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Sharing experience with aspiring medical leaders

In the first of a series of guest blogs on clinical leadership, Jonathan Fielden shares some insight into his personal philosophy and on his approach to medical leadership - and life.

The King’s Fund works with clinical leaders at all stages in their careers and we believe that clinical leadership and engagement needs to be a priority across the NHS. This is the first in a series of guest blogs that explores current issues and opportunities for clinical and medical leaders.

I’ve never really been one for looking back, or thinking about how I would advise my former self, but I am passionate about encouraging aspiring medical and clinical leaders.

The best health care organisations in the world are clinically, usually medically, led. The United Kingdom lags far behind. Now is the time for the profession to take up the challenges of health system leadership. Our NHS, our country really does need you.

Only the other weekend I was at an excellent medical leadership programme at the Royal Berkshire Hospital in Reading. The room was full of budding medical leaders, showing that the future of the profession and health is more vibrant than many would suggest currently. This is the first thing that I would pass on to aspiring medical leaders: you are part of, and will remain so as long as you wish to, the best possible profession, one that is a privilege to be part of and an amazing job; not just a profession, but a vocation. A profession that you should remain passionately linked to, nurturing the visceral burning ambition to improve the care for patients that brought you into it.

In short: hang onto your dreams. One of the grave sadnesses of the current disputes on contracts is that many may well lose sight of the dreams and aspirations that brought them into health care. I would urge otherwise; this ambition is what drives us to better care, and achieving the most enjoyable aspects of being a physician in its widest sense.

I would also recommend that aspiring medical leaders build a personal philosophy, one on which to set your foundations, one to check and hold fast to when the inevitable challenges to you, your decisions and the service in general come thick and fast. My personal philosophy has been threefold. First, ‘patients first’ – whenever decisions are finely balanced or you are not sure which way to turn, think patients first: ‘what difference would this make for patients’ as Don Berwick would say.

Second, always aim to ‘drive value’ – in everything you do always try to improve the quality of outcomes and experience for patients, while also being aware of the cost of achieving that – an approach best articulated in 2010 by Michael Porter. There is always a limit to the funds available to health care, and so medical leaders are guardians of effective spending.

The third aspect of my personal philosophy is always try to make where you work the best place to work, train and learn. Happy staff, cohesive teams, celebrating excellence repay you many times over multiply. The return on investment of encouraging staff and colleagues is huge, both in financial terms and most importantly quality of care. Those damaging people’s belief in our profession must understand the risks that this brings. Medical leaders must ensure that while pushing up system outcomes and performance we invest in personal and team development; the essential third leg of quality.

My next recommendation is remember that life is short. Understand that while there will always be many calls on your time, your skills and your expertise, time never runs backwards. Your children never grow younger, that missed opportunity for a holiday never comes back and no one thanks you for working too long. Value time out, give yourself time to think. Fight the urge to always be at work. Sometimes being with your family, friends or just your thoughts is the right way to recharge, refocus or be ‘mindful’.

Next, if in doubt, remember to just make that leap. I always worry more about the decisions that I haven’t made than the ones I have, even if wrong. Seek forgiveness, not permission. Too many organisations are hamstrung by bureaucracy and unnecessarily excessive governance and assurance. Necessary assurance is important, conservative desire for re-assurance so often misses the moment for real effective change.

Finally, if nothing else, remember to smile. Smile at yourself in the mirror first thing in the morning – it will empower you for the day ahead. Smile at the first person you see as you walk into work – at the very worst they will just think you’re strange. A smile is one of the lowest-cost, highest-return investments that you can make in yourself or others. Smile.