John Daly,1 Debra Jackson,1 Judy Mannix,2 Patricia M Davidson,1,3 Marie Hutchinson4 1Faculty of Health, University of Technology, Sydney (UTS), Sydney, Australia; 2School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia; 3School of Nursing, John Hopkins University, Baltimore, MD, USA; 4Southern Cross University, Lismore, Australia Abstract: In many areas of the developed world, contemporary hospital care is confronted by workforce challenges, changing consumer expectations and demands, fiscal constraints, increasing demands for access to care, a mandate to improve patient centered care, and issues concerned with levels of quality and safety of health care. Effective governance is crucial to efforts to maximize effective management of care in the hospital setting. Emerging from this complex literature is the role of leadership in the clinical setting. The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and in various government reports. Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to achieving and sustaining improvements to care quality and patient safety. In this discursive paper, we discuss clinical leadership in health care, consider published definitions of clinical leadership, synthesize the literature to describe the characteristics, qualities, or attributes required to be an effective clinical leader, consider clinical leadership in relation to hospital care, and discuss the facilitators and barriers to effective clinical leadership in the hospital sector. Despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership. Future strategies should aim to address these barriers so as to enhance the quality of clinical leadership in hospital care. Keywords: management, hospital care, barriers, leadership, clinical leadership, discursive paper