (OU) funded by the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme offers some much-needed answers. Drawing on data from actual service redesign attempts in the two challenging areas of sexual health services and dementia, researchers found that clinicians who did demonstrate leadership were capable of being open to new ideas and new knowledge while also having the political wisdom to carry their colleagues with them.

Dementia services were refashioned to make early diagnosis more accessible and sexual health reworked so that everything most patients needed could be provided in one visit to a high street clinic.

These gains were not easily won. The research also found extensive evidence of the scale of the challenges when seeking to overcome inertia. Notably, the obstacles are often to be found among their peers. Trust boards and hierarchies were also seen as frequent drags on innovation. In this context, the research sheds new light on the elusive idea of clinical leadership.

Those hospital doctors and senior nurses showing leadership in service redesign had begun to master a range of political and managerial skills. They developed informal links with staff working in related services, developed ideas for simplifying patient journeys and sought out innovation-minded managers and commissioners to help smooth the way for new more patient-centred arrangements.

The research project identifies and clarifies the kind of skills which will hold the key to successful delivery of the new regime, as well as ways of dealing with colleagues and trust managers who resisted new ideas. However, in all but one of the case studies, the clinicians and managers behind the creation of new service models felt it had been difficult to involve GPs. Clinical leadership was thus coming from the hospital sector. This has implications for the new Clinical Commissioning Groups which will take charge of the largest part of the NHS budget from April.

Talking about how the obstacles can be overcome, Dr Richard Holti a co-researcher on the project said: “Formal project planning is not enough; rather, informal, lateral, leadership is important. This is needed in order to bring along clinical colleagues, to reassure them and to win their cooperation and ideas. The most effective service redesigns were achieved when both of these processes worked in tandem”.

Professor John Storey, who led the project, added: “In general, clinical leadership was found to occur at multiple levels and the role of clinicians in shaping national policy should not be underestimated. Many of the important changes required national endorsement – and often funding – in order to put traction behind good ideas.”

The peer-reviewed research was conducted for the National Institute for Health Research Health Services and Delivery Research (NIHR HS&DR) Programme, and has taken place over the past twelve months during which the Coalition Government’s health reforms became law.


The full report, “Possibilities and Pitfalls for Clinical Leadership in Improving Service Quality, Innovation and Productivity”, by John Storey and Richard Holti, will published by the NHS National Institute for Health Research on 4th January 2013.

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