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31 July 2020
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Covid-19: Doctors and other clinicians as leaders and advocates of societal change

By Dr Trudy Foster

FMLM Lead for Scotland

Between them, health and social care employ approximately one in 10 of the UK population[1]. Without taking into account the extended households supported by the employees, the potential impact of these organisations, as employers, on the health and wellbeing of a large section of our society, is significant.

Doctors often find themselves as leaders of teams, be it in their departments, practices, or at regional or national levels. This puts them and other senior clinicians in pivotal positions to influence not only the culture and behavioural norms of those teams but also to impact on the culture and accepted norms of wider society.

I have heard it said, “Values highlight what an organisation isn’t doing”. That said, personal and organisational values have an essential role to play in determining cultural and behavioural norms. Who could argue with NHS Scotland’s Values of Care and Compassion, Dignity and Respect, Openness, Honesty and Responsibility and Quality and Teamwork[2]? But these values cannot and should not be taken lightly when they have the potential to impact on the lives of millions in society, and that is not considering the multiple interactions with service users week on week, month on month, year on year.

As far back as 1943, before the inception of the NHS, Abraham Maslow set out the five levels of his hierarchy of needs[3]. Maslow’s hierarchy of needs remain just as important today. Unless we address the basic needs of our staff and colleagues – to be fed, watered, given shelter, and kept safe from physical or emotional harm – we cannot expect them to attain their full potential. The potential in each case of the team, department, organisation, and society will all suffer.

Some years back, a colleague spent not only hours and days, but weeks preparing for a royal college accreditation visit to endure hours of audit and policies to tick the necessary boxes. While this is a laudable award which helps the collective focus of teams, achieving accreditation in modern times should be more aligned to the values of the NHS as a whole, and demonstrated by what we do on a daily basis, not by one-off visits and a forest-worth of reports. Nor should accreditation be financially prohibitive, where only health boards or larger health and social care partnerships can afford the time and resources required to achieve and sustain them. Is there something we can learn from FMLM Fellowship in this approach, an independently verified process of certification against an established set of standards, aligned to core values, to which individuals, teams, departments, and whole organisations can ascribe?

With reference to Mahatma Gandhi, how do we become the change we want to see? And how does that lead societal change?

Well, to begin with, any employer who provides health or social care services should sign up to be a living wage employer. This should not need to be mandated but done because it is the right thing to do, because it helps attend to the basic needs of staff and supports the families and communities around them. We could also see equality and diversity policies expanded to promote work-life balance and as leaders and employers we should follow the example of some of the most innovative corporations and “leave loudly”[4].

Recent events have shown, under the right (or is it wrong) circumstances, communities can and will come together to support each other. The Covid-19 pandemic has given us all cause to pause and reflect. Some of the building blocks are already in place, such as Realistic Medicine[5] and Person-Centred Care[6]. Now we need to move these principles of respect and collaboration outside the of consulting room, outside of the clinical space and bring them in to every aspect of our lives. We have a golden opportunity to capitalise on this community momentum and to demonstrate by our actions, how everyone in society can be valued and supported to flourish.

[1] The King’s Fund (2013) Time to think differently

[2] Scottish Government (2013) 2020 Workforce Vision: Everyone Matters

[3] Maslow A. (1943) A Theory of Human Motivation

[4] Timewise (2020) Why the best bosses leave loudly, and you should too

[5] Chief Medical Officers Annual Report 2017 Realising Realistic Medicine

[6] Person-centred care: guidance for non-executive directors (2016)

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