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.