Talking Leadership: Matthew Rice on clinicians leading change

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Matthew Rice is a Senior Consultant, Leadership and Organisational Development at The King’s Fund. He works on programmes for both new and established clinical leaders. He also works with clinical leaders in their own organisations – these have included Barts Healthcare NHS Trust, North Middlesex University Hospitals NHS Trust, and Barking, Havering and Redbridge Clinical Commissioning Group. Here, he tells us about the pressures that clinical leaders are facing now, and what is needed to unlock their potential.

What do clinicians tell you about the pressures they are under, and what is important to them?

Many clinicians have a sense of not feeling heard and perceive their ability to influence as very limited – if it exists at all. This feeling is compounded by the pressure of their workload, and a feeling of being stuck on a ‘hamster wheel’ of activity over which they feel they have little control. The changing nature of patients’ expectations also impacts on their experience of their role, as does increased regulation. I think many have the perception that the organisations they work for are preoccupied with issues relating to money – either the lack of it or the need to save even more of it – and this breeds frustration and cynicism in some.

Why are clinical leaders so important to the health and care system?

Clinical leaders (and by that I mean anyone in a clinical role regardless of position or seniority as well as those in formal leadership roles) have enormous potential to influence, and this can take place at every level – from shared decision-making with a patient right the way through to the most strategic of board decisions. There is much evidence from high-performing health care organisations internationally that the quality of the relationship between clinical leaders and non-clinical managers is a significant factor in their success. We are often asked to help with this, as getting this aspect of culture right is by no means easy.

What benefits can come to health and care organisations from supporting clinical leaders?

We know from our own and others’ work about the benefits that can come from sustained investment and support for clinical leadership. When there is a good relationship between clinical and non-clinical managers and especially when it also involves working collaboratively with patients, a shared understanding and mutual respect can lead to genuinely shared leadership, which creates the space for innovation, a safer culture, more resilient individuals and teams, and gains in productivity. Two of our publications – Reforming the NHS from within and Better value in the NHS – make a compelling case for clinicians to drive quality improvement within their own clinical areas. Put simply, the improvements needed in today’s health system are not possible without their involvement and leadership.

How can clinical leaders be empowered to lead changes in an environment of financial constraint?

Clinicians are passionate about the quality and safety of care they provide. These are key drivers of their work and resonate with some of their core values as professionals. Whatever their level of formal leadership responsibility, providing the encouragement and proper support to lead even very modest quality improvement projects can really motivate and engage them day to day. But all this takes time and I think, in all the talk about cost savings, the fact that time is also a resource is frequently overlooked. This seems to me to be one of the biggest challenges of all for those who are currently, or aspiring to be clinical leaders – how to first find, then take the time to think.

When you work with clinical leaders, what sort of help is most useful to them?

For many, our work together can be the first time they have been able to find the space to think about their leadership role, what will be required of them and how they will take it on. It can be an opportunity to fine tune some leadership behaviours and to receive feedback. Sometimes we can help them acquire new knowledge around some of the more technical aspects of leading and managing, such as finance or performance. Above all, our approach helps the people we work with to connect – to themselves as well as each other. When we worked with Barts NHS Healthcare Trust, for example, our aim was not just to help build the capacity of clinical directors as individual leaders, but to enable them to become an engaged and inspiring team at the forefront of change in their organisation. So far the feedback has been overwhelmingly positive.