Driving quality implementation in the context of the Francis report

| | Principle three: provide
high-quality clinical
leadership
‘I believe that psychiatrists chose this career in order to lead, and not simply to advise on
medication’ (College member).
Clinical leadership is essential for high-quality care,
and all doctors are leaders. We need to ensure that
medical leadership is expected and supported by
the culture of NHS trusts, to allow responsibility to
go hand in hand with authority. Psychiatrists must
play a leadership role in their clinical teams and in
their organisations.
Good medical leadership demands an enquiring
and intellectually flexible mind that is grounded in
a thorough understanding of current and future
directions of the science of mental illness and its
treatment. Sometimes leadership demands courage
and, as in science, the ability to communicate
the ‘truth’ demanded by evidence, not political
expediency.
With leadership comes accountability. We must all
strive for improvement and be able to challenge our
colleagues and employers when there is evidence
of poor practice.
Many mental health teams are formally led by the
consultant psychiatrist. In others, psychiatrists have
a de facto leadership role. Junior doctors also have
a significant role to play, and must be encouraged
to speak out, both to challenge bad practice and
to innovate.
All doctors need, and have a duty, to develop personal
leadership skills at all stages of their careers
and to work effectively within multidisciplinary
teams, including with non-clinical managers. The
College will work to facilitate and support these
objectives.
Psychiatrists, whether or not in formal medical
management roles, must:
• z advocate and implement excellent care within
their teams
• z promote a patient-safety-first culture, and
embed this in daily practice
• z support and enable colleagues to deliver
high-quality care
• z promote a culture where colleagues feel safe
and supported in raising concerns.
We need to be aware that too much ‘top-down’
regulation can impede progress and inhibit free
thinking or criticism. Consultants and medical trainees
must be empowered to lead and work with
clinical and non-clinical management colleagues
in the delivery of high-quality care without fear of
retribution.
The Francis report states:
‘A truly caring culture does not stop at the door of the
hospital provider. It should never be acceptable for
patients to be discharged at any time without knowledge
that the patient in need of care will receive it
on arrival at their destination. The emphasis should
be on continuity of care to include a follow-up as to
a patient’s well-being after discharge.’
Continuity of care is particularly important in
psychiatry, whether in hospital or in community
settings, but many services have been reorganised
so that assessment and continued care are separated,
without clear benefits or evidence (Tyrer,
2013). To avoid such changes or untried ‘models
Principle three: provide high-quality clinical leadership 15