Living leadership

This is about being a good leader and in particular a good medical leader. It’s a personal view based on observation and experience in the NHS at local, regional and national levels. I believe leadership is about what you do, what you actually do in practice, rather than your job title. It’s "walking the talk". 

Doctors are trained to identify what is wrong (with a person) and make a judgment about how best it can be fixed (cured). Even at this basic level the best option for treatment will not be the same for every patient, and medical students learn the complexity of a holistic approach and their role in providing information and advice rather than instructions. Many doctors working at the front line identify what is wrong in the local part of the health system in which they work and express clear views on what should be done to fix it. Where people have learned to take a similar holistic approach to such issues as they do with a patient, they are more successful in achieving the changes they seek.

Take the example of the theatre team that is being criticised for late starts and low productivity. The surgeon may correctly identify that there are delays in the porters bringing patients from the ward to the theatre. The surgeon could simply blame the porters. The surgeon who is taking on the leadership role talks this through with the ward sister, the theatre manager and the portering manager. They identify the underlying reason for the delay is that the ward nurses are very busy and not ready to accompany the patient to theatre when the porter arrives. They work together on a proposal to the directorate manager to implement an admissions lounge adjacent to the theatre suite. This means ward nurses and porters are not needed as patients can simply be collected by a member of the theatre team and walk to theatre. The directorate manager sees that this solution will free up staff time and improve the patient experience as well as increasing theatre productivity and agrees to the implementation. The surgeon has demonstrated leadership through his or her actions, and worked with team colleagues to come up with a solution.

Staff tend to follow the example of behaviours displayed by their leaders. The chief executive who picks up litter in the hospital corridor as they walk past will gain respect and be copied. The medical director who turns up in A&E on a busy Saturday night and asks what he or she can do to help the acute situation will get a more sympathetic hearing when asking colleagues to support delivery of the seven day services agenda.

These behaviours can be taught by example and learned. When we developed a patient safety quiz for foundation doctors in my trust we included a question, "What would you do if you find a puddle of liquid in the hospital corridor?", with an expected answer that individuals would warn people nearby, put up a safety sign and contact the facilities staff to ask for someone to come and clean it up. This is a very simple example of our expectation that foundation doctors should demonstrate leadership through their actions.

As a medical leader if you are out at a party and a stranger asks what you do, do you just tell them your job title? Or, do you have a story to tell about what you have done to improve patient care? We should all be aiming to have those good stories to tell.