Letters When managers rule

Patients and clinicians must be at the centre of decision making

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f213 (Published 15 January 2013) Cite this as: BMJ 2013;346:f213
  1. Shanaya Rathod, consultant psychiatrist1
  1. 1Southern Health NHS Foundation Trust, Tatchbury Mount, Southampton SO40 2RZ, UK
  1. shanayarathod{at}nhs.net

Jarman highlights the need to refocus on the quality of patient care and the importance of clinicians leading in the NHS.1 Darzi, in his review,2 defined quality as clinically effective, personal, and safe, and reintroduced the concept of clinical leadership as crucial to this vision. He envisaged that “a lot of clinicians will now be responsible and will have tremendous powers within the system,”3 thereby associating a clinically driven NHS with improved quality of patient care and safety. Kaiser Permanente achieved efficiency and improved quality of patient care and outcomes through making clinical leadership central to its reform agenda.4 However, at the most crucial of times, clinical leadership in the NHS is patchy at best, misinterpreted, and unsatisfactory.

Clinical leadership has been described as “leadership needed to transform the performance of the health systems that must come principally from doctors and other clinicians—whether or not they play formal management roles,”5 thereby distinguishing it from clinical management. If quality is truly desired, clinical leaders must steer away from herd-like thinking or safe opinion and lead the way in strategy, policy development, and implementation that is based on information and evidence. It is time to achieve the ultimate goal of patients and clinicians being at the centre of decision making; otherwise the vision of quality and clinical leadership will remain “the emperor’s new clothes.”


Cite this as: BMJ 2013;346:f213


  • Competing interests: None declared.


View Abstract

Sign in

Log in through your institution