A short, reasonably interesting talk on leadership

Richard Canter

Are All Doctors Leaders?Education for Clinical Leadership

KSS Deanery, London July 2010

House physician

House physician

Today

• Brief look at some models of leadership that might appeal to doctors

• Briefly examine the three competing ideologies in the healthcare sector

• Simple framework for managing the complex situation

• Some developments on leadership education in our patch

Leadership-the “heroic” model

• Usually seen as an individual activity• Emphasis on “transformational” leadership• Popular books on leadership often

anecdotal/case-series• Education focuses on

“leaders” rather than “leadership”– “Top Leaders Programme”

Leadership is co-produced

“The shrewd leaders of the future are those that recognise the significance of creating alliances with others whose fates are correlated with their own”

Heenan and Bennis 1999

Problem at NY Kennedy Airport

a) hire an attendant to monitor and reprimand “less hygienic” users

b) periodically plot spillage area on an X-bar chart, look for special causes

c) double the size of the fixtures

what would you do?JFK International terminal

men’s restrooms

Solution

etch the image of a fly on the porcelain

JFK International terminal

men’s restrooms

Leaders and Followers

• Co-leadership– Clinician-Management partnership– “careful listening”, “careful transmitting”, “open

communication”

• Shared leadership– Group level activity with individuals who step forward to

lead, or step back to follow at the appropriate moment– ? Groups make better decisions than individuals

Leaders and Followers • Distributed leadership

“can be moved between people at different levels of the organisational and society hierarchy”– Leading others to lead themselves– Develop capacity in others and the capacity to turn

their constituents into leaders – Organizing activity e.g networking– Challenge deep level hierarchies

• Seating arrangements, language, offensive humour, rewards

Leaders and Followers

“Cultural and contextual activity involving language, beliefs, values, rituals and artifacts”

“leadership is messy, involving managing emotions and sometimes getting it wrong”

NHS

• Three ideologies– Free Market Economy– Bureaucratic-legal systems– Professionalism

Ideology: a shared belief that holds a group together

The Politician

• Interested in a “free market” economy or "consumerism”

• Control is exercised by consumers– Competition is encouraged– Standardisation is discouraged – All players try to maintain quality

• ‘Value’ is based on cost

The Manager

• Hierarchical control specifying at each level and in detail– Who shall perform what, and when, and at what

speed– Planning and control by a hierarchy of managers– Governed by complex rules (legal)– Standardised production

• ‘Value’ based on predictability and efficiency

The Professional

• Control in professional bureaucracies is achieved mainly through horizontal/collegial processes

• Both formally and informally• Distrustful of hierarchies and ‘management’• On a good day, professional bureaucracies are

‘disconnected hierarchies’• On a bad day, they are ‘organised anarchies’

Mintzberg

• ‘Value’ high quality + innovation and recognise ‘reasonable’ cost

The problem

• Three groups• Three competing ideologies• Three ways of ‘doing things’

• Leadership involves managing– up– sideways– down

Four questions to ask yourself• Do I understand my environment?• Do I reform or retrench?• What action best serves the common good?• Can I find new ways of doing things?

“Moments of Greatness. Entering the Fundamental State of Leadership.” Quinn R.

The High performance Organisation. Harvard Business Review

July-Aug 2005

Four questions to ask yourself• Do I understand my environment ?• Do I reform or retrench?• What action best serves the common good?• Can I find new ways of doing things?

The Environment

• Political, SHA, PCTs, Hospitals, ISTCs, Primary Care, Deanery, Medical Profession, Allied Healthcare Professionals

• EWTD, new organisational structures, competition, etc etc

• Power and interest of the players– Energy

• £

Understand the environment• Politicians

– Read government documents/policy statements/newspapers

– What are the "big" issues?

• Organisations– Read annual reports/mission statements/business

plans/minutes of meetings– Identify collaborators/ shared interests

• Professionals– Listen carefully to what they are saying; faculty and trainees

Identify key players• Politicians

– little/ no access to this group

• Organisations– who holds the resources?– what are they thinking?– what are the aspirations of the organisation?– how can I help?

• Professionals– how can I help them to do their job ?

• career development; who is interested?

Alignment and obtaining resources

• The proposal is in alignment with the Medical Leadership Competency Framework to develop a postgraduate curriculum:

• to improve and manage services by building awareness of personal qualities,

• working with others to build effective networking teams,

• setting direction. (NHS Institute for Innovation and Improvement & Academy of Medical Royal Colleges May 2008). 

Recent application for funding

• The proposal is consistent with several of the key objectives of the NHS Leadership Work Packages (Next Stage Review). These include:

• Inclusion and Diversity; “to get more clinicians into leadership positions”,

• Clinical Leadership Fellowships; “to support SHAs and Health Innovation and Education Clusters to establish fellowships”,

• Postgraduate Curricula; “to explore ways to ensure both the curricula and appraisal process reflect the importance of leadership skills”,

• Masters degree; “to encourage development of masters level programmes relevant to the health sector and provide match funding to NHS commissioned programmes”.

Four questions to ask yourself• Understand your environment• Do I reform or retrench?• What action best serves the common good?• Can I find new ways of doing things?

Reform or retrench?

Reform or retrench?

• Both positions are sometimes appropriate– value conflicts e.g.

• efficiency versus quality• cost versus quality

• Question to ask yourself?• Question you ask others?

Reform or retrench?

• What action best serves the common good?

Four questions to ask yourself• Understand your environment• Do I reform or retrench?• What action best serves the common good?• Can I find new ways of doing things?

Encourage innovation

Involve some risk

Make the most of what is available

Education and Leadership

• Manpower (2008)– Consultants 34,910– Residents 49,178

• All medical trainees need leadership and management education

• Range of activities that escalate– Short skills to postgraduate education

Personal approach• Horizontal v vertical career development ?• Identify and ask them to step up

– Faculty, trainees, medical students• Support postgraduate qualifications in management

• Trainee leads on:– Patient safety (CMO Clinical Fellow)

• Conference on professionalism and patient safety• Collaborate with University of Michigan (MQC)

– Training the Trainers Faculty– Trainee Lead as Head of Skills and Courses Programme

Personal approach

• National Clinical Leadership Fellows– 8 Clinicians + 8 Managers

• Work together on QUIPP projects• Co-research Clinician-Management “power sharing”• University of Bath and Oxford• Full time post doc fellow to collect data

– Look for external funding to continue this

Postscript

Leadership and Professionalism

Questions later