I have been a consultant physician for less than a year and, rather unusually, my role is split 50:50 between delivering direct clinical care and medical leadership.
I have always had an interest in leadership roles, and in the last two years of my training I was recruited as a Health Education North West Leadership Fellow, undertaking a programme that was fully integrated into clinical training. This involved bespoke training with The King’s Fund as well as undertaking a Masters in health care leadership. I remember on the first day of the Masters course feeling distinctly in the minority as a doctor. One of the cohort turned to me and said, ‘You’re a doctor? Why are you doing this course then?’.
It perhaps wasn’t a completely unreasonable question; after all I had spent the previous 13 years learning the art of medicine, undertaking research and training to be a respiratory specialist. My skills were in treating disease, communicating with patients and families in their darkest hour, and practical things like putting in chest drains – so what was I doing there?
Over the next two years l studied a number of areas: patient experience, team effectiveness, delivering co-ordinated care, co-design of services, organisational development, systems leadership, as well as my own behaviours and skills. I realised how incredibly lucky I was to have frontline experience of health care alongside this. I was seeing sick patients in resus at 3am and running the acute take, but I was also being trained to think like a systems leader and starting to contemplate the ‘bigger picture’.
I was surprised by how far removed from direct care delivery many people in senior management positions were, yet these were the individuals who were setting strategy and shaping major change. I started asking: ‘Why are doctors not more involved? Why don’t we care more about the stuff that isn’t “doctoring”?’
I began to understand the different perspectives of managers and doctors and how, despite the common goal of delivering safe patient care, the hierarchical nature of NHS organisations and the slightly differing priorities of people at various levels often culminated in conflict and resentment. I realised that organisations often seem to forget that they are made up of individuals who need help, support and care to do their job properly and that a demoralised workforce is not good for patients.
A particularly interesting workshop we undertook on the Masters course was running an imaginary organisation and having to divide ourselves into ‘tops, middles and bottoms’, representing the executive board, middle management and the front line respectively. It was amazing how quickly ‘tribes’ formed and feelings started to run high, particularly among the ‘bottoms’ who felt disempowered and angry. This exercise lasted about two hours. Having been a ‘bottom’ for 15 years, and still considering myself so, I feel privileged and excited to be leading change.
To me, medical leadership is simply about ensuring that change will benefit patient care. The best way to do this is to engage and empower the people on the shop floor – the talented doctors, nurses and allied health professionals who work tirelessly for their patients. It is about winning hearts and minds.
If you want to know what is wrong with the system, go to a ward and ask any junior doctor, nurse or patient. They will tell you. These are the people who should be shaping and moulding change with senior leaders acting as enablers. If patient care is put at the centre and health care professionals are working alongside managers, then meeting targets, and making efficiencies and cost savings will follow.
It is now abundantly clear to me why doctors should be involved in health care leadership. The days when we were simply practitioners of medicine are over and we must now be equal partners in the creation and orchestration of a sustainable NHS. There is a clear need for medical leadership roles to be taken seriously, with dedicated time committed to them and not ‘squeezed’ on top of busy clinical schedules.
Is there is a role for Health Education England to develop integrated training tracks for leadership in the same way it has for academia? I believe so. The challenge will be ensuring that clinical colleagues do not view this as ‘management’ training and that they welcome this new breed of medical leaders.
- These guest blogs explore issues and opportunities for clinical and medical leaders. Read the other blogs from the series.