Paramedic clinical leadership

Paramedic clinical leadership within the North West regionWhat is clinical leadership?The role of the supervisor and team leader is well documented to be integral in ensuring a team can deliver quality in whatever it does (Glenapp, 2008; Parsons, 2009). In the context of ambulance service out-of-hospital care, the importance of this supervisory/leadership role is no different. For the correct quality of care to be delivered within the unplanned and complicated environment of unscheduled care, it could be argued that the importance of strong leadership, supervision, and coordination is greater than many other more conventional healthcare environments. It is with this challenge in mind that this article has been formulated, to offer an element of understanding to a situation now prevalent within the UK's NHS ambulance services; clinical leadership, and more specifically that of front-line clinical leadership and supervision.In ‘Taking Healthcare to the Patient’ (Department of Health (DH), 2005) a number of recommendations were made, but specifically the document highlighted the need for transformational leadership within ambulance trusts. Clinical leadership is regarded as a process by which an individual infuences others to set standards, accomplish objectives and directs the organization to greater consistency. Leaders are generally identified by a number of key characteristics; knowledge, skills, and attributes. Therefore clinical leadership that covers a range of areas will encourage clinicians to inform strategy, improve and drive quality, service design, and resource utilization. This work will prove critical to boards, executives, and clinical teams to ensure their organizations are developed and shaped appropriately. Clinical leadership in the ambulance services is designed to provide a framework that will support ambulance trusts as they move forward in the 21st century. Although good clinical leadership is vital for ‘today’, ambulance trusts must also ensure they look forward to the medium–longer term with reference to succession planning and talent management.The report also identified a potentially more pressing need for changes to the workforce at this level. In recent years call volume and subsequent attendance has shown a 4–5% increase year on year (NHS Information Centre, June 2010). Conversely, the number of life threatening calls requiring an immediate response have not seen this rise and remained static at around 10% of total call volume. It is increased demand for urgent primary and social care that now makes up the bulk of the calls received by ambulance services. Traditional ambulance training has focused on the need to manage life threatening emergencies, leaving many situations where paramedical staff can offer no more than transport to the emergency department. To safely address this ever increasing demand, ambulance services also need to invest in education and not just training, a view shared by Lendrum et al (2000). The College of Paramedics (2008) suggest that a practitioner working at this level, making decisions to refer to other sources and not transport, should be educated to a minimum of HE level 6, a view shared by the Government's own ‘Skills for Health Career Framework (2010)’.What has NWAS been developing in terms of its clinical leadership?Following the merger and subsequent re-organization of the North West Ambulance Service's (NWAS) general management structures some years ago, there has been development of clinical roles and responsibilities and implementation of a robust model of clinical leadership and supervision across the organization. In ‘Taking Healthcare to the Patient,’ Peter Bradley discussed at length the need to establish a tiered system of clinical leadership throughout the ambulance services and to also create an aspirational career pathway within the paramedic profession. This is further emphasized in many other related policy documents both locally and nationally.Clinical leadership within NWAS is leading to a network of clinical leaders across the organization, educated over and above that of registrant level (academic levels 6, 7 and 8), providing a tiered system of clinical leadership to the practitioners working within the teams they clinically lead. In conjunction with this clinical leadership, all the extended role paramedics will practice at a level above that of base registrant with the ability to offer a greater degree of assessment, diagnosis, treatment and referral capabilities than that of current paramedics. These practitioners will have the following titles: ‘…competent clinicians have been forced to develop their careers away from patient care…’Senior Paramedics–educated to bachelors level (academic level 6). Responsible for the clinical leadership of a team of paramedics and emergency medical technicians;Advanced Paramedic– possessing masters level education (academic level 7). Responsible for clinically leading a team of senior/ specialist paramedics; and,Consultant Paramedic– educated to at least masters level, aspiring to PhD (academic level 8). Responsible for clinically leading a team of advanced paramedics and the most senior paramedics within the organization.The NWAS’ current development processes have also led to an increased clinical presence within the emergency control centres, with the creation of a specialist paramedic role to manage low acuity calls.

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