JL

Clinical Leadership MRTY3122 - Practice Flashcards

What is Clinical Leadership

  • Clinical leadership is about advocating for patients, delivering high‑quality patient care, and motivating teams to achieve patient‑centred outcomes.

  • It also involves instigating and facilitating change when current systems aren’t working.

  • Important distinction: clinical leadership is not management (see contrasts below).

Clinical Leadership at a glance

  • Core focus: delivering safe, effective care; speaking up for safety; empowering colleagues; aligning goals and sharing a vision for excellent care.

  • Leadership vs management:

    • Leadership focuses on patient care and team empowerment.

    • Management covers recruitment, rostering, financial performance, capital projects, administration, accreditation, and performance management.

    • Both are needed, but clinical leadership emphasizes advocacy, safety, and system improvement.

Emotional wellbeing and safety context

  • Topics may be emotionally triggering: adverse events with case images; motorcycle trauma; clinical deterioration; workplace issues.

  • The University offers wellbeing and counselling services; access is free for students.

  • Emphasis on creating a supportive learning environment.

Values and traits in clinical leadership

  • Traits deemed most important (collective view):

    • Being relational and flexible; caring/compassionate; visible in practice; effective communicator; courageous; able to manage resources; inspires confidence; articulate; adaptable to change; approachable. (Examples of perceived importance: 90%, 89% levels across several traits.)

  • Traits deemed least important in some assessments: artistic/imaginative; aligning people; being a teacher; taking calculated risks; mentoring; negotiating; creative/imaginative; consistency; management experience; being a coach.

  • Key takeaway: people‑facing, relational, and adaptive capabilities are prioritized over purely administrative traits.

Emotional intelligence (EI)

  • EI definition: the ability to perceive and express emotion, assimilate emotion in thought, understand and reason with emotion, and regulate emotion in self and others.

  • High EI is highly desirable for managers and leaders and particularly valued in clinical leaders.

Pillars of Clinical Leadership

  • Communication

  • Innovation

  • Patient safety

  • Courage

  • Clinical knowledge and experience

  • Humility

Psychological safety

  • A psychologically safe workplace enables clinical leadership by encouraging staff to speak up and challenge the status quo.

  • Four domains of psychological safety:

    • Learner safety

    • Collaborator safety

    • Inclusion safety

    • Challenger safety

Barriers to clinical leadership

  • Lessons from "Silence That May Kill" (aviation): challenger safety is essential.

  • Barriers include:

    • Authority gradient (power gradient) between staff and leaders.

    • Dysfunctional team dynamics.

    • Medical dominance and competing stakeholder interests.

    • Poor organizational culture.

Consequences of poor organizational culture

  • Internal impacts: organizational failure, reputational damage, loss of trained staff, higher turnover, poor working conditions, increased workload, higher costs, lost time, reduced service capacity.

  • External impacts: negative health outcomes, poor clinical care, patient harm, delays in care, reduced access to health services, loss of public confidence.

Mid Staffordshire NHS Foundation Trust Inquiry (2013)

  • Scale: served ~320{,}000 patients and employed ~3{,}000 staff.

  • Findings: between 2005–2008, between 400 and 1{,}200 patients died due to substandard care.

  • Critical organizational cultural issues identified:

    • Lack of openness to criticism

    • Lack of patient-centered thinking

    • Secrecy and concealment of problems

    • Acceptance of poor standards

    • Failure to place the patient first in all actions

Practical implications for radiography and clinical practice

  • ALARA principle: keep exposures As Low As Reasonably Achievable.

  • Imaging request screening: assess whether the examination is appropriate.

  • Resource allocation and radiation safety considerations.

  • Contrast safety and overall patient safety.

  • Team‑based responsibility for safety and dose management.

Clinical leadership in radiography and multi‑disciplinary teams

  • Patient safety priorities:

    • ALARA

    • Procedural safety and patient care

    • Radiation safety for team members (PPE, shielding, monitoring)

    • Image/dose optimisation

  • Soft patient‑care tasks: patient comfort, room turnover, and non‑technical duties integral to safe care.

  • Final check with the whole team and patient before a procedure begins (procedural time‑outs):

    • Correct patient (+ ID)

    • Correct procedure (+ consent)

    • Correct operative site

    • All relevant clinical concerns addressed

    • Time‑outs are led by the most senior team member and involve every clinical team member; provide a space to clarify concerns before proceeding.

Time‑outs and graded assertiveness

  • Time‑outs require respectful, professional communication and clear escalation routes.

  • Graded assertiveness framework includes phrases such as:

    • What you are doing is not safe, we need to stop and get help.

    • I am concerned that…

    • I think we should consider…

    • Have you considered…

    • Can you clarify…

  • Audience awareness: tailor communication to the target audience and escalation path.

Clinical leadership as a student

  • Leadership expectations for students are not to be an automatic leadership figure; rather, contribute to patient safety by:

    • Following directions

    • Alerting supervisors to potential issues

    • Reflecting on incidents and considering where clinical leadership fits

Dunning‑Kruger effect in clinical leadership development

  • Conceptual model: Peak of Mount Stupid → Valley of Despair → Plateau of Sustainability → Slope of Enlightenment.

  • Highlights that knowledge confidence does not always align with actual competence; learning progresses through awareness of limits and growth.

Obstructive behaviours vs leadership

  • Obstructive behaviours can delay patient care and increase team workload.

  • Important to distinguish obstructive behaviours from constructive leadership actions.

  • Obstruction degrades team dynamics and can worsen patient outcomes.

Practical case study ideas (cath lab context)

  • Case study: applying clinical leadership in the cath lab may involve

    • Speaking up when protocol deviations are noticed

    • Leading a debrief after a near‑miss to implement system changes

    • Facilitating interprofessional communication during high‑pressure cases

    • Balancing rapid decision‑making with patient advocacy and safety

Notes on context, ethics, and real‑world relevance

  • Ethical implications: prioritising patient safety, advocating for vulnerable patients, ensuring transparency and accountability, and balancing resource use with patient need.

  • Philosophical themes: humility, truthfulness, respect for patient autonomy, and the duty to improve systems for broader health outcomes.

  • Real‑world relevance: historical lessons from major inquiries (e.g., Mid Staffordshire) underscore the consequences of culture and leadership failures on patient outcomes.

Key numerical references and formulas (LaTeX)

  • Celebrating 175 years of The University of Sydney: 175 years

  • Mid Staffordshire Inquiry (2013) findings:

    • Population served: 320{,}000 patients

    • Staff: 3{,}000 employees

    • Deaths attributable to substandard care: between 400 and 1{,}200

    • Time frame of inquiry findings: 2005 ext{ to } 2008

  • Leadership trait importance (illustrative): percentages reported include values such as 90\%, 89\%, 89\% for several highly valued traits; least important traits include 22\%–21\% in specific categories.

  • Safety and exposure references (radiology): ALARA principle; imaging request screening; resource allocation; contrast safety; PPE and radiation safety measures.

Summary of connections to foundational principles

  • Interprofessional collaboration and patient advocacy align with CPD and lifelong learning.

  • Psychological safety is a prerequisite for effective leadership in high‑reliability environments like radiology and the cath lab.

  • Transformational leadership principles support change management, alignment of team goals, and utilization of diverse skills to improve service delivery.

  • The Dunning‑Kruger framework reminds students that developing leadership competence requires humility, reflective practice, and ongoing learning.

Implications for exam preparation

  • Be able to distinguish between clinical leadership and management functions.

  • Understand theoretical models (Great Man, Contingency, Transformational) and their applicability to healthcare settings.

  • Recall key pillars and values of clinical leadership, and explain how psychological safety enables leadership in practice.

  • Identify barriers to leadership and consequences of poor culture, with real‑world examples from major inquiries.

  • Apply the time‑out and graded assertiveness concepts to hypothetical scenarios in radiology or cath lab contexts.

  • Demonstrate awareness of ethical and professional responsibilities, including patient safety, advocacy, and continuous professional development.

References to course context

  • Case study focus: Clinical Leadership in the cath lab (practical application)

  • Content warnings: wellbeing, adverse events, clinical deterioration, workplace issues; resources available through university supports.

  • CPD and lifelong learning emphasis as part of LO2 and LO5 outcomes.