Careerism is a bad trait for leadership in quality improvement

I heard the phrase ‘careerism is a bad trait for leadership’ from Brent James, who is also known as the Einstein of healthcare improvement. The FMLM is a new organisation which has Leadership for medics as its major mandate; the other angle being management. The main leadership that is needed right now is in quality improvement. It is probably the ideal time to discuss intentions.

Management first. Task defined, task completed, achievement is clear, reward with pay or promotion. If you are a manager your colleagues know what you are working for, what you are asking them to work towards, what you are likely to get in return and possibly what your colleagues might get in return for working with you. This is a deliberately simplistic explanation but probably broadly true.

Leadership has numerable aspects. Sir Muir’s recent blog post here speaks about motivation and inspiration.  When you are a leader you are expecting things like loyalty and commitment from your followers. You may begin to see why leadership is in a completely different and unique league. I am sure someone has already invented methods to quantify all these high minded facets of leadership but it surely won’t be easy.

When you are leading quality improvement in healthcare the intention has to be very explicitly, purely and simply quality improvement. If the intention was anything else, especially if there was a shade or suspicion that the career improvement of the leader was the primary intention the leader will immediately lose credibility. The activity in hand or the current project might be successful but the sustainability cannot be achieved; the activity could fail if the intention was wrong. Further future activity by such a leader will not get enough buy in and life becomes one long constant struggle after that.

In charities, non-governmental organisations and independent entities leadership and leaders are able to define themselves on the basis of their primary intention which would involve going forward in new directions in their areas. In an organisation like the NHS or organisations such as the Royal Colleges, faculties and other hierarchies within medicine in UK, leadership and organisational hierarchical roles are undeniably tightly intertwined. This brings about conflict and confusion within the minds of leaders and followers about the primary intention of quality improvement activity. Is it purely and simply to improve healthcare quality or is it to fulfil the organisational role? This could be one of the reasons why glowingly remarkable leadership in medicine has arguably not been such a common entity in modern times. This issue is also very difficult to resolve.

In common with general society, doctors will share many kinds of intentions and traits; not all of them will be necessarily altruistic. Some wanting to lead healthcare quality improvement will have a primary intention of career advancement. My advice to them would be firstly try and find another area and if you are unable to do so, please be aware that if things are not going so well it may not be the system or the followers it may be a problem with your primary intention.

Quality Improvement in healthcare, when successful, could result in rewards for the persons involved with it. Leaders could be rewarded with better pay and higher positions. This would be a secondary effect, which is perfectly acceptable.

Followers have uncanny abilities to differentiate between primary intentions and secondary effects. And loss of credibility would be very painful indeed. That is why intentions are important and that is why careerism is not good for quality improvement leaders.