While the General Medical Council recognizes the significance of these skills for doctors and provides guidance on management and leadership responsibilities, there is currently no equivalent emphasis or mandatory training in optometry.
Traditionally, discussions about leadership and management in optometry have focused mainly on business and practice management, leaving many clinicians disengaged from this aspect. However, it is crucial for all optometrists to understand that leadership skills are essential, especially in light of the changing landscape of the National Health Service (NHS) and the increasing clinical responsibilities they face. These skills enable optometrists to deliver safe and efficient services to their patients.
Over the past 60 years, the role of optometrists has undergone significant transformations. Optometrists now manage ocular pathology in community practice, rather than referring all eye diseases to secondary care. They also have the authority to prescribe therapeutics, allowing them to take on greater patient management and treatment responsibilities. As general practice faces mounting pressures, more patients are being directed to optometrists for eye care. This underscores the fact that optometry practices and individual optometrists cannot operate in isolation; they are integral parts of a broader healthcare system dedicated to delivering patient care.
In April 2017, the Scottish Government published the Community Eyecare Services review, which aimed to assess current service delivery and propose actions to meet individual patient needs in Scotland. The review drew on other recent reports such as ‘Realistic Medicine’ and the ‘National Clinical Strategy.’ The consistent message from these reports is that services must continually improve and adapt to meet the evolving needs of the Scottish population, considering the ongoing economic pressures. The community eyecare services review explicitly stated that achieving this goal would require all optometrists to possess “good leadership and management skills within the practice.”
Recognizing that optometrists operate within a complex healthcare system forms the foundation for understanding the essential nature of leadership skills. It has been argued that effective clinicians are those who comprehend the systems they work in and strive to enhance those systems, rather than simply working harder within them. In other words, effective clinicians actively engage in leadership to deliver and improve the quality of the services they provide.
The concept of leadership encompasses various interpretations, and a universally agreed-upon definition is challenging to establish. Numerous leadership theories have emerged and evolved over the past few decades. While earlier literature portrayed leadership as an individual pursuit, emphasizing specific traits like charisma and self-confidence as prerequisites for effective leadership, more recent theories have shifted the focus towards viewing leadership as a process. This paradigm shift recognizes that while not everyone may hold a formal leadership position, everyone within a team can contribute to the leadership process. This perspective, often referred to as “shared leadership” or “distributed leadership,” is particularly valuable in situations where tasks are complex and require independent decision-making, such as in healthcare.
Embracing this perspective of leadership requires a shift in mindset for those who have traditionally associated leadership solely with positional roles. Fortunately, in recent years, extensive work has been conducted in the field of medicine and other healthcare disciplines to explore this type of leadership and its application in practice.
Leadership frameworks have been developed to highlight the importance of shared leadership in healthcare. One notable framework is the Medical Leadership Competency Framework (MLCF), established in 2008 by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges. The MLCF outlines the competencies necessary for doctors to actively contribute to the delivery and improvement of healthcare services. It has been successfully integrated into undergraduate and postgraduate training and widely adopted as the foundation for leadership development. Building on this success and with support from various clinical groups, the Clinical Leadership Competency Framework (CLCF) was introduced. The CLCF retains the same five core domains as the MLCF but includes clinical examples of their application in diverse clinical settings.
At the heart of the CLCF is the notion that the healthcare team’s goal is to provide a service. In the context of optometric practice, this means delivering eye care services to the public, including eye examinations, contact lens services, spectacle dispensing, and sometimes extended services. The CLCF emphasizes the concept of shared leadership, recognizing that the most successful services are those that acknowledge the contributions of every team member to the leadership process. Each team member is empowered to participate in the leadership process by demonstrating behaviors aligned with the five core domains: demonstrating personal qualities, working with others, managing services, improving services, and setting direction. Each core domain comprises four categories called “elements,” each containing four competencies that describe the desired activities or outcomes to demonstrate.
The Clinical Leadership Competency Framework (CLCF) consists of five core domains that highlight the essential competencies for effective clinical leadership:
- Demonstrating personal qualities: 1.1 Developing self-awareness 1.2 Managing oneself 1.3 Continuing personal development 1.4 Acting with integrity
- Working with others: 2.1 Developing networks 2.2 Building and maintaining relationships 2.3 Encouraging contribution 2.4 Working within teams
- Managing services: 3.1 Planning 3.2 Managing resources 3.3 Managing people 3.4 Managing performance
- Improving services: 4.1 Ensuring patient safety 4.2 Critically evaluating 4.3 Encouraging improvement and innovation 4.4 Facilitating transformation
- Setting direction: 5.1 Identifying the contexts for change 5.2 Applying knowledge and evidence 5.3 Making decisions 5.4 Evaluating impact
The competencies within the domains of ‘Demonstrating personal qualities’ (domain 1) and ‘Working with others’ (domain 2) are clearly relevant to clinicians in optometric practice. These competencies align well with the professional standards set by the optometry regulator. Although these attributes may not always be explicitly associated with leadership, clinicians recognize their value in delivering high-quality services.
However, the significance of the remaining domains (Managing services, Improving services, Setting direction) may not be fully understood, particularly at the practice level. It is helpful to illustrate how these domains can be applied in day-to-day optometric practice.
Consider a small independent optometry practice with a single testing room. The practice operates clinics five days a week, with one optometrist (who is also an independent prescriber), one receptionist, and a practice manager. Appointments are typically booked at least two weeks in advance, and the patient base primarily consists of elderly individuals. The optometrist often works through lunch breaks and accommodates emergency patients, leading to a stressful environment for the entire team and compromising patient safety. How should this situation be managed, and who is responsible?
One possible solution is to do nothing and continue working harder within the existing system. However, effective leadership aims to work smarter, not just harder. An alternative approach is to start managing and improving the service, as outlined in domains 3 and 4 of the CLCF. This requires skills such as auditing to assess the current situation, identifying areas of inefficiency, proposing and implementing changes to the service, and evaluating the outcomes using improvement techniques.
It is crucial for the optometrist to recognize their active role in contributing to this process and not solely rely on the practice manager to address these issues. The value of the CLCF lies in breaking down the elements that clinicians need to enhance their services and improve patient care.
Moving forward
The example mentioned above may resonate with many clinicians, as they may encounter similar challenges in their practice. However, perceiving these challenges as opportunities for shared leadership, involving different team members in service delivery and improvement, might be a new concept for many in optometric practice. It calls upon clinicians to expand their focus beyond the individual clinical relationships in the consulting room and engage in the broader leadership and management of their services. Leadership is not solely reserved for those pursuing a career in practice management or holding the title of “practice manager.” Instead, every clinician has an inherent leadership role and the responsibility to contribute to the effective functioning and enhancement of their services.
Summary
The ultimate goal of all healthcare services, including optometry, is to provide high-quality and safe patient care. Achieving this objective is not a solitary endeavor but requires an approach where the entire practice team can contribute to the leadership process. It necessitates clinicians actively engaging in supporting, leading, and managing their services. Allowing for the team and technology to support him or her in this effort as they lead a shared leadership office.
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