Blog - National Clinical Leader Network Conference - Elizabeth Bradbury - Part 1

Date: 20 February 2019

Elizabeth Bradbury

Comply and improve, what's my role as a clinical leader?

The clinical leaders role in health and care regulation and continuous improvement 

This blog is based on a presentation at the National Clinical Leader Network Conference on 23 January 2019.

Imagine that you are at a BBQ, your friends know you are a clinical leader and ask you ‘how good is health and care around here?’

  • What do you say?
  • What evidence would inform your reply?

Many clinical leaders would be confident talking about their own service, citing compliance with the Care Quality Commission (CQC), professional and training requirements, and they’d be knowledgeable about service benchmarks and local improvement initiatives, but would you know the overall picture for your organisation?

It’s a tough question, and the quality curve (below) illustrates the full spectrum of care from needing through basic compliance to the highest level of quality, this may help you frame your answer:


Left of the quality curve is about compliance

All health and care organisations need to comply with minimum CQC quality standards, and many clinical leaders will find themselves working on initiatives to comply with defined clinical requirements and national operating standards such as those relating to access.

Think of the NHS maternity units and learning disability units where major failings in care have been reported in the national press in the last couple of years. These services failed to comply with the minimum standard of care; they are on the left hand side of the quality curve. Intensive clinical and organisational improvement activity, leadership support, and cultural change will have been underway to address the shortcomings and reach a minimum compliance standard.

Whilst you may never have worked in a service or organisation with major failings in care, if your role entails moving between different wards, teams, general practices or care homes, the differences in the culture and approach to compliance and improvement may be palpable.

Right of the quality curve are health and care organisations rated as good or outstanding by the CQC

Of course we should try to drive this curve to the right, challenging ourselves to continually innovate and improve and of these trusts, West Sussex NHS Foundation Trust, described four strategic quality aims underpinned by a number of improvement initiatives with a stringent measurement framework.


These organisations are characterised by a well-embedded culture and system of quality, continuous improvement and a board that describes an exciting and ambitious vision to be the best.

They agree with staff and service users a few priority areas to which everyone, regardless of their role or level of seniority, can contribute. They support staff with quality improvement training so they can effectively participate in or lead change, and establish a line of sight or ‘golden thread’ linking work with patients or service-users with the Trust’s strategic aims, so everyone can see how their contribution adds up to improving the organisation overall.

As a clinical leader it’s highly likely your role will entail work on both compliance and continuous improvement, these questions may be useful to you:

  1. Do you know what you need to comply with in your clinical role?

    If not, who can help you find out? Some of this may be covered in induction processes for new staff, in policy and procedure documents in your work area, and your organisation’s governance lead can advise.

  2. What are your organisation’s quality improvement aims and priorities?

    Your Trust’s Quality Improvement Strategy should outline these and should be on the public website. Generally QI strategies are refreshed every 3-5 years. If you can’t find it, the executive lead for quality should be able to help, this is often the medical director or chief nurse.

  3. What’s your role in supporting these?

    There are many roles and you may fulfil several, looking at this table might help you think about different aspects of your role and what each entails.

  4. Is your QI work aligned with these strategic aims?

    If not, can it be aligned? If the answer is ‘no, not easily’ then perhaps it’s time to discuss with your team whether this initiative is the best use of your time and energy.
  5. What improvement help and support is available to you?

    Recent NHS Improvement and CQC publications promote the development of an organisational system and culture of quality, with an emphasis on building improvement capability in the workforce. AQuA describes this as a skills escalator in the document A Sense of Urgency A Sense of Hope. 


Ask yourself what QI knowledge and skills you and your team need to fulfil their different roles. Your organisation may have internal training resources e.g. a quality improvement team. Royal Colleges and organisations such as AQuA offer this training too.

As a clinical leader, how can you support others to apply what they’ve learnt about QI?

Keep an eye out for part 2 of the blog which will explore measurement for improvement and partnering with service users to co-design and co-produce improved care.

  • Summary:

    This blog is based on a presentation at the National Clinical Leader Network Conference on 23 January 2019.

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