The role of ambulance clinicians in management and leadership

Clinicans as managers and leaders

The challenge is to view these problems as opportunities, and to bring together what may at first appear to be opposing perspectives in the development of innovative solutions. As such, ambulance clinicians have a critical role to play in the management and leadership of organizations. Clinicians often have a thorough understanding of where barriers and obstacles exist, that prevent not only them, but the organization within which they work, from delivering effective patient care.

This is a view supported by Capsey (2010) who argues that paramedics (as an example) have a unique perspective on the provision of patient care, with the paramedic profession having a ‘wealth of knowledge...for applying care in the unscheduled, out-of-hospital environment.’ A further challenge for the profession; health care organizations and individual clinicians, lies in developing the supportive structure and creating opportunities for ambulance clinicians—to realize their potential in leading service and quality improvement.

Case example—from manager to ambulance clinician

After graduating from The University of Hull in 2001 with a BA (Hons) in International Management, James joined the NHS graduate management training scheme as a general management trainee (www.nhsgraduates.co.uk). The scheme is a two year management and leadership development programme, combining practical management experience with post-graduate study, within a structured and supportive environment. For the first year of the scheme, James was based at Addenbrooke's Hospital in Cambridge.’I worked as a service manager within the emergency department to gain experience of operational management, while also working across the surgical services directorate as part of a multi-professional team to develop integrated care pathways. I then undertook a three month project placement with the then Tees, East and North Yorkshire Ambulance Service, working on the development of GP out-of-hours services and exploring alternative responses to Category C 999 calls’ says James.

For his final placement, James worked as a primary care manager for South Cambridgeshire primary care trust. In this role, the focus was on developing more strategic management competencies. This involved working on a number of projects; such as improving access to NHS dentistry through the development of dental access centres, clinical governance within dentistry, primary care estates development and supporting the work of the regional emergency care network. On successful completion of the training scheme in 2003, James took up a substantive post as assistant general manager for elective services and critical care at Hinchingbrooke Health Care NHS Trust.

Having always had a passion for the ambulance service and an interest in the rapidly evolving role of the paramedic, James decided to change direction in 2005 and made the transition from manager to ambulance clinician. ‘I joined Tees, East and North Yorkshire ambulance service as a trainee ambulance technician. I wanted to broaden my knowledge, skills and experience while working directly with patients’ explains James. ‘I felt strongly that for me, it was important to gain experience as a clinician as part of my career within the NHS. I wanted to be able to understand for myself where things work well for patients and staff, but also where barriers and obstacles exist for both clinicians and managers in being able to provide high quality patient care.’ In 2008, James completed his MSc in health care management, for which he researched the concept of clinical leadership within the ambulance service, and the role ambulance clinicians have in driving service and quality improvement. This led to a part-time secondment (remaining part-time clinical) within the medical directorate of Yorkshire Ambulance Service NHS Trust, to assist with developing clinical leadership as a concept within the organization. In 2009, James qualified as a paramedic. This was then followed by six months in the role of service and quality improvement manager, before he returned to full-time clinical practice in January 2010.

The importance of management and leadership development

As O’Meara et al (2010) argue:

‘The sustainability of vibrant, healthy, and high performing ambulance services depends on competent, experienced, and well educated leaders and managers’.

Historically, the management and leadership skills of ambulance clinicians, along with their potential, have not been widely recognized. All too often, clinicians have found themselves ‘promoted’ in to formal positions of management and leadership, with very little (if any) preparation.

There has also tended to be a lack of opportunities for those wishing to undertake management and leadership development, to acquire and subsequently demonstrate competence within a structured and supportive environment. This is surprising, given that ‘poor management practice is at least as lethal as poor clinical practice’ (Edwards et al. 2003).

Once again, the challenge for the profession and for organizations is how to facilitate sustained access to structured and supported management and leadership development opportunities. This, given that ‘good quality managers can create an environment that supports clinicians and in which high quality care prospers’ (Edwards et al. 2003).

The emergence of ‘hybrid roles’

A potential solution to the problem of how to build increased management and leadership capacity within organizations, while providing individual clinicians with a structured and supported approach to developing their management and leadership abilities, could be found in increasing the number of ‘hybrid roles’ (Taylor, 2008).

Such roles can be specifically designed to combine clinical practice, with formal positions of management and leadership. These may be temporary, secondment type roles, to enable clinicians to provide leadership and develop new skills as part of specific projects. On the other hand, they may be offered on a permanent basis as a means of combining clinical practice with aspects of general management. Thus, symbolizing the value placed by the organization on clinical practice informing management practice, and vice versa.

This approach could well prove increasingly useful, given that a common dysfunction of contemporary organizations stems from a lack of shared perspective and understanding among members. Not least, this is a recurrent criticism that is levied against clinicians and managers, by each other. Hybrid roles could be designed to provide exposure to all aspects of management and leadership, and at all levels within the organization. Opportunities could combine elements of clinical practice with team leading, research, project management, education, general management and strategy development.

Equally, it is important to challenge the concept that career development should be focused on linear, vertical progression within one organization. Instead, emphasis should be on the development of competence and capability across a range of areas. This involves both vertical and horizontal movements between roles, with consolidation of competence and learning.

It is recognized that increasing the number of such roles would need a considerable supporting structure to be put in place. Not least, a significant increase in the mentoring and coaching capacity of the organization(s) concerned—to support individuals undertaking development, along with their managers.

A cultural shift would also be required. This would need to recognize the value of a largely practical approach to management and leadership development, underpinned by opportunities to undertake formal education modules.

There would also need to be an increasing tolerance for experimentation, and an acceptance that mistakes are not only inevitable, but that making them is an important part of the learning process. For the individual, there would need to be a commitment to developing their approach as a reflective clinical and management practitioner.

Practical advice for ambulance clinicians interested in management and leadership development

Conclusion

The aim of this article has been to highlight, by means of a case study, the rather unique approach that one individual has taken to their career within the NHS to date. An approach that has enabled them to develop the knowledge, skills, competence and understanding to operate effectively as both a health care manager and paramedic.

The management and leadership role of ambulance clinicians has been highlighted, along with the valuable contribution that they can make to leading service and quality improvement. The concept of ‘hybrid roles’ has been introduced, as a possible way in which ambulance clinicians may undertake formal management and leadership development, while retaining an element of clinical practice.