Leadership is about enlisting the aid and support of others in setting direction, influencing others and managing change, in order to achieve a common goal. While some current theorists see leading and managing as distinct but complementary activities, both seem to be important for success, and the separation of the two functions – management without leadership and leadership without management – is seen by many as harmful.
Clinical Leadership is not restricted to people who hold designated medical leadership roles; rather, leadership is shown through a shared sense of responsibility for the success of the medical organisation and its services. Acts of leadership can come from anyone in the organisation, as appropriate. Physicians are crucial in Clinical Leadership.
The Clinical Leadership Academy is focused on the achievement of the physicians’ continuous development and competency in this field, as clinical doctors are, naturally, the centre of clinical leadership activity/competency.
This document was prepared by the AEMH and discussed with the UEMS. It benefited from the valuable insights provided by other EMOs, and as a result was amended accordingly.
In the past, hospitals were routinely led by doctors. Modern practice, however, tends to favour trained managers, most frequently non-physicians. This can have unwanted consequences, as reported by Robert Francis in 2013, when care failings were addressed at Stafford hospital: “The Trust Board […] did not tackle the […] disengagement of senior clinical staff from managerial and leadership responsibilities”.; the recommendation was to strengthen leadership.
Conversely, there is an increasing body of evidence that having physicians in leadership positions leads to improved hospital performance and patient care (Horton R, 2008; Halligan A, 2008; Falcone BE et al., 2008; Darzi A, 2008, Darzi A., 2009; Candace I et al., 2009; Stoller JK, 2009; Dwyer AJ, 2010), that hospitals with the greatest level of clinician participation in management may perform 50% better (Castro PJ et al., 2008), and that organisations with stronger clinical leadership are more successful in improving services (National Co-ordinating Centre for NHS Service Delivery and Organisation, 2006). The greater involvement of doctors on the institution’s board significantly increases organisational performance, in terms of care quality, efficiency, lower morbidity and increased patient satisfaction (COST, 2012).
In 2008, Lord Darzi broadened the leadership role physicians are entitled to even further: “If clinicians are to be held to account for the quality outcomes of the care that they deliver, then they can reasonably expect that they will have the powers to affect those outcomes. This means they must be empowered to set the direction for the services they deliver, to make decisions on resources, and to make decisions on people.”
It is not, therefore, surprising that highly reputed academic or professional institutions (the Medical Schools Council, GMC, Conference of Postgraduate Medical Deans, Academy of Medical Royal Colleges and NHS Employers) consider leadership as one of the key roles of a doctor.
Hence, engaging in leading (and managing) systems of healthcare, on whatever scale – team, department, unit, hospital or health authority – is not an option, it is a professional obligation for all clinicians.
AEMH = European Association of Senior Hospital Physicians
CL = Clinical Leadership
EACCME = European Accreditation Council for Continuing Medical Education EACL = European Academy of Clinical Leadership
ECMEC = European Continuing Medical Education Credits EMOs = European Medical Organisations
ETR = European Training Requirements
UEMS = European Union of Medical Specialists
I. TRAINING REQUIREMENTS FOR SENIOR DOCTORS WITH CLINICAL LEADERSHIP EXPERIENCE (FELLOWSHIP)
A CL Fellowship applies to doctors who have completed their general professional training as physicians, have experience as clinical leaders and wish to be recognised by the European Academy of Clinical Leadership.
1. CONTENT OF TRAINING AND LEARNING OUTCOMES
DEMONSTRATING PERSONAL QUALITIES
Doctors showing effective leadership need to draw upon their values, strengths and abilities to deliver high standards of care. This requires doctors to demonstrate competence in:
A) Technical-professional skills
• Professional courses
Relevance of the experience acquired, training and type of functions performed.
• Continuing personal development
Participation in CPD activities, experience and feedback.
B) Time spent in practice
• Developing self-awareness
By being aware of their own values, principles and assumptions, and being able to learn from experience.
• Acting with integrity
By behaving in an open, honest and ethical manner.
C) Educational activities as trainer
• Training activities
In medical internships and other training and medical education courses attended and given.
• Managing themselves
By organising and managing themselves while taking account of the needs and priorities of others.
Doctors show leadership by working with others in teams and networks to deliver and improve services. This requires doctors to demonstrate competence in:
A) Experience, capacity and ability to manage teams
Working within teams, building and maintaining relationships by listening, supporting others, setting direction, gaining trust and showing understanding.
B) Experience, capacity and ability to manage services
Developing networks by working in partnership with patients, carers, service users and their representatives and colleagues within and across systems to deliver and improve services; planning and managing resources, people and performance, in order to improve services.
C) Experience, capacity and ability to manage organisations
Encouraging contributions by creating an environment where others have the opportunity to contribute.
PROJECT OF MANAGEMENT OF A MEDICAL DEPARTMENT
A) Managing Services
Doctors showing effective leadership are focused on the success of the organisation(s) in which they work. This requires doctors to demonstrate competence in:
• Planning by actively contributing to plans to achieve service goals.
• Managing resources by knowing the resources available and using their influence to ensure that resources are used efficiently and safely, and reflect the diversity of needs.
• Managing people by providing direction, reviewing performance, motivating others and promoting equality and diversity.
• Managing performance by holding themselves and others accountable for service outcomes.
B) Improving Services
Doctors showing effective leadership make a real difference to people’s health by delivering high-quality services and by developing improvements to service. This requires doctors to demonstrate competence in:
• Ensuring patient safety by assessing and managing risk to patients associated with service developments, balancing economic consideration with the need for patient safety.
• Conducting critical evaluations by being able to think analytically and conceptually, and to identify where services can be improved, working individually or as part of a team.
• Encouraging improvement and innovation by creating a climate of continuous service improvement.
• Facilitating transformation by actively contributing to change processes that lead to improving healthcare.
C) Setting Direction
Doctors showing effective leadership contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values. This requires doctors to demonstrate competence in:
• Identifying the contexts for change by being aware of the range of factors to be taken into account.
• Applying knowledge and evidence by gathering information to produce an evidence- based challenge to systems and processes in order to identify opportunities for service improvements.
• Making good decisions based on their values and the evidence.
• Evaluating impact by measuring and evaluating outcomes, taking corrective action where necessary and being held to account for their decisions.
a) CV Evaluation
|Demonstrating personal qualities||Technical-professional skills||0-1|
|Time spent in practice||0-1|
|Education activities as trainer||0-1|
|Leadership skills||Experience, capacity and ability to manage teams||0-1|
|Experience, capacity and ability to manage services||0-1|
|Experience, capacity and ability to manage organisations||0-1|
b) Project of management of a medical department
II. TRAINING REQUIREMENTS FOR TRAINEES
1. CONTENT OF TRAINING AND LEARNING OUTCOMES
A. THEORETICAL KNOWLEDGE
Demonstrate knowledge of:
1. Teamwork: ways in which individual/team behaviours impact on others; personality types, group/team dynamics, learning styles, leadership styles; the role in the way a group, team or department functions; (multi-disciplinary) team structures and responsibilities within the broader health context, including other agencies;
2. Individual and collective performance: how decisions are made by individuals, teams and the organisation;
3. Best practice: importance, transparency and consistency; local processes for collecting and dealing with and learning from clinical errors; integration of different (medical, social, etc.) aspects of care;
4. Communication: effective communication strategies within organisations; specific techniques and methods that facilitate effective and empathic communication; how complaints arise and how they are managed; methods of obtaining feedback from others; facilitation and conflict resolution methods; how to approach difficulties in dealing with patients and team members;
5. Ethical aspects: relating to management and leadership e.g. approaches to the use of resources/rationing; approaches to involving the public and patients in decision- making; patient empowerment and partnership;
6. Management: business management principles – priority setting and basic understanding of how to produce a business plan; the requirements of running a department, unit or practice relevant to the specialty; efficient use of clinical resources and clinical processes in order to provide care; funding and contracting arrangements relevant to the specialty; how financial pressures experienced by the specialty department and organisation are managed; organisational outcomes management techniques and processes; project management methodology;
7. Risk management: issues pertinent to specialty, understand potential sources of risk and risk management tools, techniques and protocols; tools and techniques for managing stress;
8. Governance and legislation: how healthcare governance influences patient care, research and educational activities at local, regional and national level; the duties, rights and responsibilities of an employer and of a co-worker (e.g. looking after the occupational safety of fellow staff); relevant legislation and local Human Resources policies; the responsibilities of the various Executive Board members and Clinical Directors or leaders;
9. Quality improvement methodologies: including methods of obtaining experience/feedback from patients, the public and staff; patient outcome reporting systems within the specialty and the organisation, and how these relate to national programmes; individual performance review purpose, techniques and processes, including the difference between appraisals, assessments and revalidations; the principles and processes of evaluation, audit, research and development, evidence-based clinical guidelines and standard setting in improving quality; methodologies for developing creative solutions to improving services; change management;
10. Research: how to evaluate scientific publications including the use and limitations of different methodologies for collecting data, peer reviews.
B. PRACTICAL AND CLINICAL SKILLS
Demonstrate abilities in:
1. Critical self-awareness: maintain and routinely practice it, including the ability to discuss strengths and weaknesses with a supervisor, recognising external influences and changing behaviour accordingly; understand the limitations of self-professional competence; balance personal and professional roles and responsibilities; recognise the manifestations of stress on the self and know where and when to look for support; use a reflective approach to practice, with an ability to learn from previous experience; use assessments, appraisals, complaints and other feedback to discuss and develop an understanding of own development needs;
2. Team leading: show awareness of and sensitivity to the way in which cultural and religious beliefs affect approaches and decisions, and to respond respectfully; take on differing and complementary roles within the different communities of practice within which they work; recognise, analyse and know how to deal with unprofessional behaviours; recognise the manifestations of stress on others and know where and when to look for support;
3. Extended collaborative working: support bringing together different professionals, disciplines and other agencies, to provide high-quality healthcare; work collegiately and collaboratively with a wide range of people outside the immediate clinical setting;
4. Effective working relationships and communication: develop it with colleagues and other staff through good communication skills, building rapport and articulating own views; create open and non-discriminatory professional working relationships with colleagues’ awareness of the need to prevent and tackle bullying and harassment; communicate effectively in the resolution of conflicts, providing feedback, and identifying and rectifying team dysfunction; communicate with media; show effective presentation skills (written and verbal);
5. Empowering people: encourage staff to develop and exercise their own leadership skills; enable individuals, groups and agencies to implement plans and decisions; contribute to staff development and training, including mentoring, supervision and appraisal; train and educate trainees;
6. Team/service (activities) management: contribute to the recruitment and selection of staff; identify and prioritise tasks and responsibilities, including delegating and supervising safely; analyse feedback and comments and integrate them into plans for the service; manage time and resources effectively in terms of delivering services to patients; improve services following evaluation/quality management; apply creative thinking approaches (or methodologies or techniques) in order to propose solutions to service issues; prioritise tasks, with realistic expectations of what can be completed by self and others; prepare for meetings – reading agendas, understanding minutes, action points and background research on agenda items; facilitate, chair and contribute to meetings;
7. Auditing and implementing changes accordingly: undertake an audit project; use and adhere to morbidity and mortality reporting systems; report clinical incidents; assess and analyse situations, services and facilities in order to minimise risk to patients and the public; contribute to meetings covering audit, critical incident reporting, patient outcomes; evaluate outcomes and re-assess the solutions through research, audit and quality assurance activities;
8. Managing working conditions and resources: monitor the criticality and quality of equipment and safety of environment relevant to the specialty; compare and benchmark healthcare services, public procurement, health technologies assessment; use clinical audit with the purpose of highlighting resources required;
9. Improving medical practice: question existing practice in order to improve services; use and adhere to complaint management systems; provide medical expertise in situations beyond those involving direct patient care; identify trends, future options and strategy relevant to the specialty and delivering patient services; understand and evaluate the wider impact of implementing change in healthcare provision and the potential for opportunity costs; develop protocols and clinical guidelines, use, adhere to and implement them;
10. Promoting research: use a broad range of scientific and policy publications relating to delivering healthcare services; guarantee research ethics.
C. COMPETENCES (ATTITUDES & BEHAVIOURS, PROFESSIONALISM)
1. Personal growth: commit to continuing professional development, which involves seeking training and self-development opportunities, learning from colleagues and accepting constructive criticism; recognise personal health as an important issue;
2. Team leadership skills: recognise co-workers’ health as an important issue; recognise and showing respect for diversity and differences in others; respect colleagues, including non-medical professionals; respect their skills and contributions; show recognition of a team approach and willingness to consult and work as part of a team; understand the needs and priorities of non-clinical staff; articulate strategic ideas and use effective influencing skills; use authority appropriately and assertively to resolve conflict and disagreement/be willing to follow when necessary; supervise the work of less experienced colleagues; appreciate the importance of involving the public and communities in developing health services;
3. Patient-focused approach: take decisions that acknowledge the rights, values and strengths of patients and the public; promote value-based non-prejudicial practice; show awareness of equity in healthcare access and delivery; actively seek advice/assistance whenever concerned about patient safety;
4. Personal qualities: be conscientious, and able to manage time and delegate;
5. Liability in governance: be prepared/willing to accept/take responsibility for clinical governance activities, risk management and audit in order to improve the quality of the service; participate in decision-making processes beyond the immediate clinical care setting;
6. Governance knowledge and support: accept and promote professional regulation; act according to medical ethics, including confidentiality; comply with guidelines that influence healthcare provision;
7. Excellent professional conduct: promote professional attitudes and values; show probity and a willingness to be truthful and admit errors, attitudes and behaviours that assist dissemination of good practice;
8. Ability to manage resources: commit to the transparent and proper use of public money; show commitment to take action when resources are not used efficiently or effectively;
9. Good communication: commit to good communication whilst also inspiring confidence and trust; respond constructively to the outcome of performance reviews, assessments or appraisals; listen to and reflect on the views of patients and carers, deal with complaints in a sensitive and cooperative manner; interact effectively with professionals in other disciplines, teams and agencies; take full part in multi-disciplinary meetings; act as an advocate for the service;
10. Ability to improve and change: support colleagues in voicing ideas; be open-minded, positive and proactive to improvement and change, new ideas, new technologies and treatments; commit to implementing proven improvements in clinical practice and services; understand issues and potential solutions before acting; obtain the evidence base before declaring effectiveness of changes.
2. ORGANISATION OF TRAINING
A. SCHEDULE OF TRAINING
The trainee will have to document a minimum of 200 “hours”, ECMECs or a combination thereof. This is the trainee’s portfolio.
The “hours” will be counted by the recognition of the trainee’s portfolio/educational activities by the CL Board. The CL Board will recognise specific CL educational activities and will grant a number of “hours” for each such activity.
All activities recognised by the EACCME that the CL Board considers relevant for the CL training, will be accepted as such, with the respective number of ECMECs.
The trainee will have to have fulfilled this number of “hours”/ECMECs over the last 10 years.
The trainee will have to document a minimum of 40 “hours” / ECMECs per each section in
B. TRAINING CURRICULUM
Leadership of completed medical-social projects
Innovation within a team framework
Relevant specific medical legal/regulations education
Chair/Reporter of Meetings/Working Groups
|4||Relevant winter/summer schools, conferences/congresses/workshops, etc.|
3. ASSESSMENT AND EVALUATION
a) The Eligibility Assessment Process is based on:
– proof that the applicant is a physician;
– the accomplishment of the 200 “hours”/ECMECs, as detailed in section II. 2 A. or that the candidate has successfully completed an MBA with a relevant Clinical Leadership training/section/curriculum.
– Assessment (+ Learner response to the curriculum);
– The CL Board assesses the CL portfolio;
b) The evaluation is based on:
– The Applicant’s portfolio, multi-source feedback
– Case-based focused discussion
– Audit assessment: learner questionnaire, feedback of the Programme Director (of the relevant educational activity), on the four main following sections:
o Learner acquisition of knowledge
o Learner acquisition of skills
o Learner competences (attitudes & behaviour, professionalism)
o Impact on the patients and the healthcare system as a whole
The CL Academy is governed by the AEMH in close collaboration with the UEMS.
This academy is managed in collaboration with other EMOs and universities (from different European countries). Other European medical bodies will also be welcome to join, if they show an interest in doing so and if the CL Academy Board agrees to their request.
The CL Academy is managed by the CL Academy Board.
III. TRAINERS, TRAINING INSTITUTIONS
As for the specificity of Clinical Leadership and as CL is not a speciality (nor a sub-specialty), there will be specific requirements for trainers (e.g. leading position/experience/function as a senior hospital physician – chief physician and/or medical director, relevant experience in leadership training) and for the training institutions (e.g. approved clinical leadership training capacity/experience), to be detailed and laid down by the CL Academy Board after inauguration.
The recognition of trainers and their quality management, as well as requirements for training institutions, will be included in the assessment of the accepted trainee’s portfolio/educational activities, as per Section II 2. A.
If, over time, a need (and opportunity) arises to develop specific/specialised training centres, these ETR will be completed with the relevant sections on training requirements for trainers and on training requirements for training institutions.