Talking leadership: learning to lead as an NHS consultant

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Dr Kin Yee Shiu is a consultant in nephrology and acute/general medicine at the Royal Free London NHS Foundation Trust, where she is also clinical lead for chronic kidney disease and renal outpatients. Dr Shiu took part in our Leadership for consultants programme in 2017. Here, she talks about her experience of the programme and the challenge of leading change as a consultant.

Tell us about your leadership journey

Around the time I became a consultant I was given the role of clinical governance lead, and really took to it. By finding areas of our work that needed improving, and working with others to improve them, I got amazing feedback from colleagues. This experience kick-started the journey for me.  

We get a lot right at the Royal Free, so I could see around me examples of good leadership but I found myself wondering how I could do that too. You are taught to be a doctor, you train to be a consultant – but there’s not the same clearly defined path to becoming a leader as there is in clinical medicine. We all have our own way of being a doctor, and I realised I needed to find my own way of learning to become a successful leader. 

At the time, I was very unsure of myself and of the system. I didn’t know how to navigate a whole new world of people talking languages I didn’t understand: operational management, finance, administration. I started to consider doing a course. The King’s Fund Leadership for consultants programme came highly recommended by a couple of people close to me, and I saw what they gained from it, and how much they developed personally and as leaders. I knew from them that the programme understood clinical practice, and it would stretch and push me out of my comfort zone.  

The programme didn’t change who I am, but it changed how I see the world. I did the programme alongside consultants with years of experience and plenty of workplace challenges. They’d come to the point where they understood improving their leadership skills was their answer. I feel lucky that in my early days as a consultant, I worked out that continual development as a leader would be essential to my future.

What do you think are the main leadership challenges for consultants in today’s health and care system, and what happens when consultants don’t lead? 

The usual answers would be: lack of money, workforce issues, low morale - and yes, these are challenges. But I wanted to answer in terms of something more do-able, within the grasp of consultants as individuals. I think the leadership challenge we have is to understand the system we work in, understand the teams and people around us who help our patients, and then work out how to make change happen together with others to make things better for our patients.  

Consultants need to be good clinicians who put people first. To do that, we need training and support, and leeway to make mistakes and learn – in a safe way. We then are well placed to be powerful advocates for our patients and their care.  

I think we need to remember that as doctors we are very capable of diagnosing then treating our patients – but leadership doesn’t function like that. It takes skill to withhold your own judgement in order to bring other people with you in problem solving. It takes skill to develop trust and respect as a leader (aside from what people may think of you as a clinician). Being able to listen, work across disciplines, and reach out to others across hierarchies – this is the real key to leading across the health and care system. As consultants we work in multidisciplinary teams and so have the chance to inspire and empower our colleagues to lead alongside us (whether they are nurses, admin staff or managers). That ripple effect can transform a whole team, or hospital, or network. Effecting change can take a long time, and as consultants we are often in post for decades so have the benefit of the long view too. 

We also need to be able to ask the right questions, ask for the right data and know what format we want the answer in. To succeed at making change happen, we need to be able to tell the story of what we want to change at a macro and micro level, and to communicate that to others in ways they understand, so they can respond appropriately and efficiently.  

My own view is that when a consultant doesn’t lead well, they themselves can end up frustrated, disengaged and feeling pushed around. The default is to focus back on the day job of being a good doctor. Which ultimately, I think, makes it harder for the patient voice to be heard. If consultants can’t express the problems patients are having and advocate for them, and if they can’t work with other leaders in the organisation, then they can’t make things better for their patients. Good leadership has a positive effect on the consultant, the teams around them and our patients. 

Tell us a bit about what you did on the programme? In what way was the programme at The King’s Fund useful to you? What did you take from it? 

The King’s Fund course is different. You don’t sit down and get lectured to - you participate and practice. And you learn huge amounts from the other people in the room: their mistakes, their experience, their perspectives and skills.  

It was utterly transformative. It felt like taking apart a clock, understanding what makes it tick, and putting it back together again – but better. What we learned was fascinating on so many levels. I can’t thank the facilitators enough for the wide and varied techniques they used to help us see what excellent leadership means in practice. They highlighted the value of opposing (and complementary views) and how a leader can create the climate for the team to have a much better view, together. They encouraged us to be curious, to look in the dark corners, to be open to ideas from the unlikeliest of places, and to avoid getting distracted from the end goal. 

While taking part in the programme I was asked to take on a project at work. Bringing my live challenge to the group helped me to decide whether to take it on and then, when I did, how best to take it on. Throughout, I learned so much about myself: how I work best (and don’t), and practically – and how to manage failure whether it’s personal or when leading a team. 

Truthfully, it was exhilarating but exhausting as an experience and I would recommend that if you do the programme you carve out plenty of time for processing the learning. 

What advice would you give to colleagues looking to grow their leadership, in a consultant’s role and beyond?  

My advice is to go for it. Our patients and the NHS depend on consultants with strong leadership skills. It’s worth going on a course, but I’d say look for a course that will expose you to a diversity of views, and that makes you feel safe. I’d also suggest going on a quality improvement course. For me, quality improvement and leadership skills go hand in hand and I wouldn’t be the leader I am now, had I not done both. I’d also suggest you start local and start small – talk to leaders in your setting, ask for support, and work to understand the culture you are operating in. Knowing how responsive your organisation is to change or innovative ideas will give you the context to understand what you may or may not be able to achieve.  

My final tip is to spend a lot of time being curious. And the first thing to be curious about is whether you have access to an organisational development manager or team. Many trusts have these and they could provide you with coaching, support, or even funding for your personal development.