There are lots of different styles of clinical leadership, for example transactional, transformational or situational. There are also lots of roles undertaken by clinical leaders, such as medical director, chief clinical information officer or chief nurse at a clinical commissioning group. Sustainability and transformation plans are gaining pace, talk of accountable care systems is rising from murmurings in policy circles to organisations outside of those circles and clinical commissioning groups are merging. These are all signs that 'places' are getting bigger but also that the definition of where 'places' are is becoming more fluid and therefore less predictable.
Adaptability is a core skill for leaders. In place-based clinical leadership, leaders need to change their focus away from the organisation that is paying them and look system wide.
However, 'system' doesn’t mean 'place.' So why place and not system? In this context, 'place' means multiple geographical places, groups of people, type of professional and interactions between multiple individuals and organisations all at the same time.
"In this context, place means multiple geographical places, groups of people, type of professional and interactions between multiple individuals and organisations all at the same time."
It could mean primary and secondary care, councils, being an individual with a single medical condition or many conditions, sexual health services across an area or perhaps a safeguarding team.
Take, for example, the 50-year-old with type 1 diabetes who is recently divorced and whose eyesight is beginning to fail. That person will potentially need to access a GP, practice nurse, diabetes specialist nurse, consultant diabetologist, optician, ophthalmologist, sexual health services, chiropody and so on.
Is a single physician responsible for the care? Unlikely. However, place-based clinical leaders will have to think about how the patient can be best served by the services they have or are designing. In essence, place is wherever an individual citizen could be at the time they access any service. It will need listening skills, data sharing, a welcoming attitude to encroachment on previously unilaterally delivered services and a desire to make the current payment structures work for the place too.
These ideas are working and they’re even working in the US, where co-operation between providers has traditionally been limited. They’re not rip-roaring successes, but some patients are getting better outcomes than those not in a place, particularly those with clinicians in charge of the place. These improvements are being made via dense contracts between organisations who are all signed up to being or becoming a place. So, it is possible to design places that look after citizens and patients and still benefit the organisations that sit within a place. It’s beholden upon clinical leaders to keep the patient central to those places.
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