Instilling Clinical Leadership,
Ownership and Accountability
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History tells us….
• Tripartite management
– Based around the hospital
– Separation of personal and public health care
services
– Professions developed power bases
– Professional leadership was strong
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Along came General Management
• Healthcare services desperately needed
the models and skills of management
• Mind over mind set…manage the nurses
not the nursing
• Functional divisions – mostly based on
medical specialties
• Integration of primary, secondary, tertiary
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Management is management!
• Leadership through formal authority
• Structures needed designing from scratch
• Some lacked healthcare service
experience
• Decision-making influenced by the need to
retain power rather than good leadership
• Poor understanding of the operations; bad
understanding of the culture
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Logic of managerialism is blind..
• Passion for care giving
• Value of professional practice
• Lacked authority in within own working
environments
• Feeling value and connectedness
supports leadership
• Values of caring and vocation are
essential to practice
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Mapping the social topology
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The role of leadership in exercising power
The profession as point of reference
The role and use of symbolic power
Change management and managing
people
• Sharing the leadership role
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Leadership, the exercising of
cultural, social and symbolic power
• Reproduce those behaviours which are
seen as successful
• Reproduction through experiential role
modeling
• Recognition
• Behaviour is meaningful
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Culture
• Familiar and comfortable with the doxa
• Social stability based on shared norms
• Cultural and social capital such as higher
education and social recognition enables
reproduction of standards
• Culture recognised as the norm and gives
authority
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New paradigm
• Professions challenged by the need for
utility
• Skills to recognise and include the
economic imperatives placed on an
organisation
• Challenge of economic utility underlies
much of the tension between corporate
and clinical decision-making.
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The profession as point of
reference for leadership
• No matter what the context of decisions
• Professional maturity encompasses
metaliteracy - valuing the opinions, values
and ideas of others
• Can not be separated without
considerable experience and engagement
in other decision-making processes
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Professionhood
• A commonality of characteristics which
circumvent the formality of operational
structure
• Leadership characteristics can not be
formalised
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Role and Use of symbolic power
• Generalising behaviour
• Education as the bridge
• Don’t change the underlying values of the
profession
• Rules of play in the healthcare services
environment
• Leadership demonstrated through skills in
getting others to follow
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Change Management
• Inherent in the leadership role is change
manager
• Change is integral to the survival of
organisations
• Setting direction
• Establishing standards
• Communicating the change
• Envisioning the future
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Values based Leadership
• Regular testing of morality and ethics
• How we behave toward and influence
each other
• Aligned to the establishment of ethical
boundaries inside which subordinates
make decisions
• Emotional intelligence is the mark of a
good leader
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Managing People
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Key leadership role
Embedded in change process
Embedded in organisational culture
Developing staff, plans, board relationship
Culture of “Stepping up” to leadership
Not clinical direction but leadership
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Sharing the leadership role
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Sharing of power
Involvement in executive decision-making
Involvement in strategy
Determination of organisational priorities
Allocation of resources and funds
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Sharing of leadership
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Collaboration
Hesselbein
Individuals do nothing alone
Individual motivating capabilities and
Large group/organisational motivation
Shortell
• Leaders as change agents Pfeffer
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Value of Sharing
• Confidence to delegate
• Reinforce the power
• Opportunities for collective decisionmaking
• Familiarity with the “practical sense” of the
organisation; understanding the game
• “Pull the team together” and “get people
up to the game”
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Mintzberg
“….about leadership based on mutual
respect rooted in common experience
and understanding.”
Musings on management (1996)
• Establishing credibility
• Being alert to the qualities of others
• Creating an environment in which others
can flourish
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Clinical Leadership
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Set direction
Establish standards
Integrate agreed values
Setting ethical boundaries
Change agent
Transformational and situational
Establish trust
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Obligation
Having the skills to lead is an obligation of
leadership in public healthcare
organisations
Assuring the public’s confidence in the
services provided
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Accountability
Accountability is demonstrated through
professional maturity in the forms of:
• Leadership
• Credibility
• Education
• Experience, including life experience
• Metaliteracy – many perspectives
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Professional maturity
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Leadership in the context of
governance
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Creating a culture of Accountability
• Establish credibility – expertise and
outcomes
• Demonstrate education through
qualifications and experience
• Demonstrate experience through practice
and achievement of outcomes
• Stepping up to leadership
• Sharing the lead role
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Creating a culture of Accountability
• Using power to balance tension
• Managing and meeting targets for change
• Understand and use the opinions and
values of others – metaliteracy- being
literate in the perspectives of others
• Having the skills to get the job done as
well as clinical skills
• Embed in practice
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