Clinical leadership training: what are the benefits?

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).

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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.

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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.

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The junior doctor contract: we now need strong leadership at all levels

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This article covers the author’s personal views of where the medical profession stands following the outcome of the junior doctor contract referendum. It builds on a previous post to this blog, and was adapted for publication in The BMJ. The text below is the unedited version.


 

Kaanthan Jawahar says that junior doctors, having voted to reject the proposed new contract, now need to work with another and with senior colleagues to tackle the problems that lie ahead.

The EU referendum result has set a mandate to split the UK from the EU. An uneasy feeling followed, where those voting to remain bemoaned the far right and older electorates for dictating their future.

Yet it was the disenfranchised working-classes hedging their bets on uncertainty by voting to leave that influenced the outcome. In their eyes, anything was better than preserving the status quo that austerity had given them.

I see parallels in this group when I consider my junior doctor colleagues. Years of discontent, increasing workloads, decreasing training opportunities, bureaucratic e-portfolios, and worsening work-life balances are why morale is rock bottom. The contract dispute is simply the latest in a long series of changes that have worsened junior doctors’ working lives. It’s no wonder the contract was rejected, though in this context the Government is pressing ahead with introducing the new contract despite the outcome of the vote.[1,2]

I voted to accept the new contract. I believed it offered a chance for the medical profession to take back control. Through exception reporting, barriers between frontline junior doctors, guardians of safe working, directors of medical education, and educational supervisors would be broken down. This could be a powerful workforce planning tool to quantify rota gaps, forcing employers to act via contractual board and national-level accountability frameworks. Our supervisors would be performance managed by new and pre-existing junior doctor fora bolstered with contractual remits and powers.

I believe that the proposed payment structure, though complicated, is fairer than what we have now and that the contract goes as far as it can on whistle blowing, with the ultimate endgame being legislative change. I’ve even reconciled that the removal of automatic pay progression will adversely affect some less than full time trainees (LTFTs). Many disagree with me on this, but I worry that ‘paying off’ LTFTs detracts from the underlying problem – that society and medicine discriminates against those needing to work less than full time. We should re-focus our efforts into supporting these LTFTs into full-time work where possible.

I may be overly optimistic. Many colleagues cannot fathom a world where exception reporting works, where relationships with our senior colleagues improve, where employers act to fill rota gaps, or where medical staffing pay us for all work done. They view me as deluded or as an apologist.

This divisive feeling could be the downfall of junior doctors. We are not each other’s enemy, but we risk becoming exactly that. No one comes to work to do harm. There are good senior colleagues out there and employers rarely, if ever, set out to do the wrong thing.

A leap of faith is required now with strong leadership, both from the BMA nationally, but also the very junior doctors that were on the picket lines locally. I see a world where the leaders are those on the junior doctor fora, who hold employers to account, who show their colleagues that it is ‘ok’ to exception report, who flatten the hierarchies between junior and senior colleagues and fight for equality in the workplace. We must approach the unknown with a plan. Grass roots activists, shop floor junior doctors and national BMA leadership must roll their sleeves up. We need it all if we are to get through this.

  1. Rimmer A. Junior contract will be imposed, Hunt says. BMJ Careers 6 Jul 2016http://careers.bmj.com/careers/advice/Junior_contract_will_be_imposed%2C_Hunt_says

Historic articles hosted by FMLM

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Below are summaries of a few articles I wrote some time ago, which are currently hosted on FMLM’s website. For the full text, please follow the corresponding links within the summaries.

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Our Iceberg is Melting – Changing and Succeeding Under Any Conditions

This is a book review where the author, John Kotter, illustrates his 8 step process of successful change through an allegory featuring penguins. It’s an enjoyable and accessible read – a very good place to start for any frontline healthcare professional with an interest in change management. I also wrote a follow-up article reflecting the contents covered by the book onto my own clinical practice at the time.

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Medical students and trainees ‘fix bed-blocked hospital’ at the FMLM national conference

I designed and facilitated a workshop at the 2015 FMLM National Conference to a mixed-medical audience of 60 delegates. This article refers to the second part of that workshop, where groups had 30 minutes to examine a case study of a hospital experiencing winter pressures. They were tasked with identifying short and longer term solutions, and then pitched to the hospital’s ‘board’.

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Team Sports and Team NHS

In the wake of ex-England cricketer Kevin Pieterson’s confrontational autobiography, I was struck by how failed team-working transcends different contexts. I reflected on how this can be applied to NHS settings in this article.

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The universal electronic patient record – possible but improbable

After attending an event where technology was lauded as integral to the patient’s user experience (the healthcare UX), I reviewed previous attempts by the NHS to instigate universal electronic patient records, as well as examine what is being done now to attain this goal and how outcomes may be different. The article argues that aligned stakeholder engagement and appropriate investment are mandatory prerequisites to successful implementation of such a large IT project.