Leadership and Clinical Education

Workshop 1

What is leadership?
Whats it got to do with clinical education?
Adding a leadership dimension to clinical facilitation

Workshop 1: Learning outcomes

Reflect on the concept of leadership within the

context of clinical education

Understand the general principles of the Leadership
and Clinical Education (LaCE) framework
Discuss the application of the LaCE framework to
everyday clinical education practice
Identify opportunities for your personal/professional
development as a leader of clinical education

Leading clinical learning

What is leadership?
60 second question

How do you define leadership and what

the attributes of good leadership?

Leading clinical learning

are

What is leadership?
A leader is best when people barely know he exists;
not so good when people obey and acclaim him;
worst when they despise him. Fail to honour people
they fail to honour you, but of a good leader who
talks little when his work is done, his aim fulfilled they will say We did this ourselves
Lao-Tzu (6 BC)

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What is leadership?

A leader is a dealer in hope

Napoleon Bonaparte

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What is leadership?

Setting an example is not the main means of

influencing others; it is the only way.
Albert Einstein

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What is leadership?

. any behaviour that influence the actions and

attitudes of others to achieve certain results
Australian Leadership Development Centre, 2007

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What is clinical education?

60 second question

How do you describe clinical facilitation/education and

what are the attributes of good facilitation?

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What is clinical education?

Clinical education (my definitional attempt) ..

a process which facilitates the translation of theory

into clinical knowledge and professional skills through
the provision of positive learning experiences within
quality learning environments..

McAllister et al. (1997, p.3) and...Nash (2010)

Leading clinical learning

Clinical learning environment an interactive network of forces

Learning
environment

Clinical facilitators

Students

Quality of the
learning
experience

Quality of
learning
outcomes

Clinical staff

Care recipients
Learning
environment
Leading clinical learning

Clinical education: What does the evidence tell us?

Quality clinical facilitation:

Nursing students perceptions of effective Vs ineffective

clinical teachers (n=214)

Interpersonal relationships
eg. good relationships with nursing team
Personality characteristics
eg. enthusiastic approach

1
2

Teaching ability

eg. encourages thinking and learning

Professional competence
eg. good professional knowledge

Tang et al. (2005)

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Clinical education: What does the evidence tell us?

Ratings of 5 subsets of effective clinical educator characteristics
Students (n=134)
1
2
3
4
5

Interpersonal relationships
Evaluation
Nursing competence
Teaching ability
Personality traits

Clinical educators (n=17)

Interpersonal relationships
Nursing competence
Evaluation
Teaching ability
Personality traits
Lee at al. (2002)

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Clinical education: What does the evidence tell us?

Clinical learning environments:

Positive factors

recognition of students presence, appreciation and support

a collegial environment where students are perceived as members of
the team
good communication
team spirit
a positive atmosphere
democratic leadership styles
positive interactions with staff

Papp et al. (2003), Clare et al. (2002, 2003)

Leading clinical learning

Clinical education: What does the evidence tell us?

Clinical learning environments:

Less positive factors

lack of direction
poor communication
unrealistic expectations
lack of collaboration between students and staff
unreceptive or ambivalent staff
students perceived to be a burden
Grindel et al. (2001); Clare et al. (2003); DHS, VicHealth (2009)

Leading clinical learning

Clinical education: What does the evidence tell us?

Positive ward atmosphere and effective clinical

supervisory relationships with staff - the most important

factors contributing to the quality of clinical learning
(Saarikoski et al. 2002)
Optimal clinical learning requires an adequate practice

environment, a good relationship with a team or

individual with sound theoretical knowledge and
stimulating dialogue (Field, 2004)

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Leadership: toward the how..

Thinking about how leaders lead, ie. influence others to achieve
desired results:
Several approaches/perspectives:

Leadership as power
Personal characteristics of leaders
Leadership behaviors
Leadership styles
Situational leadership models
Transformational leadership models
Killian (2007)
Australian Leadership Development Centre

Leading clinical learning

Leadership as power

positional authority, reward power, coercive power,

expertise, interpersonal power

effective leaders expand their power base beyond limits of

positional authority
use of rewards is one of the simplest yet most powerful forms of
power a leader can exert
coercive power should be used with care & judgement
expertise is useful but not sufficient on its own
importance of relational power is likely to increase
Killian (2007)

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Personal characteristics

early trait / great man theories

no single list found to hold true
contemporary thinking includes:

dominance, extraversion, sociability, self-confidence, high levels

of energy, resilience and intelligence (reasoning + social
intelligence, a sub-component of emotional intelligence)

social intelligence single largest factor impacting on

leadership effectiveness (Killian, 2007)
Aristotle once said that we are the sum of our behaviours;
excellence therefore is not an act but a habit.

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Leadership behaviours
Competency-type models

strategic thinking, change management, relationship builder,

staff developer etc.

Models based on roles/skills

decision making, technical, interpersonal etc.

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Leadership styles
concern for people / concern for results
eg. Blake-Mouton grid

1,1 delegate and disappear

9,1 produce or perish
5,5 middle of the road
1,9 friendly but not productive
9,9 team environment
high satisfaction & high production

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Situational approaches
importance of context in

deciding the right leadership

approach in a given situation
eg. Hersey & Blanchards model

S1 telling/directing
S2 selling/coaching
S3 participating/supporting
S4 - delegating

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Transactional / transformational approaches

transactional leaders - focussed on day-to-day

operations
transformational leaders - motivate followers to

perform to their full potential .. translate

intention into reality and sustain it use
power wisely
(Burns 1978; Bass 1985)

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Leadership and Clinical Education (LaCE) framework

So, to the LaCE

framework....

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Leadership and Clinical Education (LaCE) framework

This is a leadership framework that is designed to build
your professional capabilities now and in the future.
The LaCE framework conceptualises clinical education
leadership as involving:

cognitive and behavioural complexity

personal valuing of best practice
critical observation and reflection
commitment to ongoing learning and development

Leading clinical learning

Leadership and Clinical Education (LaCE)

framework
The Framework is designed around 4 key areas, all of which relate to

the role of a clinical facilitator/supervisor. The precise emphasis on

individual areas will vary depending on the individual context /
situation.
Each section of the Framework contains key attributes of clinical

education leadership practice that are supported with selfassessment tools for personal reflection.
The Framework is underpinned by core professional values in

relation to ongoing learning for quality practice and professional

development.

Leading clinical learning

Leadership and Clinical Education Framework

Dimensions of practice
Enacting
to achieve

Executing
the role

Enacting self
development

Attributes
Sharing vision and
values

Communicating
effectively

Clinical teaching &

learning

Knowing self

Setting clear goals

Interacting in a range
of contexts

Assessing students
performance

Obtaining feedback
on performance

Promoting a culture
of learning

Empowering others to
achieve

Managing day-to-day
business

Engaging in personal
and/or professional
development

Professional learning

Personal development

Enhanced student outcomes

Achievement of personal /
professional goals

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ACTION LEARNING

REFLECTION ON PRACTICE

Establishing
direction

Using the framework to enhance clinical education practice

practice
Reflecting on feedback obtained from
others
Identifying areas for personal
improvement
Putting an action plan in place
Evaluating the outcomes achieved

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LaCE dimensions and

attributes

Personal reflection on your own

Some closing thoughts

Leaders are responsible for getting results through others.

Leaders should be judged not by what they do, but rather by what those around
them are doing and achieving.
In this light it is very clear that leadership is people work, with a focus on
achieving results.
Australian Leadership Development Centre

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The task of leadership is not to put greatness into

humanity but to elicit it - for the greatness is already
there
John Adair, 1990, Not bosses but leaders

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References
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Burns, J. (1978). Leadership. New York: Harper & Row.
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Leading clinical learning