Medical leadership is driven by necessity as much as personal ambition
By Ali Raza
In an article published in the HSJ in 20171, I argued the case for a new national scheme for aspiring clinical leaders. In a nutshell, I maintained that clinical leadership training delivered through the prism of the NHS General Management Scheme would provide UK-wide standardisation, while establishing early engagement with clinical trainees in their professional journey.
Furthermore, I feel adamant that the synergy between clinical trainees and trainee NHS managers through such a scheme will help bridge clinician and managerial cultures in the next generation of NHS leaders and greatly enhance learning through multi-professional training.
Diagram 1 conceptualises the change environment which this scheme seeks to expose participants to. This model configures around a live change environment, in which clinical leaders (eg clinical directors, clinical champions and project sponsors) have responsibility for setting the strategic direction of the organisation, working in unison with general and senior management. Clinical teams and frontline staff engage with change initiatives while demonstrating effective followership.
Diagram 1. Model environment conducive to enriching clinical leadership capability
I ardently retain the view that such a scheme needs to be developed. As illustrated in Diagram 1, clinicians and managers have to work in tandem to achieve organisational objectives. Therefore, it makes sense for clinical leadership schemes to seek to replicate multi-professional working environments but, to my knowledge, such a scheme has not yet been implemented at a national level.
However, it is also important to recognise that the proposed scheme may not appeal to all medics because a proportion of doctors clearly do not start out gravitating towards leadership and management roles with the alacrity demanded by such a scheme.
An interesting case in point is a senior doctor I recently had a chance to have a sit down with. He is a consultant microbiologist with 20 years’ NHS experience, as well as director-level experience from abroad. He began by explaining how he became immersed in NHS leadership and management.
“When I began my career in medicine, I had a real passion for patient care but did not foresee my transition into leadership or management. In 2009, I was working as a consultant in the microbiology department in my trust when I was asked to step into the role of head of department, which I assumed after consultation with colleagues. At this time, I had nominal leadership training, but I’d honed a vision for the department.”
I asked him to expand further on the service he led.
“The department I led had two primary domains, one of which was the processing of specimens within a lab from patients with infection-related diseases (technical). The other domain related to interpretative services from test results, informing patient management (clinical). The service ran across several vital functions including oncology, haematology, organ transplantation and intensive care.”
I was curious to explore some of his experiences as department lead, charted below.
“When I began as department lead, the service was hampered in several ways. The quality of the service, its relationship with clinical end users and staff morale were all poor. The service had a breakdown in communication with clinical teams. I was at the helm of the service’s modernisation, which saw the introduction of new tests providing higher precision and improved timeliness. I also steered the standardisation of work-streams through implementing diagnostic standard operating procedures, pioneering complex change all the while engaging my staff, improving end user satisfaction and generating significant efficiency savings.”
The key point to note here is that his transition into leadership and management was driven by a sense of duty and consideration for his organisation. I personally know a few doctors who I went to medical school with, who have assumed medical leadership roles and positions out of such necessity.
A recent FMLM report2 covers novel ground on clinician perceptions of leadership and management.
Recommendation 9 of the report2 exhorts the NHS Leadership Academy to outline formal routes to senior leadership for clinicians, which raises some salient points:
- Routes to senior leadership should be split by clinical discipline, eg medicine, and by sub-specialty, eg microbiology and virology (the speciality of the clinician interviewed above). The routes should also have sufficient granularity to reflect different formal leadership roles, such as clinical director, clinical champion and project sponsor (as shown in Diagram 1).
- However, opportunities for formal leadership do not always follow a clear path, as in the testimony of the clinician related above. Hence, such routes should not be regarded as exhaustive, nor should clinicians feel constrained by the stipulation of such routes. This notion is reinforced by the reality that public sector working often provides opportunities for even relatively junior clinicians to partake in major change initiatives in their organisations.
- Though formal leadership roles can be ascribed to formal routes, the responsibility to engage with change initiatives through exemplary followership3 is to be borne by the wider team and front line staff (as shown in Diagram 1), which cannot be formalised in to routes. This collective responsibility to provide constructive support to change is a necessity.
These points ring true when I consider my own journey in medical school. During my medical studies, I began giving credence to the idea of transitioning into general management when shadowing NHS managers in my second year. The routes to medical leadership and management, which increasingly became an attractive option, were far from clear to me. Therefore, implementation of Recommendation 9 of the FMLM report would have benefitted me as a medical student as I certainly feel having line of sight into medical leadership and management would have informed my career decisions. However, I still contend that Recommendation 9 needs to be tempered with the above listed points.
The story of the doctor I interviewed above serves as a reminder that doctors benefit from remaining flexible and open to potential excursions into leadership and management, which medical career trajectories have a propensity to induce. This can be through discharging their duties within formal leadership roles, as well as through effective followership in their capacity as practising clinicians within their teams on the front line.
It is also clear that medical leadership training cannot be regarded as a one-size fits all endeavour. Each NHS organisation has unique change initiatives impacting on patient care. Hence, prescient insights into organisational business and change objectives should inform medical training. It is important to be acquainted with your organisation’s change environment (which may bear some resemblance to Diagram 1). For example, when I worked as a graduate project manager at Guy’s and St Thomas’ NHS Foundation Trust, I came across doctors serving in a wide variety of leadership and management roles, from project sponsors on major capital projects to disseminators of best practice in regional cardiovascular networks.
My main contention is that transition into leadership, management and followership may be borne out of necessity rather than mere personal ambition. Which is why, as a doctor, it is important to equip yourself with the relevant core transferable skills as well (Diagram 1), as you may be called upon to step up to the plate.
References
1. HSJ (2017). Updated: How a training scheme could transform clinical leadership. Available at: https://www.hsj.co.uk/clinical-leaders/updated-how-a-training-scheme-could-transform-clinical-leadership-/7020769.article
2. Faculty of Medical Leadership and Management (2018). Barriers and enablers for clinicians moving into senior leadership roles. Available at: https://www.gov.uk/government/publications/clinicians-moving-into-senior-leadership-barriers-and-enablers
3. Thach, E.C., Thompson, K.J., Morris, A. A Fresh Look at Followership: A Model for Matching Followership and Leadership Styles. Institute of Behavioural and Applied Management, 2006, pp. 304-319. Available here