Preparing for your next leadership role

Let me take you back to the run up to you getting the A level results you needed to get into medical school. Imagine you could have been shown then, a snapshot of you at work now. I wager you would have been amazed, perhaps utterly disbelieving at the things you can now do. So how did you get from there to here?

Some of your transitions will have been smooth – progressive learning supported by educational endeavours. Some of it will have been steep, very steep, especially as you morphed from one grade into another. Some of that, perhaps most of the really tricky stuff, will not have been covered or acknowledged in any of your educational pursuits? This has happened to me endlessly. The ubiquitous steep learning curve could last more than a year in my more senior roles and although it was widely recognised and acknowledged, no-one (me included) did anything to prepare me. This begs the question: is it reasonable for an organisation to have to wait significant periods of time for new incumbents to find their feet or should they/we find ways of shortening the process?

I recall my transitions well – that discomfort of being out of my depth when everyone around me seemed to be in control and far more knowledgeable. The information I needed (if I knew what it was) was not to be found through any of the familiar learning approaches and the manual never existed. Over time, I would learn and become more comfortable and hopefully more competent with challenges and roles which had been beyond me only months earlier. Had I become more intelligent? Had I become a better person? No – I had simply developed vertically.

In contrast to clinical training, leadership development mostly supports horizontal development – it helps you become more proficient at your current job. Nothing wrong in that unless that is the only focus, because most of us want to progress into bigger roles and the system most definitely needs us to do so.

Early in a medical career, the focus of training and education is almost exclusively clinical although ‘non-therapeutic’ topics are creeping in. Growing clinical competence is obviously crucial but what about the competences to work effectively in a team, perhaps to lead it; to work with disparate professions; to persuade senior colleagues to perform investigations your boss has ‘ordered’? How do you learn to handle conflict, to challenge when you see danger in a decision, cope when you make a mistake?

We understand the path to clinical excellence well but not the path to excellence in inter-personal skills, leadership, management and teamwork and yet research shows a stark positive association between these and the quality of patient care.

So, how could we learn the leadership and management competencies in parallel with clinical competence and reward patients with the attendant benefits? A good start is to acknowledge where we are starting from. Are our minds, by Kegan’s[1] definition, socialised, self-authoring or self-transforming? In Torbert and Rooke’s[2] terms, are we opportunists, experts or alchemists …or in between? This matters because research suggests that the higher we ascend these developmental levels, the more successful and effective we will be as leaders. Furthermore, it is crucial to overcoming the challenges of the modern world, well summarised in the acronym VUCA:  volatile, uncertain, complex, ambiguous.

With a better idea of our starting position, a simple, three step model to support vertical leadership growth has been eloquently described by Nick Petrie[3] (Center for Creative Leadership): heat experiences; colliding perspectives; and elevated sense -making. In brief, heat experiences equate to being thrown in at the deep end giving a compelling need to grow.

Colliding perspectives encompasses the art of comparing notes and others’ experiences to broaden your mind, to see things through a different lens. Elevated sense making is the act of being helped to comprehend the new environment by someone who has been there before and ideally recently. Importantly, you need all three to really progress.

So, how do we translate all of this into medical training? My first observation is that clinical training follows this model rather well, although I am unclear how well elevated sense-making is covered nowadays – it was pretty rudimentary during my training? The same cannot be said of leadership development which is hugely variable, a veritable postcode lottery. Whilst there are excellent examples eg leadership fellowships, they are too sporadic and usually relatively small islands in a sea of clinical training.

We need to recognise, support and grow the leadership and management skills and have a clearer view of the changing demands brought about by career progression. We need to seek out and recognise heat experiences, encourage trainees to seek out alternative perspectives and help them to make sense of what they encounter. The RCP London chief registrar initiative promises to address this by taking much of what was good with the old senior registrar role but adding formal training and recognition by the College.

In summary we need to be adding a progressive curriculum of management and leadership training to clinical training if we are to adequately equip junior doctors as their leadership roles increases as they advance through the system. They need to be supported to address the (horizontal) leadership challenges they face in their current roles as well as help them to learn the skills incumbent in progressing to the next level on the career ladder; this is vertical development. This will help to provide a more seamless approach to succession planning and talent management.

[1] Kegan R. The Evolving Self, Problem and Process in Human Development. http://www.hup.harvard.edu/catalog.php?isbn=9780674272316

[2] Torbert William R., and Rooke D. Seven Transformations of Leadership. https://hbr.org/2005/04/seven-transformations-of-leadership

[3] Petrie N. Future Trends in Leadership Development. http://insights.ccl.org/wp-content/uploads/2015/04/futureTrends.pdf