Exploring the Relationship between Clinical Leadership and Patient Care Quality in the NHS

Abstract

Background
Leadership is often identified as a solution to the challenges associated with the provision of quality care in the NHS. Clinicians are expected to engage in leadership to improve the quality of care provided to patients. This expectation is reflected in various government policies and reports, the establishment of the NHS Leadership Academy to develop clinicians’ leadership skills and the competency standards set by healthcare professional regulatory bodies in the United Kingdom. This study aims to explore how clinical leadership is enacted at the frontline of care to improve patient care quality.

Method
The study employed an exploratory, two-stage, modified qualitative Delphi methodology. Twenty clinicians (doctors, nurses, physiotherapists, and pharmacists) working in the NHS were recruited for the study. To guide the interview process, three scenarios were utilised, describing different contexts in which clinical leadership could be demonstrated at the frontline. Thematic analysis was conducted to identify patterns and relevant themes. Delphi statements were developed and shared with panellists during a consensus survey round.

Results
Ten clinical leadership behaviours were employed by clinicians to enhance the quality of care provided to patients when they encounter challenges. These behaviours include improving, collaborating, sharing, advocating, challenging, supporting, mentoring, inspiring and learning, all underpinned by evidence-based decision-making. Drawing from the Socioecological model (SEM) as an analytical framework, contextual factors that enhance or impede effective clinical leadership at the frontline were identified. These include knowledge, skills and self-efficacy at the individual level, social support, team climate and modelling at the team level, structure, policies, procedures and culture at the organisational level, and staff shortages, leadership education and performance targets at the systems level.

Conclusion
This study provides evidence for the crucial role of leadership in addressing various challenges at the frontline of care in the NHS. To ensure effective clinical leadership for enhanced patient care quality, clinicians must be supported and empowered at the individual, team, organisational, and system levels to improve the care they provide and to engage in leadership development.

Date of Award	2025
Original language	English
Awarding Institution	Edge Hill University
Supervisor	AXEL KAEHNE (Director of Studies), JEREMY BROWN (Supervisor), Joanne Inman (Supervisor) & Kirsten Armit (Supervisor)