Credibility and the medical leader

The best way to find out if you can trust somebody is to trust them.

 - Ernest Hemingway

How much does clinical work make you credible as a medical leader?

The Oxford dictionary describes credibility as ‘The quality of being trusted and believed in’. It is impossible to imagine being a practising doctor without both and it is not surprising, therefore, that medical leaders hold their clinical credibility very dearly. It is also unlikely that an individual with significant (current or recent) damage to their clinical credibility could survive in a medical leadership role.

There is a common concern that credibility as a medical leader is dependent on maintaining a level of clinical practice, but that level is currently ill-defined. Equally, there is concern that an ill-defined reduction in the level of clinical practice also has negative implications for medical leadership credibility. I question these concerns, as I believe would the growing number of medical leaders who have moved (mostly evolved) into full-time leadership roles.

This is important, not least because it has implications for how much time a doctor is prepared to devote to a role as a medical leader. Medical leadership is not getting any easier and as the responsibilities and accountabilities rise, so too does the requisite time commitment. This creates the tension of how much clinical time is enough to remain safe to practice and how much leadership time is enough to be effective as a leader?

If this issue is fudged, and it often is, doctors can find themselves in leadership roles in name only with others in the management team being the de facto leaders. This was highlighted from the US (so it is not just a UK problem) by Perry et al[i] who reported that this limits the medical leaders’ abilities to understand the business in depth, gain critical management skills and grow into being more effective leaders.

We also need to explore the definition of a medical leader – is it simply someone who has graduated in medicine? Or, is there a finite amount of clinical experience and expertise that an individual must have in order to assume the mantle? I would argue that the major contribution of the medical leader lies in their experience and hence would concur with the view expressed to me some years ago that minimal clinical experience makes you a leader/manager who happens to have a medical degree, not a medical leader. However, there is no definition of how much experience is enough to ‘graduate’ as a medical leader. Some countries have created systems in which medical leaders make an early career choice and drop clinical work, but for most the hybrid model prevails.

If credibility is an issue, I wonder where the perception of credibility lies – is it with the legions with whom the medical leader interacts or is it perhaps more in their own heads? The question ‘are you doing any clinical work?’ has opened-up innumerable conversations for me over the years, which might suggest that if I had any credibility as a leader with the person asking the question, it was not based on their knowledge of my clinical activity or performance. Equally, medical leaders work with many colleagues from other professional backgrounds whose ability to judge clinical prowess must be limited. Indeed, although transparency of clinical outcomes is increasing, even for clinical peers the assessment of clinical performance is rarely based on objective scrutiny of hard data. This was of course useful currency for the brigade (largely of yesteryear) who peddled the view that medical leadership was for failed clinicians!

This conundrum needs more focus if doctors are to rise to the challenge posed by the evidence that makes leadership a professional obligation because of its association with enhanced performance, not least in quality for patients. In my opinion, too many medical leadership roles still exist without proper consideration for the time required to adequately fulfil the role. There seems to be a tacit conspiracy between organisations not prepared to invest appropriately and doctors not prepared to give enough time which unavoidably requires lessening their clinical load. This inevitably leads many to fail or simply exist as token clinical leaders and does not do justice to the contribution they could make. At more senior levels, in both primary and secondary care, this conundrum no longer seems to be a major issue, as many are now in full-time leadership roles. So, while it is not impossible, the question of clinical backfill is not always straightforward.

Sir Roy Griffiths, in 1983[ii], described doctors as logical managerial decision-makers. Research has highlighted the benefits when they are able to fulfil this role, so it is time this issue is resolved, that doctors overcome their impostor syndrome with regards to leadership and management and organisations invest appropriately in them to support that.

[i] Perry J, Mobley F, Brubaker M. Most Doctors Have Little or No Management Training, and That’s a Problem. Harvard Business Review, December 2017. https://hbr.org/2017/12/most-doctors-have-little-or-no-management-training-and-thats-a-problem

[ii] Department of Health and Social Security (1983) NHS Management Inquiry (Griffiths Report), London: HMSO. Available at: https://www.sochealth.co.uk/national-health-service/griffiths-report-october-1983/