This is a comment piece that appeared in the February 2016 edition of The Registrar – the magazine for the Psychiatric Trainees’ Committee at the Royal College of Psychiatrists. The author reflects on the first four months of a clinical leadership year with the NHS Trust Development Authority (now NHS Improvement).
Over the last 5 years, leadership and management fellowships have grown in popularity amongst doctors in training. These include local initiatives, such as Quality Improvement Fellows within Health Education East Midlands, local health economy opportunities (e.g. Darzi Fellows) and national schemes, including the National Medical Director’s Clinical Fellow Scheme. They look to develop clinician skills in leadership and management, an item included on postgraduate medical curricula across specialties, but one that is ambiguous and proves hard to evidence. Anecdotally there are issues in securing time out of programme to embark on such schemes due to this very issue.
Whilst research and medical education fellowships have discrete outcomes within a given time frame, the benefit of a leadership and management fellowship is hard to articulate. The current focus of under- graduate and postgraduate medical training focusses on clinical skills. These rightly include the so-called ‘soft skills’ – our ability to interact with others harmoniously. This, however, is often limited to patients and our immediate teams. Perhaps by proxy we learn presenting skills, and through representative work (if that’s your cup of tea) we can learn about policy and public speaking. But then we go to our first consultant interviews and our leadership and management competencies are typically evidenced by an expensive coaching course we attended a couple of months ago.
The Shape of Training Review places teamwork, management and leadership as a generic capability as part of the broad-based specialty training pathway , so it’s a priority going forward, integrated into clinical training. The Darzi Fellowship scheme was evaluated in 2010 and found the impact on the fellows was far-reaching with respect to their personal goals and development and contributed to positive organisational change within their hosts. The longer term benefits are yet to be measured, however work by Goodall (2012) suggests doctors as CEOs in healthcare organisations have better performing organisations on patient outcomes. They attribute this to the workforce’s perception of their leader as clinically credible – the ‘expert leader’. What I’m hoping to convey here is that there is an existing evidence base for such schemes. Within the current NHS context and projections of where healthcare is moving, I would go further and say they are becoming essential.
My subjective personal growth as a leadership and management fellow in my first four months has been substantial. I have gained or improved skills in verbal and written communication, NHS structural knowledge, assurance procedures, presenting, public speaking and political awareness. I personally feel more able to affect organisational change through engaging relevant stakeholders to improve the service for patients – even within the challenging context the NHS faces. We, as clinicians, will be expected to do more and more to drive our services forward for our patients. I feel ready to do this.
People often ask why I am ‘wasting’ a year on a leadership scheme – sadly this sentiment often reflects their own cognitive dissonance in a skill they are bereft of. There are several parallels here with parity of esteem; the notion where psychiatry is belittled by other medical specialties as ‘not real medicine’, and political mandate sidelines the needs of our challenging patient population. I could not recommend the leadership fellowship more highly – it will change the way you think and act, it will develop skills you would not have utilised otherwise, and, most importantly, it will benefit your patients and the NHS.