Exploring the contextual factors influencing clinical leadership and patient experience

Introduction
The NHS has prioritized the leadership development of healthcare professionals as a fundamental strategy for enhancing organizational outcomes and patient care (NHS Institute for Innovation and Improvement, 2011). Consequently, various leadership development programs, frameworks, and models have emerged to support this initiative. Despite the emphasis on patient experience as a quality-of-care indicator, the conceptual and evidential link between leadership development and patient experience has not been systematically investigated yet.

Aim and objectives
We present preliminary findings from an ongoing Delphi study aiming to investigate clinical staff perceptions regarding the relationship between leadership training and patient experience.

Method
Twenty participants were purposefully selected from physicians, nurses, physiotherapists, and pharmacists currently employed in the NHS. Recruitment took place through the Faculty of Medical Leadership and Management (FMLM) Clinical Leadership Fellowship program and the MSc Leadership Development Programme at Edge Hill University. Semi-structured interviews were conducted to gather in-depth insights into participants' views on the enablers and barriers to demonstrating clinical leadership. Thematic analysis, as outlined by Braun and Clarke (2006), was employed to identify patterns and themes within the interview data. Ethical approval was obtained from the Edge Hill University Health Research Ethics Committee.

Findings
Participants identified several enablers and barriers influencing their engagement in clinical leadership. Enablers included a strong commitment to continuous learning and development at both personal and organizational levels, an empowering work environment and organizational culture, possession of positive leadership traits and skills, participation in formal leadership training, organizational dedication to patient-centredness, and the ability to lead oneself. Conversely, participants reported barriers such as resistance to change and innovation, a limited focus on patient outcomes in leadership training, a lack of authority to challenge poor behaviours, limited opportunities for engaging in leadership activities, and a fear of repercussions for speaking up.

Discussion
These initial findings provide a foundational understanding of the complexities surrounding clinical leadership in the NHS and its impact on patient experiences. The identified enablers and barriers may serve as impetus for refining existing leadership programs and developing targeted interventions to address systemic challenges, so as to improve the experiences of patients. Furthermore, the identified contextual factors underscore the necessity of fostering an empowering environment that enhances clinical leadership effectiveness, aligning with the NHS's commitment to continuous improvement in patient care. We hope to provide additional insights that deepen our understanding of the complex relationship between clinical leadership and patient experience as the study advances through the Delphi process.