Following on from the last post, yesterday I was briefly interviewed by a junior doctor who is “on a leadership course”.

He was running a survey to find out “why theatres don’t run efficiently and who is to blame and whether this maters (sic) to anyone”. I tried to help by answering the questions but they were so vague as to be impossible to give a valuable response to. I asked what all this had to do with leadership and he responded, “To make people work better.”

I knew I was missing something.

At a recent open discussion between the Trust and invited employees, we engaged in a discussion group where we were asked how we would express our support of the values the Trust wanted us to espouse.

Unfortunately I think this epitomises the failure of Clinical Leadership.

There is leadership, there is engagement, there is opinion seeking, there is discussion, there are shared values and there is a great big Twitter fail whale.

The engagement is almost totally one sided. The discussion revolves around decisions already made. The values are decided by one group and “shared” with the other group as de facto.

This is NOT clinical leadership. It disappoints me that others should think it so.

There can be no doubt that the NHS without effective leadership will be (is) in trouble. There are many reports, projects, initiatives and clinicians addressing this problem whether it be by meausuring, documenting, planning or even studying the issue. What is interesting me of late is who should be undertaking leadership roles.

In the ideal world it is clear that a leader needs the appropriate

•  
  • desire
  • skill
  • capacity
  • authority

to be an effective leader.

The characteristics that separate one clinician from others and designates them as a clinical leader are not however clear. The reasons why colleagues make the move into leadership will affect their ability to deliver in this role and simply being the only volunteer, selected by rota or even the best at interview does not necessarily embue the candidate with the characteristics that are required for success. Previous blog posts have atested to the value of developing effective, employed junior managers, thru’ schemes such as the MBA, into senior managers utilising their experiences gained in the realities of the task and blending and refining this with essential knowledge delivered by experts. 

Embryonic clinical leaders have no experience of the realities of management, self select for many reasons not all altruistic and commence work as a necessarily part-time role with no training whatsoever. The environment in which they work is firstly foreign, secondly hostile and thirdly there are few rewards with little support. Would you like that job?

For leadership to be effective the leader has to have the desire to lead the team. Whilst this may seem obvious it is very different from simply balancing budgets, developing the service or achieving targets as required by more senior levels and these priorities themselves may disengage rather than engages the team. The skills to achieve this balance with conflicting stresses are not acquired during clinical training, by osmosis or even simple good sense but take time, effort, mistakes and effective relationships to develop. Little of that is offered to the new clinical manager.

The actual capacity to lead must also be questioned. In a clinical directorate with a budget of millions of pounds do we really feel that the most senior figure, the lead and the encourager can do this job on an adhoc basis even without the time to address the challenge of developing their own role? What is certain is that no-one comes to the task fully fledged or full time. This wouldn’t happen in industry.

Lastly, the authority to lead is not implicit in such posts. It may be a position of managerial superiority but this only effective applies to those who consider that the management structure has this legitimacy. Unfortunately, due to the disconnect between the vast majority of clinicians and mangement, this relationship is seen (and perhaps expressed) as illegitamcy.

Whether all this is true or not it perhaps addresses the fundamental problem of current “Leadership” development programmes. The concept of the programme and the development of indivuals in roles of leaders is somewhat moot until the right leaders are in the job and not just “selected” when everyone else has taken one step backwards.

There is an artistry to effective leadership.

Expression changes everything.

This post by Garr Reynolds speaks more eloquently than I do.

I am blessed that currently I work in an institution that gives me many opportunities to reflect on different management styles. A further blessing is some insightful and gorgeous friends who stimulate and support my thinking and development.

Take a look at this piece of art. I love it.

Sinister Rainbow, Emma d'Souza (medium- acrylic, silk thread & felt)

Is it just paint splashed around? Is the artist authentic ? Does it encourage other people to come and look at other pieces of work? Will it influence others? Will you look at your own work and want to do better or differently next time? Could the artist explain why? Would you be proud to display or own this piece of art? Is it art?

I believe the same questions can be raised of management style.

I’m sure, with the right materials and time I could attempt to produce something like that. But is that art? Is it just the finished article we are looking for? Is a poor copy worth the same? Surely what is more important is the journey to that end point.

We all have to accept that targets are met, roles fulfilled, projects planned and appraisals achieved but surely (please?) what is actually more important is not the end point but the nature of the  journey in getting there. There has to be more art to management than simply administration.

As the political conference season draws to a close, a colleague of mine made the point that clinicians within the hospital Consultant Medical Staff Committee are analagous to the political opposition.

Considering and extending this I believe it does offer an interesting view as to the different roles clinicians may play in the management of the hospital.

Some are directly involved in committees of power although restricted in their ultimate influence by not being a member of the ruling party. Some exert influence through lobbying using skills and contacts developed over time. Sadly others engage purely in “yaa boo” politics attempting at every step to block and criticise the party in power.

Ultimately the role of the opposition is to hold the government to account because without them the government would not be responsible or effective for society as a whole. Clearly however the two sides hold very different opinions and philosophies over how and why things should be done but both, whatever our personal feelings, are actually striving for the greater good. Issues about election would be interesting to explore!

(Quite pleased in being positive again!)

I’ve had a bit of a rough week with our management team. I wrote a post and decided against publishing it as all it reflected was my negativity.

So I thought, why not seek out some positivity? Let us all (as there are regular visitors to the site) hear your encouraging stories of management, clinical leadership and how it works for you. Share how you can see how things are improving or where change has happened for the better.

Go on, let’s hear the up side?

A phrase guaranteed to strike a chill in the heart of anyone who has ever heard these words.

The recurring theme on this blog and the probable theme of my dissertation is the engagement of clinicians and management. I regularly bemoan the state of this interface and long for improvement. Some would suggest my view is biased and I have tried to reflect on this and question why it should be that some believe there is effective interaction and yet others disagree.

On the one hand Staff Surveys, Clinical Leadership Engagement programmes, such complex human resource terms as High Performance Work Systems (HPWS), Chief Executive Briefings and even open staff meetings such as “The Big Conversation” show a significant desire and investment from management in finding out what staff actually feel about the organisation within which they work. On the other hand is the negativity and lack of interest show by significant numbers and elements of staff towards such initiatives. When I personally consider the relational coordination as described by Hoffer Gittel it leaves me cold as our unit, department and organisation fail (from my perspective) across all seven criteria.  Clearly the signals that are being put out are not those that are being received.

The failure of each side to effectively engage with the other is not due simply to lack of available avenues of discussion. There are many contributing problems such as deeply held beliefs and suspicions; hurts and barriers from previous experiences; misunderstandings and mistrusts; all have so tainted the relationship that despite there being opportunities for rapprochement, neither side can really make any headway.

This is made worse by fundamental attributional error: “everything” is the fault of “management”. This might be lack of car parking spaces; the peeling paint in the theatre changing room; decisions regarding resource allocation in oncology; appointment of  junior service managers or even the corporate logo; everything bad appears to be blamed upon “management”. Consequently, whether such actions were valid or not, there is direct allocation of blame, with its implicit presumption that such actions and all future actions are examples just the “sort of thing that management does.”

And so we are doomed to follow this path towards permanent mutual resentment until each side effectively engages with the other. Is that a consumation devoutly to be wished?

Is it a fantasy? Is it a dream? Is it a story of a search for missing characteristics? Is it possible or is it even Kansas?

In preparation for my recent essay I came across the Really Learning Website and a “subjective think piece” written by Valerie Iles that explores the introduction of management into the NHS over the last twenty years, its relative successes and alternative approaches.

The piece is insightful, thought provoking and challenging. You should read it. It finishes with a paragraph that summarises much of what I have blogged about over the last few months.

“As we challenged our assumptions we might also recognise as fundamentally flawed the notion that any management consultant or policy advice team is better at devising structures and processes for the complex, dynamic interdependent set of systems, that together comprise our national health care, than are the people working within them. It is not Roy Griffiths’ fault that his prescription took the system as a whole in the wrong direction for 20 years, but we must make sure we never again allow one person’s view  to prevail. We must find ways of allowing locally relevant solutions to develop and flourish, devised, owned and implemented by local teams of clinicians and managers, held to account only for their outcomes and not for implementing a centrally prescribed set of processes. “

It wasn’t The Wizard that changed things.

In the European Grand Prix at Valencia this Sunday the Maclaren Mercedes of Lewis Hamilton came into the 2nd pit stop with a 4sec advantage over the second place car of Reuben Barrichello.

Working as a slickly oiled machine the car went up on the jacks, the wheels came off, the fuel pump went in and…then they realised there were no wheels to go back ON the car. After what must have seemed like an eternity the spare set of boots came out of the garage and were fitted. Presumably behind that protective gear there were a few red faces. Following his pit stop Barrichello won the race by 2.3 secs.

Looking at the result we can see Barrichello’s pit times were 8 sec shorter than Hamilton and when Hamilton entered the pits he was 4 secs ahead of Barrichello. Interesting maths.

Interviewed immediately after the race the team principal Martin Whitmarsh when asked specifically about the incident said, “It didn’t affect the outcome of the race…we lost the race because we weren’t quick enough (on the track).”

Interviewed immediately after the race, driver Lewis Hamilton refused to allocate blame to the pit crew and said, “We win and lose together… these things happen.”

When the stuff hits the fan most adults fully recognise their error. It is not always necessary to specifically or openly point it out; those with insight hopefully learn. Sometimes leaders attempt to protect the reputation and “feelings” of a team by publicly sidestepping or even denying problems. Other leaders openly accept the problem, avoid blamestorming, and unite the team in moving forward despite the problem.

Was there really a problem? Did it really affect the result? How is the reputation of the team affected by each approach? Which leader would you prefer to lead your team?