Over time, this has evolved to a view that recognises clinical behaviour as a significant determinant of effectiveness and costs and involves clinicians in decision-making and accountability related to strategic direction, service development and resource management. The key principle behind the service management approach in Community and Mental Health Services has been to acknowledge the competencies of both management and clinical staff in leadership. The focus is on fostering an appreciation of both sets of competencies and both sets of demands. In addition, the approach aims to achieve best and most efficient use of resources. As a result, structures do not follow an inflexible structure but differ between clinical units within Community and Mental Health Services.
Clinical consultants are an expensive resource relative to business managers.
Thus, where Clinical Coordinators head a clinical unit, they tend to be supported by a business manager to relieve them of tasks that represent inefficient use of their time. This is the structure used in Sexual Health Services, where the Clinical Coordinator heads the Service and a business manager reports directly to this head. It should be noted that clinical leadership is not limited to medical staff. In some clinical units in Mental Health Services, a co-management approach with joint responsibility has been established. The focus on a clinical management partnership is very necessary to close the gap in mutual understanding of each party's particular skills, knowledge and orientation.