Leadership and Clinical Education
Workshop 1
What is leadership?
What’s it got to do with clinical education?
Adding a leadership dimension to clinical facilitation
Workshop 1: Learning outcomes
 Reflect on the concept of leadership within the
context of clinical education
 Understand the general principles of the Leadership
and Clinical Education (LaCE) framework
 Discuss the application of the LaCE framework to
‘everyday’ clinical education practice
 Identify opportunities for your personal/professional
development as a leader of clinical education
Leading clinical learning
What is leadership?
 ‘60 second’ question
How do you define ‘leadership’ and what
are the attributes of ‘good’ leadership?
Leading clinical learning
What is leadership?
A leader is best when people barely know he exists;
not so good when people obey and acclaim him;
worst when they despise him. Fail to honour people
they fail to honour you, but of a good leader who
talks little when his work is done, his aim fulfilled they will say “We did this ourselves”
Lao-Tzu (6 BC)
Leading clinical learning
What is leadership?
A leader is a dealer in hope
Napoleon Bonaparte
Leading clinical learning
What is leadership?
Setting an example is not the main means of
influencing others; it is the only way.
Albert Einstein
Leading clinical learning
What is leadership?
…. any behaviour that influence the actions and
attitudes of others to achieve certain results
Australian Leadership Development Centre, 2007
Leading clinical learning
What is clinical education?
 ‘60 second’ question
How do you describe clinical facilitation/education and
what are the attributes of ‘good’ facilitation?
Leading clinical learning
What is clinical education?
 Clinical education (my definitional attempt) ..
a process which facilitates ‘… the translation of theory
into clinical knowledge and professional skills
through the provision of positive learning
experiences within quality learning environments..’
McAllister et al. (1997, p.3) and...Nash (2010)
Leading clinical learning
Clinical learning environment – an interactive network of forces
Learning
environment
Students
Clinical facilitators
Quality of the
learning
experience
Quality of
learning
outcomes
Clinical staff
Care recipients
Learning
environment
Leading clinical learning
Clinical education: What does the evidence tell us?
 Quality clinical facilitation:
Nursing students’ perceptions of effective Vs ineffective
clinical teachers (n=214)
Interpersonal relationships
 eg. good relationships with nursing team
Personality characteristics
 eg. enthusiastic approach
1

Teaching ability
3

eg. encourages thinking and learning
Professional competence
 eg. good professional knowledge



2
4
Tang et al. (2005)
Leading clinical learning
Clinical education: What does the evidence tell us?
Ratings of 5 subsets of effective clinical educator characteristics
 Students (n=134)
1
2
3
4
5
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

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Interpersonal relationships
Evaluation
Nursing competence
Teaching ability
Personality traits
 Clinical educators (n=17)

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


Interpersonal relationships
Nursing competence
Evaluation
Teaching ability
Personality traits
Lee at al. (2002)
Leading clinical learning
Clinical education: What does the evidence tell us?
 Clinical learning environments:

Positive factors

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




recognition of students’ presence, appreciation and support
a collegial environment where students are perceived as members of
the team
good communication
team spirit
a positive atmosphere
democratic leadership styles
positive interactions with staff
Papp et al. (2003), Clare et al. (2002, 2003)
Leading clinical learning
Clinical education: What does the evidence tell us?
 Clinical learning environments:

Less positive factors
lack of direction
 poor communication
 unrealistic expectations
 lack of collaboration between students and staff
 unreceptive or ambivalent staff
 students perceived to be a burden

Grindel et al. (2001); Clare et al. (2003); DHS, VicHealth (2009)
Leading clinical learning
Clinical education: What does the evidence tell us?
 Positive ward atmosphere and effective clinical
supervisory relationships with staff - the most important
factors contributing to the quality of clinical learning
(Saarikoski et al. 2002)
 ‘Optimal clinical learning requires an adequate practice
environment, a good relationship with a team or
individual with sound theoretical knowledge and
stimulating dialogue’ (Field, 2004)
Leading clinical learning
Leadership: toward the ‘how’..
Thinking about ‘how’ leaders lead, ie. influence others to
achieve desired results:
Several approaches/perspectives:

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Leadership as power
Personal characteristics of leaders
Leadership behaviors
Leadership styles
Situational leadership models
Transformational leadership models
Killian (2007)
Australian Leadership Development Centre
Leading clinical learning
Leadership as power

positional authority, reward power, coercive power,
expertise, interpersonal power
effective leaders expand their power base beyond limits of
positional authority
 use of rewards is one of the simplest yet most powerful forms of
power a leader can exert
 coercive power should be used with care & judgement
 expertise is useful but not sufficient on its own
 importance of relational power is likely to increase
Killian (2007)

Leading clinical learning
Personal characteristics



early trait / ‘great man’ theories
no single list found to hold true
contemporary thinking includes:


dominance, extraversion, sociability, self-confidence, high levels
of energy, resilience and intelligence (reasoning + social
intelligence, a sub-component of emotional intelligence)
social intelligence – single largest factor impacting on
leadership effectiveness (Killian, 2007)
Aristotle once said that “we are the sum of our behaviours;
excellence therefore is not an act but a habit.”
Leading clinical learning
Leadership behaviours
 Competency-type models

strategic thinking, change management, relationship builder,
staff developer etc.
 Models based on roles/skills

decision making, technical, interpersonal etc.
Leading clinical learning
Leadership styles
 concern for people / concern for results
 eg. Blake-Mouton grid
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1,1 delegate and disappear
9,1 produce or perish
5,5 middle of the road
1,9 friendly but not productive
9,9 team environment
 high satisfaction & high production
Leading clinical learning
Situational approaches
 importance of context in
deciding the ‘right’ leadership
approach in a given situation
 eg. Hersey & Blanchard’s model
S1 – telling/directing
 S2 – selling/coaching
 S3 – participating/supporting
 S4 - delegating

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Transactional / transformational approaches
 transactional leaders - focussed on day-to-day
operations
 transformational leaders - motivate followers to
perform to their full potential ….. translate
intention into reality and sustain it … use
power wisely
(Burns 1978; Bass 1985)
Leading clinical learning
Leadership and Clinical Education (LaCE)
framework
So, to the LaCE
framework....
Leading clinical learning
Leadership and Clinical Education (LaCE)
framework
This is a leadership framework that is designed to build
your professional capabilities now and in the future.
The LaCE framework conceptualises clinical education
leadership as involving:
cognitive and behavioural complexity
personal valuing of ‘best’ practice
critical observation and reflection
commitment to ongoing learning and development
Leading clinical learning
Leadership and Clinical Education (LaCE)
framework
 The Framework is designed around 4 key areas, all of which relate to
the role of a clinical facilitator/supervisor. The precise emphasis on
individual areas will vary depending on the individual context /
situation.
 Each section of the Framework contains key attributes of clinical
education leadership practice that are supported with selfassessment tools for personal reflection.
 The Framework is underpinned by core professional values in
relation to ongoing learning for quality practice and professional
development.
Leading clinical learning
Leadership and Clinical Education Framework
Dimensions of practice
Enacting
to achieve
Executing
the role
Enacting self
development
Attributes
Sharing vision and
values
Communicating
effectively
Clinical teaching &
learning
Knowing self
Setting clear goals
Interacting in a range
of contexts
Assessing students’
performance
Obtaining feedback on
performance
Promoting a culture
of learning
Empowering others to
achieve
Managing day-to-day
business
Engaging in personal
and/or professional
development
Professional learning
Enhanced student outcomes
Leading clinical learning
Personal development
Achievement of personal /
professional goals
ACTION LEARNING
REFLECTION ON PRACTICE
Establishing
direction
Using the framework to enhance clinical education practice




practice
Reflecting on feedback obtained from
others
Identifying areas for personal
improvement
Putting an action plan in place
Evaluating the outcomes achieved
Leading clinical learning
LaCE dimensions and attributes
 Personal reflection on your own
Some closing thoughts…
Leaders are responsible for getting results through others.
Leaders should be judged not by what they do, but rather by what those around
them are doing and achieving.
In this light it is very clear that leadership is people work, with a focus on
achieving results.
Australian Leadership Development Centre
Leading clinical learning
The task of leadership is not to put greatness into
humanity but to elicit it - for the greatness is already
there
John Adair, 1990, “Not bosses but leaders”
Leading clinical learning
References
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Bennis, W. & Nanus, B. (1985). Leaders : the strategies for taking charge. New York: Harper & Row.
Blake, R. & Mouton, J. (1994). The managerial grid. Houston: Gulf Publications.
Burns, J. (1978). Leadership. New York: Harper & Row.
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facilitation. Journal of Advanced Nursing, 37, 577–588.
Hersey, P., Blanchard, K. & Johnson, D. (2001), Management of organizational behavior: leading human resources.
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Lee, C., Cholowski, K. & Williams, A. (2002). Nursing students’ and clinical educators’ perceptions of characteristics of
effective clinical educators in an Australian university school of nursing, Journal of Advanced Nursing, 39(5), 412420.
McAllister, L., Lincoln, M., McLeod, S. & Maloney, D. (1997). Facilitating learning in clinical settings. Cheltenham, UK
: Stanley Thornes.
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Leading clinical learning