Around the world policy initiatives have aimed to increase the engagement of clinicians in the management of health services and research has shown that this contributes to improved patient healthcare. Research led by Professor Ian Kirkpatrick at Leeds University Business School has identified obstacles to this engagement and proposed ways to overcome them. The findings have been distilled into training and educational material which has been delivered to National Health Service (NHS) staff and guidance which has been used by NHS organisations to improve practice. Collectively, this work has contributed to improved and more efficient patient healthcare in several NHS trusts.
Although research has demonstrated that increased clinical engagement in the management of health services can contribute to improved patient care, less is known about how the obstacles to such engagement can be overcome in practice. This has been the focus of research carried out by Kirkpatrick and colleagues at Leeds University Business School since the year 2000.
In the early phase of this research, Ian Kirkpatrick and Terry McNulty assessed the impact of public-management reforms on health service professions. This was designed to understand the obstacles to reforms, specifically those aimed at turning doctors and professionals (such as social workers) into managers. McNulty and Ewan Ferlie also looked at how clinical professionals responded to change and the difficulties of establishing new hybrid professional-manager roles.
Building on this work Kirkpatrick led an inquiry, commissioned by the Centre for Innovation in Health Management (CIHM) at the University of Leeds to address how obstacles to clinical engagement could be overcome and how performance could be improved. The Inquiry identified specific conditions and policies in an organisation which supported greater levels of clinical engagement. Further work (Gianluca Veronesi and Kevin Keasey) looked more specifically at relationships at the board level in NHS organisations.
The final stage of the research involved a two-year knowledge transfer partnership (KTP) with Leeds Teaching Hospitals NHS Trust and NHS Leeds and a Health Foundation-funded project led by Rebecca Malby and Richard Thorpe. The relationship between clinical engagement and hospital performance has also been extended internationally with a European Science Foundation COST action programme and research in the UK, Australia and Canada funded by the Worldwide Universities Network.
The research has been widely disseminated to health professionals across the NHS and wider healthcare sector through conferences, policy groups, workshops and the CIHM network of around 1000 members including over 300 NHS top-level decision makers. Members have been able to access reports, an online toolkit and attend events. The research has benefitted practitioners in two main ways:
- Organisational change initiatives have included the development of a Toolkit for Developing Productive Relationships between Management and Medicine. This has been used across the NHS in organisational development projects carried out in conjunction with CIHM. Hertfordshire, Shopshire and East Riding Primary Care Trusts used the Toolkit as part of their work with CIHM to improve clinical engagement for practice-based commissioning. The toolkit is also freely available online. CIHM works with Leeds Medical Senate to improve clinical engagement and this has led to a direct improvement in patient care and more efficient working including the establishment of the Leeds Institute for Quality Healthcare. The KTP with Leeds Teaching Hospitals NHS Trust resulted in a change intervention with clinical directors across the Trust.
- Leadership development programmes have been delivered to hundreds of NHS staff. Examples include: The Darzi Clinical Fellows Programme which was run by CIHM in 2009-10 and again from 2012 to date. So far the programme has been completed by over 110 clinical professionals (the majority being doctors) with another 60 due to start the programme later this year, and the feedback has been outstanding. In 2010-11 a set of leadership programmes for senior doctors were delivered for Leeds Teaching Hospitals NHS Trust and Rotherham NHS Foundation Trust, the Leeds-wide Senate Programme (26 senior doctors) and a practice-based programme for commissioning leads and their practice managers (200 people in total). Other top-level programmes included Leading Transformation Programmes for NHS Yorkshire & Humber and the Board Level Director Leadership Programmes for NHS North West.
- Kirkpatrick, I. and Vincent, S., Knowledge Transfer Partnership, (2008-10), ‘Enhancing the Effectiveness of Clinical Directorates’, £130,000, Economic and Social Research Council, Northern Way and Leeds Teaching Hospital NHS Trust
- Kirkpatrick, I. and McCabe, C., Knowledge Transfer Partnership, (2010), ‘Delivering a health promoting hospital: challenges and opportunities’, £29,000, NHS Leeds and Technology Strategy Board
- Malby, R. and Thorpe, R., (2008-09), Effective Leadership Development Interventions, Health Foundation
- Kirkpatrick, I., (2010-14) ‘Enhancing the role of medicine in management in European health systems’ €400,000, European Science Foundation COST Action IS0903
- Kirkpatrick, I. (PI), Veronesi, G., Ross, D.M. and Short, S., (2011), ‘Navigating from below: patients shaping health systems to address non communicable diseases’ £11,000 WUN Researcher Development Fund (in partnership with colleagues at Universities of Sydney and Alberta)
- Kirkpatrick, I., Malby, R., Dent, M., Neogy, I., Mascie-Taylor, H., Pollard, L., (2007), Centre for Innovation in Health Management, University of Leeds, January [downloaded 16/03/12]
- Keasey, K., Malby, R., Turbitt, I., Veronesi, G. and Neogy, I., (2009), National Inquiry into Fit for Purpose Governance in the NHS, Centre for Innovation in Health Management, University of Leeds, [downloaded 16/03/12]