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17 April 2020
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Trainee leadership on the frontline

I’ll be the first to admit – I did not see this coming. I heard the news from China, and watched but didn’t make the connection. "It won’t happen here..." I watched as loose plans were made.  A ‘pod’ made at the entrance to ED. I screened and swabbed people but with little actual concern. "It's the ‘flu, and we deal with that all the time." I heard myself saying, although admittedly while knowing very little.

How wrong I was – on so many fronts. Fast forward a month and here we are in the thick of it. Dealing with challenges we never expected. The phrases ‘to don and doff’ becoming every day vocabulary, running an ED with two separate areas; covid and non-covid.

Junior doctors, like all NHS staff, are being asked to take on new roles and responsibilities even within our existing roles. So how do we, as juniors doctors, show good leadership in this time?

We start as we should always do when we are thinking of leading – we look at ourselves. The first domain of the FMLM leadership standards are around ‘self’. This is broken down into two areas; self awareness and self development, and personal resilience, drive and energy.

This is an emotional time; we will all be affected. For many our resilience will never have been tested in this way. Some of us may not be sleeping, others anxious and stressed for ourselves, or for family members and loved ones. We need to ensure that to look after others we are looking after ourselves.

Never has the analogy of applying oxygen been more true. But to do this effectively we must have self awareness and insight. Our emotions in this time will affect how we interact with our patients and our colleagues.  We need to be patient with others and give people the benefit of the doubt, be compassionate and not react. Equally, we must challenge our own behavior and think of our impact on others.

Demonstrates a clear people and patient-centred approach, considering the impact of their style, decisions and actions on all those affected.

The other day I was on my final night of a busy set of night shifts and as the registrar in charge of the department it had been stressful. Due to the re-design of the department we now had ‘covid’ and ‘non covid’ areas, creating twice as many areas to oversee, with some areas not ideally adapted for the patient cohort.

Staff anxiety was high and challenging discussions with patients and relatives had taken its toll when a patient in the ‘non covid’ area asked me for a face mask.

Anxious about stock levels of PPE I said "No, I am afraid they are for staff only" but offered no other explanation or reassurance. One of my junior colleagues sat next to me, looked shocked and offered further explanation to the patient, explaining that this was the ‘non covid’ area and he need not worry about coming into contact with any confirmed cases and that staff were wearing masks to protect patients as much as for themselves.

I felt terrible, I had not acknowledged this patient's concerns, but been abrupt in a reply and demonstrated poor leadership to my colleague.  Reflecting on this later I realized I had saturated my levels of empathy and my compassion was waning. I was at a point that I almost didn’t care.

So how do we fight against this compassion fatigue?

Simple things like ensuring you have breaks, water, and five minutes out are all vital to ensuring we remain resilient leaders. Thinking about Maslow’s hierarchy of needs: had I eaten? Slept well?

Furthermore for me, leading is about sharing this vulnerability with others. Letting people know they are not alone in their anxieties and that it is ok to be apprehensive because you may be too.

Another one of the standards that I firmly believe is crucial at this time is:

Has the courage to speak up and speak out when standards, quality or safety are threatened.

This is also a time where we as juniors have a voice, and we need to use this voice. We rotate around, we talk to junior doctors in other trusts and settings. We need to speak when we see problems. Particularly when things are changing daily, or even hourly in some settings.  Are things working well somewhere else and can we learn from them? Rota redesign, workshift patterns, rest and wellbeing facilities; these are the issues we as junior doctors are perfectly placed to influence; now is not the time to keep quiet.

Not only do we need to see and demonstrate compassionate leadership in this time but ‘compassionate and good followership’. This is new for everyone. We cannot expect people around us to get it right all of the time. They are not drawing on experience of previous situations. We have to give people chance to experiment, to try and to fail. To be good followers we must support and not be overly critical. A certain degree of trust will be required within our teams - trusting in people’s motivations and looking to support our seniors and our colleagues, ensuring they are also supported.

This is the time to look beyond our traditional teams and seek cross-team collaboration and learning. Again the FMLM leadership standards discuss the importance of effective teamwork and looking beyond:

Identifies opportunities for collaboration and partnership, connecting people with diverse perspectives and interests.

Seeks out beyond the immediate team and professional area for new perspectives, ideas and experiences and shares best practice, incorporating this to enhance quality and delivery of services.

In the month since this began I have seen teamwork like no other, specialties working and pulling together. Red tape eliminated, rather than our default ‘no’ people saying ‘yes’, smoothing out the pathways.

We are seeing this – cross learning and sharing not only from different trusts but countries.

We will all have our stories to tell from this, our own examples of exceptional leadership and not so good leadership. The Trainee Steering Committee would love to capture these thoughts are experiences and share them. Please write to tsg [at] fmlm [dot] ac [dot] uk

Also, if you want to capture your examples in a more personal way and reflect upon your development please consider using the Leadership development passport.

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