The case for professionalising and validating medical leadership

I recently attended the Faculty of Medical Leadership and Management (FMLM)’s third national conference at which about 400 delegates (mostly doctors) examined the future challenges for medical leaders and managers in the NHS and private health care. 

At the event, FMLM launched the latest results from their consultation exercise on setting professional standards for doctors in medical leadership and management roles. Niall Dixon, Chief Executive of the General Medical Council (GMC), praised the standards stating that they were congruent with the GMC’s Good medical practice

One of the priorities of our own medical leadership work is to support those attracted to medical leadership and management, recognising that this role has many challenges associated with it. We believe that one way of encouraging medical leaders is to give them the same professional status that the medical profession gives to education, training and clinical practice.

The FMLM standards will formalise and define good practice for all doctors including GPs, secondary care specialists and those currently in training. As Sir Bruce Keogh reminded the conference, though, the standards on their own do little to improve patient care unless they are implemented and recognised by the profession they are intended to serve.

Our task is to gain commitment from doctors at all levels to build on these standards and bring them to life. Dr Kirkup’s report into maternity and neonatal services at Morecambe Bay and its recommendations around clinical leadership reinforce the importance of integrating them with the standards we deem acceptable for all professionals providing care. Our work on revalidation cautioned against driving compliance and suggested instead that seeking commitment by focusing on what doctors are minded to do ‘when no one is watching’ reaps longer-term culture change.

The launch of the standards has reinforced the importance of providing leadership development and mentorship. You and I and others know that the quality of leadership in an organisation at all levels determines the culture in which care is provided and received. However, a new report also launched at the FMLM conference, Leadership and leadership development in health care, shows that we do not currently have the body of evidence required to support this view.

Doctors are taught to examine the evidence base in their clinical work, and without great leadership much of the innovation in medicine that originated in the UK would not have been developed. The response to this report has highlighted the importance of measuring the impact of leadership development and being able to demonstrate its effectiveness. Leadership is not an easy thing to quantify but that does not mean that we shouldn’t try.

The question this raises for me is to what extent are we encouraging clinicians in a leadership role to examine and reflect on their decision-making process and their management style when they are at their best and at their worst? It is just as important to know what it is that stimulates you to a positive outcome as it is to understand what leads you to take a course of action you later consider ill advised.

The ability to shape social situations (sometimes referred to as reflexivity) is not always something that we notice at the time; it is often only appreciated after a leader has gone, but it remains important to develop this skill in our medical leaders.

All this reminds me of the cohort we call ‘the emerging leaders in medicine’, many of whom are members of FMLM. They have an energy and a passion that we need to keep ignited by supporting them throughout their careers. They are entering the workforce in greater numbers, with more women coming through medicine than ever before. From seeing their peers in other industries and organisations, this cohort have expectations of more choice in how their career is designed and more variety – and they want it now.

If we take away only one key message from the FMLM conference it is that leaders in health and care must clear the path and make room for this cohort. At the launch of the NHS Five Year Forward View, Don Berwick reminded us of the importance of his ‘triple aim’ (improving the patient experience of care, improving the health of populations and reducing the per capita cost of health care). Achieving this triple aim is the goal we are assigning to these emerging leaders; our responsibility is to develop and support them in this.

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Comments

#543289 Mahir Al-Rawi
consultant surgeon
BCUHB

Thanks and I attended the FMLM conference. It was an excellent conference and I would suggest to repeat in a more regional way (outreach). The conference was very expensive as well.
My point is that unless some of the current leaders change or leave their current rules to others, nothing will change. Many of the current "leaders" as you know have been appointed by managers for known reasons. What we need is genuine change from this and let "the emergent leaders in medicine" in. Thanks

#543295 Vijaya Nath
Assistant Director
The King's Fund

Thank you for leaving a comment . My colleagues and I agree that the 'emerging leaders' will shape the future & improve what came before .
This will take dedicated time and my health warning is that leaders at all levels should work to influence change, this does not need formal office, that will come.
On the day that we unveil a statue of Mahatma Gandhi in London,a poignant reminder to me and I hope others -of one who still influences leaders and yet he never held formal office.

#543296 Abeyna Jones
Occupational Medicine Registrar
Kings College Hospital

I found the FMLM conference inspiring and a motivator amongst the many other activities I currently pursue as an "emerging leader" in healthcare. I experienced the opportunity to network and learn without hierarchy which is something I hope to see in the widespread culture of the NHS. We need an environment which fosters the right kind of leader that can deliver and develop our vision for the NHS in the future.

As leaders, we cannot forget the focus on health and wellbeing of NHS staff as its greatest asset, which also means respecting our diverse background, experience and talents. Investing in staff will translate to the quality of patient care we can deliver.

And finally, i believe that these potential agents for change need to be given the opportunity and space to reflect and be brutally honest with themselves. How do we facilitate this in a heavily service driven environment? It is only then, they will have the power to observe, shape and influence.

#543312 Dr Stephen T Webb
Consultant Intensivist
Papworth Hospital NHS Foundation Trust

Thanks Vijaya, a thought provoking blog. Your comment 'the question this raises for me is to what extent are we encouraging clinicians in a leadership role to examine and reflect on their decision-making process and their management style...' got me thinking. Self examination and reflection is not something doctors are particularly good at it, we find it easier examining, treating and assessing others. We need the skills to do this well and the FMLM seem to have identified this need by offering the Strategic Peer Supprt Programme which launched at the annual conference. Hopefully this will provide a peer support network to aid learning and reflection which we all need to become better clinical leaders.

#543467 Barry Faith
Member of the public

My concern is that professionalising clinical leadership is not matched by the professionalising of management leadership. My experience (a foundation-trust hospital) is that senior management operate a two-faced culture: a public one that the outside world sees and is of course, patient focussed; the other being internal and secretive, where scrutiny (by myself as a governor and latterly as a hospital member, after 'removal' for asking questions - - - -) is frowned upon. I suggest such two-faced cultures are hard to maintain and secretive one will predominate, albeit the public pretence continues.

#543515 Aruna Abhyankar
Consultant Paediatric Surgeon

Many thanks for this blog. I could not attend the conference. Whilst many of us are trying to influence changes through more effective leadership the opportunities and support for allowing time remains a challenge..especially with waiting list pressures.
Lateral move into other departments is not possible for a medic but is no bar for a nurse or a manager..leaving a rather narrow scope. Unless involvement of a medic in each major project is a deafult setting only a few will achieve the balance of passion opportunity and training. They may well be the superleaders but do not help the aspirations and expansion at local level. We need a collaborative approach rather than them and us...Just as we inspect the lack of perceiced self reflection and lack of management awareness, the knowledge of clinical reality including the ethical dilemmas and in those who hold key positions should be reviewed. My concern is unless clinicians feel that managers are equally appraised or are aware of the managerial pressures many may remain disillusioned And dismissive of the fine balance between healthcare and heathbusiness

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