Psychiatric leadership development in postgraduate medical education and training.

The value of strong, compassionate medical leadership in the delivery of high-quality care to patients within mental health services is clear. Leadership development, however, is far less well explored. This article is for psychiatric trainees, trainers and mental health organisations.

The Royal College of Psychiatrists' Leadership and Management Fellow Scheme.

The Royal College of Psychiatrists' Leadership and Management Fellow Scheme aims to develop and support a new cohort of leaders within psychiatry. This article provides an introduction to the scheme, which is accessible to all higher trainees with the support of their host organisation. We explore its development, structure and how it is evolving to provide a strong platform for achieving the College's ambition to benefit patient care by embedding a culture of medical leadership within mental health services.

Routine clozapine assay monitoring to improve the management of treatment-resistant schizophrenia.

Aims And Method: Routine therapeutic drug monitoring in clozapine therapy has previously not been considered justifiable. Using observational data, the clinical utility of annual clozapine assay monitoring is explored within a large mental health trust.

Results: After the introduction of routine monitoring, the rate of clozapine assays rose to 2.

The Importance of Leadership Development in Medical Curricula: A UK Perspective (Stars are Aligning).

"Medical leadership and management" describes the engagement of doctors in the leadership and management of both individual patient care and of the departments, organizations and systems within which they work. Around the world, doctors are generally accepted as the leaders of clinical teams, holding ultimate accountability for individual patient care. However, the role of doctors as organizational and system leaders within healthcare, despite evidence of benefit, shows considerable variation.

Exploring medical leader identity and its formation.

Purpose: "Becoming" a doctor involves the acquisition of medical knowledge, skills and professional identity. Medical professional identity formation (MPIF) is complex, multi-factorial and closely linked to societal expectations, personal and social identity. Increasingly, doctors are required to engage in leadership/management involving significant identity shift.

A case report of the successful administration of clozapine in the face of myocardial infarction, pulmonary embolism and hyperlipidaemia resulting in the termination of long-term seclusion.

Background: Cardiometabolic health significantly impacts on the mortality of people with severe mental illness. Clozapine has the greatest efficacy for Treatment Resistant Schizophrenia (TRS) but the greatest negative impact on cardiometabolic health. Balancing the risks and benefits of treatment, dignity, autonomy, liberty, mental and physical health can be challenging, particularly when imposing interventions with potentially life threatening adverse events, such as clozapine.

The mental health of foreign national prisoners.

Foreign national prisoners include people who are subject to criminal proceedings and have been deprived of their liberty in a state in which they are neither a national nor a resident. In the United Kingdom, they constitute approximately 10,000 individuals and represent around 12% of the total prison population. Significant health disparity exists within the general prison population compared to society at large and foreign national prisoners suffer even higher rates of both physical and mental health disorders.

Leading the integration of physician associates into the UK health workforce.

The introduction of physician associates into the UK health workforce is one of the most significant examples of potentially disruptive innovation in many years, and lessons can be learned from research into the introduction of advanced nurse practitioners. Positive, forward-looking health-care leadership is required at all levels to ensure the successful integration of physician associates into the UK workforce. This review found that organizational culture had an enormous impact on the introduction of advanced nurse practitioners and likewise will affect the integration of physician associates.

Integrating physician associates into the health workforce: barriers and facilitators.

Physician associates have been identified as a potential solution to the shortage of health-care workers in the UK, but the introduction of physician associates has not been universally welcomed and some uncertainty exists around their specific roles. This review enhances understanding of the barriers and facilitators for integrating physician associates into the workforce and identifies six key themes to inform future policy decisions at local and national levels.

The assertive approach to clozapine: nasogastric administration.

Aims and methodAn 'assertive approach' to clozapine, where nasogastric administration is approved, is assessed through a case-load analysis to provide the first systematic description of its use and outcomes worldwide. RESULTS: Five of the most extremely ill patients with treatment-resistant schizophrenia were established and/or maintained on clozapine, resulting in improvements to their mental state; incidents were reduced, segregation was terminated and progression to less restrictive environments was achieved.Clinical implicationsDespite being underutilised and rarely enforced, in extreme circumstances, an assertive approach to clozapine can be justified.

Inclusive and person-centred leadership: creating a culture that involves everyone.

Contemporary leadership theory is based on the dynamic processes that occur between leaders and followers. One such theory is inclusive leadership, which is a person-centred approach that focuses on the empowerment and development of followers. It has roots in other leadership theories such as transformational leadership, but there are distinguishing features.

Transformational leadership: is this still relevant to clinical leaders?

Transformational leadership theory has been at the centre of health-care leadership research for the past three decades, has had a tangible influence on the evolution of NHS leadership development strategies, and is still evident in current frameworks. This article provides an overview of the key concepts and weaknesses of transformational leadership theory and discusses its relevance within the context of the NHS working environment.

Exploring UK health-care providers' engagement of trainee doctors in leadership.

The need for doctors at all levels to undergo some form of leadership development is well evidenced, but provision remains patchy and models underpinning such development are often inconsistent. This article sets out the findings of a literature review into leadership development opportunities for doctors in training in the UK.

Twelve tips for integrating leadership development into undergraduate medical education.

Healthcare systems need effective leadership. All healthcare professionals can and should "learn to lead" and this requires a clear focus on leadership development from the earliest stages of a career. Within medicine, undergraduate students should be provided with opportunities to thrive and develop their skills in terms of leadership, management and followership.

What do doctors and nurses think about development of clinical leadership?

Leadership development for health-care professionals is a priority within the NHS. Training is generally targeted at individual staff groups in isolation, even though contemporary leadership thinking recognizes the benefits of collaborative leadership between different clinical disciplines. Focussing on the attitudes and perceived training needs of undergraduate and qualified medical and nursing professionals, this article highlights the similarities and differences and will help to inform the design of existing and future leadership programmes.

Learning from error: leading a culture of safety.

A recent shift towards more collective leadership in the NHS can help to achieve a culture of safety, particularly through encouraging frontline staff to participate and take responsibility for improving safety through learning from error and near misses. Leaders must ensure that they provide psychological safety, organizational fairness and learning systems for staff to feel confident in raising concerns, that they have the autonomy and skills to lead continual improvement, and that they have responsibility for spreading this learning within and across organizations.

Leadership in learning organizations: a strategy for improvement.

The learning organization is a potential framework for managing transformational culture change and delivering high quality health care. It helps to shift the focus from the development of individuals as leaders to one which takes a 'whole organization' approach.

Vertical leadership in highly complex and unpredictable health systems.

This article explores how the concept of vertical leadership development might help health organizations cope with and thrive within highly complex and unpredictable health systems, looking at concepts of VUCA (volatility, uncertainty, complexity and ambiguity) and RUPT (rapid, unpredictable, paradoxical and tangled).

Clinical leadership effectiveness, change and complexity.

This article explores how an understanding of approaches to leading and managing change and complexity science can help clinical leaders engage with and manage change in complex environments and systems more effectively.

Supporting the engagement of doctors in training in quality improvement and patient safety.

This article discusses how doctors in training and medical students' routine, formal and meaningful engagement in quality improvement initiatives is a vital component of establishing a 'culture of care'.