The paper makes clear that clinical leadership was not perceived to be about vesting leadership skills in individuals, but about ensuring health care organisations were equipped to conceptualise and support a model of distributive leadership.

Objective: To develop clinical leadership among health professionals working in public sector organisations to improve their skills in ensuring high quality and safe health services. Methods:A longitudinal pre-post-intervention mixed methods study that included 60 health professionals working in one state in Australia. Results:The program was successful in the development of clinical leaders.Conclusions: An interdisciplinary, inter-sectoral leadership development program involving health professionals from metropolitan, regional and rural areas can be successful in developing knowledge, skills and competencies among these health professionals in health service quality and safety.Implications: Health professionals can participate in a development program to enhance their clinical leadership skills. While this was a post-qualification course, targeting experienced health professionals, the learnings could be applied to pre-qualification education of health professionals.

Mentoring can assist nurses to transition to new roles and develop knowledge and skills in clinical leadership essential for advanced practice roles. Nurse managers should make greater use of mentoring programmes to support nurses in their transition to new roles.

There are many theories regarding the importance of the middle manager role in QI, but little empirical research into exactly what this role may be and how it may be strengthened. This research adds to the knowledge base, and provides clear steps for achieving increased staff involvement and QI implementation.

This paper reports on a training programme using action learning sets designed to enhance the management abilities of health-care managers. Numerous independent reports in Australia, and around the world, have related the lack of management systems and processes to substandard health-care delivery. This has suggested a need for better approaches to the education, training and ongoing development of health-care managers, and this paper reports on an action learning approach trialled over a three-year period. Participant managers reported significantly greater levels of empowerment and self-efficacy after participation in the year-long action learning sets intervention. While too early to measure the translation of these reported individual improvements into specific management practice, the literature strongly supports more effective management practice among managers who report high levels of empowerment and self-efficacy.

Public hospitals are required to have quality systems in place to meet accreditation standards, achieve government performance expectations and continually improve care. However, previous study suggests that there has been limited success in the implementation of effective quality systems. Using document review, self-evaluation and qualitative data from interviews and focus groups of 270 board members, managers and staff we explored the implementation of quality systems in eight Australian public hospitals. Using normalisation process theory, we found that the hospitals took a technical, top-down approach to quality system implementation and did not provide staff with opportunities for socialization of the technology that enabled them to normalise the quality work. 'Quality' was consistently described as an 'extra' set of tasks to do, rather than a means to creating sustained, safe, quality care. Despite enormous goodwill and positive intent, a lack of understanding of how to effect change in the complexity of hospitals has led the boards and senior managers in our sample to execute a technical, top-down approach based on compliance and reactive risk.

The implementation of clinical governance in health care services introduces increased responsibility and transparency around safety and quality into all staff roles. Encouraging staff to assume these responsibilities as part of their daily routine is fundamental to achieving effective clinical governance, and requires health care managers at all levels to embrace clinical governance leadership and management. Fostering this role will need to be approached skilfully if managers are to achieve effective leadership of clinical governance activities. This paper reviews the management and quality-related literature to explore how these roles may best be developed to ensure that health care managers are equipped and willing to undertake the critical task of translating clinical govern- ance policy into day-to-day practice.

To explore the impact of the organisational quality systems on quality of care in Victorian health services. During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.