It's not just the shape of the ball that's different

Returning from the excellent and inspiring FMLM annual conference in Edinburgh, I was reflecting on the styles of leadership that I had observed, and what I could learn from them.

I am fortunate that some of my experiences of late have been outside the normal sphere of hospital practice and recently had the privilege of co-leading a multi-professional medical team at an international sports tournament.

Our team of doctors, physiotherapists, osteopaths and a chiropractor were responsible for health and well being of over 400 athletes and managers of all ages during an intense tournament lasting nearly three weeks. During this time, we had to deal with everything from insect bites to heat stroke, head injuries to viral illnesses, and some serious musculoskeletal injuries including a number of serious fractures.

Following the tournament, I reflected on what we had achieved and learned and it dawned on me that I had observed, and been part of, three completely different leadership styles:

Football: to me, the predominant style of leadership that I observed from the football managers whilst pitch-side was direct and critical. That is, whilst giving due praise and celebrating skill and good play, often the direction was highly critical and negative. In general, they were micromanagers - trying to direct play and tactics throughout the game, and issuing multiple instructions to individual players. That said, it seemed that the players expected, and needed that, but that as a result, the on-pitch role of the captain became almost redundant.

It was very much a parent-child relationship but one that fostered camaraderie amongst the players and left the managers rather exposed. In adopting such a leadership style, when the team did badly, one could very definitely lay the blame at the management team's door but conversely they also revelled in the glory of the win.

Rugby: in contrast, the leadership style that I observed on the rugby sidelines was distributive and much more about the team than the individual. Many of the tactical decisions were taken, and learned by the players prior to the match, so that the direction during the game was on a more macro level. In addition, although the captain played a motivating role, decisions about play during the game were taken by leaders of distinct groups, such as the forwards and the backs. This struck me as similar to a military model and this was further emphasised by the war like nature of the motivating language.

For me, the result was a hierarchical structure stretching from off the field on to it, but one where the in play decisions were distributed out. It is well known that the discipline on the rugby field is usually better than that in football and I wonder whether in part this was due to the way in which the responsibility and accountability was spread more uniformly rather than staying in the centre, as I perceived it to be with the football team.

Medical team: although possibly biased, my perception of our team, and that of others within it, was that the predominant style of leadership was respectful and empowering of the individual. The multi-professional nature of the team led to fruitful discussion and advice seeking at all levels. The result was that a numerous parent-parent relationships developed, which fostered good team work and distributed the varied workload equally.

There was, from my point of view, and those of others that we gained from the post-tournament feedback, a mutual respect between team members and a sense that problems and successes were shared in equal measure. When difficult issues arose, whether logistical or clinical, communication was key to resolving these quickly and this was fostered by a lack of hierarchy. However, lines of responsibility were clear, and although the day-to-day management of the team was performed by a physiotherapist, particular in the pre-tournament stage, ultimate clinical decision making remained with the doctors.

Protocols and individual's responsibilities were clear, and decisions were made as a team. This became particularly important when dealing with the squad management especially when issues of a political nature arose.

It became clear to me that although the leadership and follower-ship styles were very different, they seemed to be adapted to each situation and were what was expected by other members of team. Of interest in each case were the lines of responsibility and accountability and particularly how situations were dealt with where things did not go as planned. What was not clear to me, particularly within the sports teams, was how learning and improvement took place and whether there was appraisal of the impact that the leaders had.

Reflecting on how I can take this experience forward, these would be my three top tips for effective leadership:

1. Effective leaders do not necessarily have to be the ones shouting the loudest, but are those that empower other members of the team to achieve success;
2. The whole is greater than the sum of its parts and so good leaders will build teams that recognise the strengths and weaknesses of the individuals and create an environment in which each can flourish;
3. Autocracy rarely achieves the right results - an environment where leaders listen and team members feel able to speak up is vital. However, there are undoubtedly moments where clear, authoritative decision making is necessary.

Dr Marc Wittenberg is part of the National Medical Director's Clinical Fellows scheme and works at NHS England and BMJ
marc.wittenberg [at] nhs.net