The anatomy of physician leadership
FMLM and Cass Business School held a one day workshop in London on 1 October for senior and aspiring medical leaders from different sectors to discuss the evidence for medical leadership and explore ways to motivate and support doctors into leadership positions.
Fellows on the National Medical Director’s Clinical Fellow Scheme were among the participants; below they share their takeaways from the event and their reflections on how to take medical leadership to the next level.
Learning from Cleveland
Dr Stefano Palazzo, National Medical Director Clinical Fellow 2015-16, Monitor
“As part of the workshop we were lucky enough to hear from Dr James K. Stoller MD, Chairman of the Leadership Academy at the Cleveland Clinic in the US. He gave us insights into how medical leadership has progressed within this world-leading institution, and provided inspiration for how this could look in the future in the NHS.
“For decades the Cleveland Clinic has had a practicing clinician as its CEO. Dr Stoller explained that this made decision-making within the organisation easier, and with real consideration for the frontline staff. For example, he described a situation in which investment in iPhones for all junior medical staff on the wards was being considered. Although this cost over $1 million, the CEO immediately understood the power of having easy and immediate access to patient notes, observations and drug charts. This meant that, rather than a long process with extensive discussions of the business case for this significant investment, it was signed off within days. This quickly brought benefits to patients and staff – benefits that would otherwise have taken years to realise. This model of physician CEOs is something we should aim to replicate in the UK – authentic individuals with an inherent insight into the life of their employees will always make better leaders.
“The Cleveland Clinic is also clear about investing in the future. Each of the physician leaders within the organisation is encouraged to identify junior staff who may want to rise to management or director roles later in their career. These junior staff are mentored, supported and coached and given ample opportunity to gain experience of leadership roles. Through this, on reaching a senior stage they are prepared for the challenges that these roles pose, and are better equipped to succeed. This should inspire us within the NHS to think about developing our clinician leaders early. We should not be leaving people to ‘learn on the job’ when thrust into a role they were not prepared for. If we succeed in doing this, there is no doubt that outcomes for hospitals, staff and most importantly patients will be better.”
The value of leadership programmes for doctors
Dr Kaanthan Jawahar, National Medical Director Clinical Fellow 2015-16, NHS Trust Development Authority
“It has always concerned me that there is a lack of formal leadership development for doctors. The evidence base for clinician leaders was laid bare at the workshop – research by Dr Amanda Goodall and Prof Peter Spurgeon has shown that executive positions in healthcare occupied by qualified doctors will tick the boxes of expert leadership and credibility. This then translates to better workforce engagement, better patient outcomes and improved recruitment and retention.
“It all sounds like a no-brainer, but formal development opportunities are rare on a local basis. Some LETBs are ahead of the game and have quality improvement fellows, but for full immersion into the healthcare leadership landscape one would need to look towards the Darzi and National Medical Director’s Clinical Fellow Schemes. But then these are pricey (for the host) secondment out of programme experiences (OOPEs) and their benefit over research/medical education is often questioned.
“Personally being on the National Medical Director’s Clinical Fellow Scheme for one month has improved me immeasurably, but I am not yet sure how to articulate how I have improved. This is echoed by the 2010 review of the Darzi scheme that identified several short term wins on personal growth, self-awareness and leadership skills. However time will tell if this is sustained and what the outcomes would be.
“The benefits of these schemes are conceptual and hard to measure. We need to guard against measuring what is easy as this could be to the detriment of these schemes. Instead, let’s take a leap of faith and back these programmes because they simply feel right."
The value of leadership development in academic medicine
Dr Maslah Amin, National Medical Director Clinical Fellow 2015-16, Health Education England
“The importance of leadership in medicine is increasingly recognised. Academic medicine traditionally encompasses research and medical education – which have provided a vast knowledge base. However leadership is essential to implementing this knowledge effectively. Leadership training for doctors is not afforded the same weight as research and medical education.
“I consider myself an academic doctor. When applying for an Academic Foundation Programme (AFP) there were only two deaneries providing a leadership programme, as opposed to numerous deaneries providing research and medical education programmes. I have just completed a leadership AFP. The next stage is an Academic Clinical Fellowship (ACF) which allows you to continue your academic training alongside your chosen specialty. However, there was not a single leadership ACF available. The only advertised programmes were stand-alone fellowships. I am involved in research and medical education. I understand that these areas develop leadership. However, the development I experienced on my leadership AFP is not comparable.
The ‘Anatomy of physician leadership’ event reinforced the importance of leadership development programmes. Without dedicated leadership training the NHS will be led by a group of ‘keen amateurs’. Fortunately,the National Medical Director’s Clinical Fellows Scheme is allowing me to maintain my leadership momentum. However, after this year, I’m afraid I will struggle to find a leadership focus in my specialty training.