Organisational Leadership in Healthcare: What is it?
Published: 28 January 2021
Published: 28 January 2021
Effective leadership is an essential component of providing high-quality care (Bismark, Walter & Studdert 2013).
So essential, in fact, that leadership has been directly identified by Australia’s National Safety and Quality Health Service Standards as a key component of a safe and high-quality health system. NSQHS Standard 1: Clinical Governance, outlines three aspects of leadership that work towards this goal. These are:
A healthcare organisation’s overall governance, leadership and culture, at the highest level, is provided by a governing body. The governing body may be:
Clinical leaders ensure that staff members are upholding their safety and quality responsibilities and operating within the scope of policies and procedures that have been established. They are expected to supervise staff, conduct performance reviews, report on safety and quality and ensure that staff understand what is expected of them (ACSQHC 2019b).
Organisational leadership falls between governance and clinical leadership. Under directions from the governing body, organisational leaders are expected to design and implement policies and procedures to ensure the organisation’s mission is met in a safe and effective manner. These policies and procedures will then be practiced and upheld by clinical leaders and staff (ACSQHC 2019c).
The success of a healthcare organisation is dependent on its leadership and culture, and actions taken by leaders set the basis of an organisation’s tone (VIC DoH 2020; AICD 2019).
As an example of poor organisational leadership in healthcare, let’s look at a case examined by The Royal Commission into Aged Care Quality and Safety.
The Commission investigated a money-saving strategy implemented by the governing body of an aged care provider in Tasmania, which led to adverse outcomes and the sanction of a facility (Alderslade 2019).
The provider had attempted to save money by using only 60% of operational income on operational costs. However, this resulted in many adverse effects felt not only by clients but staff and management, too. Issues included:
Ultimately, the provider failed 18 out of 44 accreditation standards due to ‘lacking efforts’ from the Board and upper management (Alderslade 2019).
While the governing body ultimately wore the blame for the failed money-saving strategy, it was reported that the implementation was based on conversations with facility managers (the organisational leaders) who were in the position to advocate for whether the strategy would be feasible. Additionally, once implemented, the governing body received no follow-up communication from its facility managers about how the scheme was negatively affecting staff and care recipients (Alderslade 2019).
Organisational leadership, be it effective or ineffective, will influence all levels of the organisational hierarchy.
(ACSQHC 2019c, d, e)
Under Action 1.3, health service organisations are expected to drive safety and quality improvements by designing and putting into practice a clinical governance framework. This framework should be reflected in policies, procedures and protocols (ACSQHC 2019c).
Clinical governance is defined by the Australian Commission on Safety and Quality in Health Care (ACSQHC) (2017a) as ‘the set of relationships and responsibilities established by a health service organisation between its state or territory department of health (for the public sector), governing body, executive, clinicians, patients, consumers and other stakeholders to ensure good clinical outcomes’.
The purpose of implementing a clinical governance framework is to ensure there are systems in place to facilitate:
As part of this framework, health service organisations might establish systems and processes related to:
Staff should understand the main aspects of the framework as well as their individual responsibilities. Managers should use the framework to monitor performance, evaluate feedback and recommend quality and safety improvements (ACSQHC 2019c).
More information about clinical governance can be found in the ACSQHC’s National Model Clinical Governance Framework.
Health service organisations are expected to implement strategies that aim to improve health outcomes for First Nations peoples (ACSQHC 2019d).
The need for strategies specific to First Nations patients arises from the ongoing adverse impacts of colonialism that affect the physical, emotional, social and spiritual wellbeing of First Nations communities and individuals (ACSQHC 2019d).
Strategies should ideally be developed, implemented and monitored in consultation with First Nations communities. Active engagement with First Nations peoples is the best way to establish effective strategies (ACSQHC 2019d).
Examples of strategies that may be implemented include:
(ACSQHC 2017b, 2019d)
More information about implementing strategies to improve health outcomes for First Nations peoples can be found in the ACSQHC’s User Guide for Aboriginal and Torres Strait Islander Health.
Health service organisations are expected to consider quality of care and patient safety when making business decisions related to:
This can be achieved by:
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