Being a leader is not simply about the magic 8-ball.

20 11 2009

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.




One response

4 12 2009
Linda McLean

Enjoying your blogs immensely – so keep it up. Your “fully fledged” comment is key in the above blog.
Unless and until someone has done it from the bottom up, respect will be missing.
Your “ladder of interference” got me thinking, too.
Been there,done that.
But I looked at it differently this time. From your point of view, everything had been done. The only thing you didn’t use was a tannoy.
Yet the junior doctor obviously felt that you had locked yourself in a cupboard, and made this decision secretly. You had informed no-one to cause the maximum hassle.
All we know is that something or someone failed to communicate adequately.
Moreover, we now know with absolute certainty, that it will happen again. The system that failed has not been identified. Had all four patients been “important” people – like Lords or Ladies -questions would have been asked, inquiries set up, and a system put in place that worked.
But for faceless, meaningless patients, we make no effort to discover what went wrong.
So your story encapsulates all that is wrong with a system that is intended to work for patients’ benefit, but when it works against them nobody takes the time to ask “WHY?”
We shrug our shoulders and carry on until the next episode, as nobody know whose job it is to ask the question, never mind deliver the answer.
You have identified beautifully what ails the NHS.

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