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Background: Leadership development impacts on quality of care and on workplace cultures for staff. Clinical leadership embracing transformational and other collective leadership approaches is a key enabler for developing effective workplace cultures at the micro-systems level. Following the development of a shared purpose and values framework, an internal interprofessional clinical leadership programme was set up to grow a critical community of transformational leaders across one NHS organisation in England. This programme had been unsuccessful in engaging medical doctors for more than two years. Aims and objectives: This paper shares how a dedicated, practice development-based clinical leadership programme set out to support medical doctors across one organisation with their leadership journey, equipping them to become transformational and collective leaders, and facilitators with the skills to develop and sustain person-centred, safe and effective workplace cultures. Methods: Practice development methodology, with its collaborative, inclusive and participative approach to developing person-centred cultures, combined with clinical leadership strategies, formed the basis of the programme. It emphasised the use of active and action learning, drawing on the workplace as the main resource for learning, development and improvement. Self-assessment and collective thinking about clinical leadership, together with collaborative analysis of evaluation data, led to the synthesis of insights through the use of reflection and action planning. Findings: These are presented at two levels: 1. Five individual reflections by authors to illustrate their leadership journeys, which also demonstrate the use of a range of tools and their impact. Insights and learning include recognition of the benefits of peer support and networking, development of a disciplined approach to learning, and self-management 2. A collaborative reflection and critique that embraced a sense of team ethos and community cohesion, for the first time in a safe environment, as well as a sense of shared purpose and values. Conclusions: The programme helped to identify the impact of leadership on workplace cultures and to begin to embed ways of working that are collaborative, inclusive, participative and celebratory. This unique approach by one organisation to leadership development has enabled medical clinical leaders to embark on a journey of self-transformation. Implications for practice: • An internal model grows clinical leadership capacity across an organisation through peer support and networking, and collective leadership • Investing in a safe, confidential space for clinical leads and other staff groups is a potentially effective strategy for leadership development practice • There is need to develop more skilled critical companions to support leadership, improvement and development activities • Clinical leadership development, informed by practice development methodology, demonstrates the potential to enable transformative and collective leadership to promote person-centred cultures in the workplace [ABSTRACT FROM AUTHOR]

Background The current literature and Department of Health (DH) policies suggest change should be implemented by frontline clinicians using a transformational leadership approach (Alimo- Metcalfe and Alban-Metcalfe, 2008; Darzi, 2008; DH, 2009, 2010; Govier and Nash, 2009). Despite this, change is still often led by senior managers utilising a 'top down', transactional approach (Edmonstone, 2009; Muha and Manion, 2010; NHS Institute of Innovation and Improvement, 2005). It could be argued that this is primarily due to an absence of clinical leadership due to a paucity of leadership development opportunities for clinicians. In order to encourage frontline clinicians to lead change we firstly need to understand how change is implemented on the frontline and to ascertain their development needs. Aims This paper explores how frontline clinical leaders, specifically ward nurse managers (WNMs), implement change and why they choose a particular strategy. The aim is to explore the change process, through investigating change management from the perspective of those leading change. Methods A case study methodology was adopted (Cohen et al, 2000; Yin, 2009). The case study comprised 18WNMs from one acute NHS hospital within the UK. The data were collected via semistructured questionnaires and interviews. Results The case study demonstrates the WNM's soft approach to change management, based on transformational principles, is in contrast to senior managers who focus on managerial leadership (Edmonstone, 2009). This point is not explicit in the previous literature and two new models are offered to explain this conclusion. Originality/value This study provides new insight into theWNM's approach to managing change and their development needs. This is an important perspective that so far has been neglected. Conclusion WNMs appear to be intuitively adopting change models and using a pragmatic, experiential approach to implement change. However, their progression from change novice to expert is stifled by their poor theoretical evidence base and their lack of experience of leading change. A bespoke 'Leading Change' development programme for WNMs is recommended. [ABSTRACT FROM AUTHOR]

The authors study the association between physician leadership styles and leadership effectiveness. Executive directors of community health centers were surveyed (269 respondents; response rate = 40.9 percent)for their perceptions of the medical director's leadership behaviors and effectiveness, using an adapted Multifactor Leadership Questionnaire (43 items on a 0-4 point Likert-type scale), with additional questions on demographics and the center's clinical goals and achievements. The authors hypothesize that transformational leadership would be more positively associated with executive directors' ratings of effectiveness, satisfaction with the leader, and subordinate extra effort, as well as the center's clinical goal achievement, than transactional or laissez-faire leadership. Separate ordinary least squares regressions were used to model each of the effectiveness measures, and general linear model regression was used to model clinical goal achievement. Results support the hypothesis and suggest that physician leadership development using the transformational leadership model may result in improved health care quality and cost control. [ABSTRACT FROM AUTHOR]