Leadership in healthcare

Leadership has become a bit of a buzzword – senior managers and policy makers can often be heard discussing the importance of leadership to organisations. However, while attention is often placed on a few senior individuals, research suggests that leadership may best be seen as dispersed across the organisation. This material will introduce you to why leadership is given so much emphasis today, identify some of the benefits of clinicians taking on organizational leadership roles, and discuss some of the challenges of leadership. At the start of your careers, issues of leadership can appear somewhat distant concerns. However, as healthcare professionals, you may have opportunities for influencing the practice of your team or department sooner than you think.

In the past, there has often been a cultural divide between ‘business’ managers and healthcare professional groups. A good amount of research suggests that clinicians willing to take up leadership roles can have benefits both to the overall performance of organisations, but also crucially to the quality of individual patient care.

For example, a recent largescale study conducted by academics at the Universities of Birmingham and Manchester identified the clear benefits of medical representatives on NHS boards. Similarly, a disconnect between the (non-clinical) management and healthcare professional groups can be extremely problematic for healthcare organisations and lead to a culture of distrust, poor communication and disengagement. Because of this, there is now an international trend towards ‘hybrid’ clinical professionals who are involved both in direct patient care and in broader organizational issues. Although there are certainly challenges to this given the amount of time it takes to learn professional skills, starting to engage in issues of leadership early in your career could be one way to tackle these challenges.

Leadership is sometimes felt to be the preserve of people in formal – and perhaps senior – ‘leadership’ roles. For example, those identified as Clinical Director’ in a hospital, or people with the work manager in their job title. However, common definitions of leadership suggest that this assumption would be a mistake. Although there is no single, agreed upon definition of leadership, most experts in the field suggest leadership is about intentionally seeking to influence others towards the achievement of a collective goal.

Three things are important here.

First, this suggests that leadership is a process, not a role inhabited by senior individuals.

Second, it suggests leadership is characterised by social influence and we all influence others from time to time, even if only in comparatively small ways.

Third, this suggests leadership is at least to some degree intentional. This suggests that leadership involves taking the initiative to achieve things that we think are important. All clinical professionals from very early on in their career, can begin to intentionally influence a number of important aspects of pharmacy practice. For example, our everyday actions are likely to influence:

  • Improving and maintaining the safety and quality of services
  • Spreading innovations in processes or new technology
  • Building positive relationships with patients
  • Developing a positive working environment, for example with
  • supportive relationships amongst colleagues
  • Building positive relationships across the health system
  • Strengthening social connections across the organisation and
  • building social networks
  • Sharing knowledge and evidence

Leadership development

The extent and impact of our leadership can therefore be developed, just like other skills.  This is important as there is often pressure on healthcare organisations to run more efficiently and more cost- effectively. However, there is often not a clear or agreed picture of how this is to be done. Developing leadership skills can help you shape and change the teams and organisations you work in ways that you think are more effective and help you to improve your practice. As part of your professional training you learn excellent communication and interpersonal skills, which can contribute to the overall development of the organization, not just the improved health and wellbeing of your patients. Therefore, we encourage you to develop your leadership skills, in ways that we begin to outline below and that you may carry on investigating through the course of your career.

The study of leadership started off by focusing on the character traits of important leaders from leaders, but increasingly focused on what are successful approaches to leadership that we can all learn from.

More can be learnt from this BBC radio documentary.

Early theories of individuals in leadership tried to find common characteristics of leaders. As an example here is a trait theory of leadership by Zaccaro (2004):

Figure 1: Model of Trait Leadership (Zaccaro, 2004)

However, these had lots of methodological problems, and also tended to reflect wider biases that exist in society (for example highlighting traditionally male characteristics). More contemporary literature on leadership in public life tends to focus on important skills and qualities that we can develop. Things like:

  • Communicating effectively
  • Involving other people in decisions
  • Remaining calm and positive in difficult situations
  • Fairness in their dealings with others
  • Ensuring their organisation focuses on the way it benefits society (rather than protecting its own patch)

The NHS has developed its own leadership competency framework and has sought to develop its leadership capacity through the advent of the Leadership Academy. Although I don’t think anyone would say this is perfect, it could be a place to start to understand some of your own leadership development. Have a look at the criteria below:


These are the essential roles and skills that the NHS determines are essential to leadership roles. Have a look at the NHS Leadership Model to further familiarise yourself with their recommendations.

Challenges of leadership

Although leadership has received a lot of attention over recent years, some people feel that it doesn’t always add up to improvements in front line care. There are worries that encouraging everyone to be ‘leaders’ is reducing some of the collegiality that used to be present amongst front line teams – others say that ‘leaderism’ has distracted us from what is important. Certainly there is a large and growing number of ‘how to’ guides to leadership and not as much evidence that the quality of leadership is actually improving.  In healthcare organisations there are many things that shape how things work aside from the individual skill of particular leaders. For example;

  • Organisational politics
  • Government funding
  • Relationship with other healthcare organisations
  • The demands of patients
  • The demands and availability of staff
  • Public policy change
  • New technology

We do not therefore suggest that leadership is the answer to all the problems facing healthcare organisations, but just one part of a very complex picture.

One way to begin to think about the challenges of leadership in practice is to put yourself in the shoes of a senior manager at a healthcare organisation. What are the big challenges you think they face? There are often pieces in The Guardian, the Health Services Journal, or the British Medical Journal that cover key challenges of NHS Leadership. Keeping up to date with these broader challenges can help you to understand the local changes in your organisation or department.