Clinical Leadership

The RCPCH Clinical Leads Development Programme supports current, new and aspiring paediatric clinical leads and clinical directors of children’s services. Its aim is to develop confident, knowledgeable paediatric clinical leaders able to sustainably manage and lead their team to ensure the best outcomes for children and young people.

There are a range of resources and guidance available for paediatric clinical leads and clinical directors, and other paediatricians working in leadership roles.

Prof. Michael West explores the links between compassionate leadership and innovation and discusses how we can ensure collaboration across boundaries in health and care in a presentation recorded by The King’s Fund at the 7th Annual Leadership and Management Summit in 2017 below:

In the presentation, Prof. West outlines “when we spread compassionate leadership from ourselves across the system, we then have the ability to transform the health and wellbeing of communities”. Collaborative and inclusive leadership can enable us to deliver the highest quality care for families and contribute to transformational change in health services.

More insight on clinical leadership is available from the King’s Trust and some additional resources examining the overall role and function of clinical leadership are listed below:

The NHS Long Term Plan highlights the importance of visible senior clinical leadership in enabling and assuring the delivery of high quality care both within organisations and in the new system architecture. NHS Improvement produced a guide to provide a framework for action and shares case studies illustrating the range of experiences clinicians have had in their leadership journey.

The NHS Leadership Academy have developed the Healthcare Leadership Model to help clinicians become better leaders in their day-to-day roles. The model is made up of nine leadership domains that learners can explore at their own pace and includes self-assessment and 360-degree feedback tools to support personal development.

Leadership for Clinicians (LeAD) is an e-learning programme with over 60 short interactive sessions developed in 2013 by Health Education England in partnership with the Academy of Medical Royal Colleges, NHS Leadership Academy and Faculty of Medical Leadership and Management. It aims to support clinicians, of all professions, to develop an understanding of their role in the management and leadership of health care services.

The General Medical Council’s annual report covers a number of areas including the state of medical practice, the state of medical education, and the changing medical workforce of the UK. In 2020, the global COVID-19 pandemic has tested the resilience of the health system and its workforce to unprecedented levels and learning from this is captured alongside case studies.

In August 2019, the GMC commissioned an independent study looking at how doctors in senior leadership roles establish and maintain a positive patient-centred culture. It set out to explore the lived experiences of senior clinical leaders and examines how to build or sustain a positive culture, emphasising that good leadership and positive cultures are vital to health care and patient safety.

In November 2018, the Department of Health and Social Care published an independent report carried out by the Faculty of Medical Leadership and Management. This report sets out the barriers and enablers for clinicians moving in to senior leadership roles within the NHS.

Published by The King’s Fund in collaboration with the Faculty of Medical Leadership and Management and the Center for Creative Leadership, this report provides an overview of the evidence emerging around leadership in health services. The review describes the leadership task and identifies the most effective leadership behaviours at individual, team, board and national levels.

This paper led by Prof. Michael West argues that collective leadership provides the optimum basis for caring cultures. It explains the interaction between collective leadership and cultures that value compassionate care, and outlines the main characteristics of a collective leadership strategy and the process for developing this.

Service standards

As you start your leadership journey, it is important to recognise the standards of care expected of the service. Understanding core requirements and benchmarking against these will help to guide service development and ensure a culture of continuous improvement.

Organisations setting these standards in paediatric care are outlined below:

Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. Core standards are those that all funded providers should be able to demonstrate, and developmental standards are those that may require further changes in practice over time to provide excellence in care. A full list of NHS service specifications is available online – scroll down to section P to find a wide range of specifications relating to paediatric services.

RCPCH Facing the Future standards for paediatric care offer a vision of how paediatric care can be delivered to provide a safe and sustainable, high-quality service. Areas covered include acute paediatric care, emergency care settings, care in the community and ongoing health needs of children and young people.

In October 2020, the RCPCH published standards for child protection produced in collaboration with the Child Protection Special Interest Group. The standards provide a benchmark for consistency in commissioning and service design, and aims to promote equitable, high quality child protection services across the UK.

The National Institute for Health and Care Excellence quality standards set out priority areas for quality improvement in the health and social care, covering areas where there is variation in care. Each standard provides a set of statements to help provide a benchmark for quality, and information on how to measure progress in related improvement activity.

Service improvement

Once we identify the standards that are needed to be achieved, the next phase of management development and a core component of leadership is to understand the current system, its processes and the outcomes for children and young people under their care, and the use of data to drive and prioritise further improvement.

Resources to support service development, project management and quality improvement within the NHS are listed below:

This example of a business case template aims to support organisations and teams within the NHS in their own project development. Containing suggested text and guidance to aid with completion, organisations can adapt the document in accordance to their own local governance arrangements. The sections also help clinicians to examine the considerations required at the beginning of a typical project.

NHS Quality, service improvement and redesign tools offer a comprehensive collection of tools, techniques and methodology that can be applied to a range of improvement activities. The collection has four categories allowing search or browsing by stage of project, type of task, approach or patient pathway.

The Healthcare Quality Improvement Partnership oversees national healthcare quality improvement programmes including the National Clinical Audit and Patient Outcomes Programme. Its National Clinical Audit Programme includes annual reports from data submitted to national paediatric audits such as Epilepsy12, National Paediatric Diabetes Audit and the National Neonatal Audit Programme.

To embed quality improvement into everyday work, it is vital that we are able to compare our outcomes with others, and to share and develop improvement opportunities between different units and hospitals. These standardised data collection tools developed by Dr Oliver Rackham, RCPCH Clinical Lead for Audit aims to standardise methodology and datasets in common conditions for data collection and analysis, in keeping with agreed national standards of care, to help healthcare professionals conduct their own local / regional projects.

As part of the RCPCH Epilepsy Quality Improvement Programme, watch a recording of a webinar presented by Dr Pat O’Connor and Mirek Skrypak from the programme faculty on using data for improvement:

Workforce support

Workforce planning and management is essential to deliver high quality standards of care and ensure sustainability of both the service and its multi-disciplinary team. Resources to support team job planning and service design are outlined below:

The RCPCH supports workforce planning to ensure there is an appropriately trained paediatric medical workforce to deliver safe and sustainable services for children in the UK, including workforce reports and guidance based on data collected via the census, audits and other research projects.

The RCPCH is establishing a network of volunteer RCPCH member Ambassadors across England to advocate locally for children, young people and the workforce that serves them. Ambassadors engage with local ICS, STP or LWAB on behalf of the workforce with support from the RCPCH to ensure that adequately resourced child health professionals are able to provide the highest quality care to children and young people.

In 2020, the RCPCH created an online wellbeing hub to support members through challenging times and emphasise the importance of taking care of each other. It includes useful wellbeing resources, webinars, blogs, virtual support spaces and contacts from both the paediatrics workforce and wider healthcare community.