Clinical leadership in hospital care: The right kind of clinical leadership is needed

EDITOR—Olsen and Neale are right to point to the importance of clinical leadership in reducing adverse events in hospital care.1 What is required, however, is not the leadership beloved of politicians, where bullish confidence and decisiveness, often in the face of considerable opposition, are the order of the day. Rather, an atmosphere of trust in the clinical team is needed so that the most junior members of staff, or even the patient's relative, have the confidence to raise concerns about the quality of patients' care.

This approach is being pioneered by the Health Foundation in partnership with the Institute of Healthcare Improvement in its safer patients' initiative. Launched in 2004, the £4m initiative involves four acute trusts from across the United Kingdom that will become models of excellence in patients' safety.

The conventional leadership, trust board and clinical directors, has a crucial part to play in encouraging safe practice through demonstrating its importance, collecting data, and showing a willingness to listen to issues that concern clinical teams and acting on them. But the key is education and training of staff to adopt proved safer practice and to adapt it to the situation in which they find themselves.

Thus leadership needs to be shared throughout the system so that those nearest to the problem can identify its causes, offer solutions, and take action, all the time feeling confident that they are being listened to and backed by senior staff. Although it is early days for the safer patients' initiative, the Health Foundation is committed to providing evidence that investing in leadership leads to improvements in the quality of patients' care. Evaluation findings from its portfolio of work will be made available as work progresses.