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30 August 2011
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Encouraging Disruptive Leadership

As the Faculty for medical leadership and management opens for business, I’m wondering where junior doctors will fit into its infrastructure.

Doctors in training are best placed to see frontline inefficiencies and often have innovative ideas for system improvement. While Fortune 500 companies actively nurture talent and sponsor their emerging leaders, the NHS (Europe’s largest employer) has traditionally expected medical leaders to evolve organically. This meant climbing the ranks to consultant followed by frantic survival of the fittest.

Recently, several leadership schemes for junior doctors have flowered across the health service. Their impact depends upon doctors retaining the leadership skills acquired and breaking through traditional hierarchies to drive forward quality improvement. Disruptive leadership can lead to large-scale innovation but it can be quelled by system inertia.

More of the same won’t work – we must create the future we want to see. The Faculty could be a hub for emerging leaders looking to develop leadership skills and for senior leaders seeking talent for their organisations. Difficult questions need to be addressed. Why aren’t there any junior doctors on hospital executive boards? How do we retain talent that might otherwise be poached by the private sector?

How should the Faculty engage with junior doctors? That should be the question on everyone’s lips.


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About the author

Fiona Pathiraja's picture

Fiona Pathiraja

Fiona Pathiraja is a specialist registrar in radiology, based in London. She was clinical adviser to Sir Bruce Keogh (NHS medical director) at the Department of Health and has previously worked as a healthcare management consultant.

Follow her on Twitter @dr_fiona

Also by Fiona Pathiraja



12 years 4 months ago

Encouraging Disruptive Leadership

Hi Fiona,

One of the most interesting ways for the Faculty to engage with junior doctors would be to create a structure based on leadership-based competency rather than career grade. It could really shake the system up!


12 years 5 months ago

Constructive-disruptive leadership


I think you have made an excellent point. When we look at organisational structures we see a simplistic pyramid of shapes and interconnecting lines. Yet reality couldn’t be more different. Communication and influence do not flow along these lines in a rational way and influence over decision making is never that straight forward.

That might seem fairly obvious for experienced NHS readers, but when junior doctors and, like myself, junior managers are inducted to the NHS we see this hierarchical structure and fall into line. As James commented, it is often only as we begin to gain experience and confidence that we realise it is not how things work.

I completely agree with you that a cultural change is needed and, in part, organisations and perhaps the Faculty need to acknowledge the value that junior staff have to offer. Yet I think if we are to really change the culture it is us that needs to take action. We are the ones that need to acknowledge that our opinions are valid and voice them appropriately. We have more influence than we realise, particularly if we come together.

So I turn your question around, how do we want to engage with the Faculty? How do we make sure it is meaningful for us? And how might we use this forum to encourage our junior docs (and others) to stand up and make the changes they want to see?

Another Fiona
Junior manager

12 years 6 months ago

Disruptive Leadership

I have sat in many meetings where the inertia in systems of management is as palpable to me as the resistance in a therapy session with a patient. To me one is a more complex version of the other. Yet in the latter I am empowered to lead, often in a "disruptive" way that hopefully allows personal "innovation". In the former, as you say hierarchies, needed to be broken through and that requires the confidence of many people in a room not just the one in therapy.

I would argue that maybe one reason junior doctors are not on hospital executive boards is related to a two way problem at the heart of which is the itinerant nature of junior doctors lives. For junior doctors it produces transient relationships with organisations. These relationship don't encourage a sense of belonging or ownership and therefore a culture of investment cannot be maintained. The pressure of training require juniors to probably spend additional time outside of work in at least thinking about innovation if not making it happen - they have to feel this is worth it. I wonder if a lot of the time they feel it isnt, perhaps the inertia has got to them.

I guess the other side is that management structures equally see junior doctors as itinerant. Investing in a person gives you meaningful results, investing in a role (e.g the junior doctor rep) can be an inconsistent business as the qualities of the inhabitant change every 6-12 months. Change projects rarely fit neatly into the 6-12 month term of one person - how do you manage continuinty of an embedded role in that position? To me this is the equivalent of changing therapist half way through leads to disengagement.

In my core training it took me the best part of three years in the same Trust to build up the confidence, trust and position within various heirarchies to begin to make meaningful and proactive changes to lives of my colleagues and the wider healthcare systems. I am now at a new trust. I hope not back at the beginning personally or in the principles of leadership, managing change etc. But in terms of networking, the power of my provenance is weakened by the discontinuity between healthcare organisation and these are neighbouring trusts.

If the Faculty is to engage with junior doctor it must seek to motivate them to invest, to move beyond the seemingly endless itinerant nature of our existence, and believe that meaningful change is possible in such complex organisations. We retain talent by giving it the space to invest. A culture of investment.

As you suggest Fiona, if the Faculty can take on the role as a proactive hub for trainees with leadership potential such that the crucial relational provenance of members can be maintained across NHS organisations, may be this will help overcome some of the sense of the mournful wandering (audit) bard.

James Woollard

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