Defining medical leadership
What is medical leadership?
Medical leadership has existed as long as medicine itself and remains the dominant model in many healthcare systems outside the UK.
Recent years have seen a growing interest in medical leadership in the UK, exemplified by the establishment of a Faculty of Medical Leadership and Management (FMLM) by all the UK medical royal colleges and faculties in 2011. Aiming to improve the care of patients through better medical leadership, FMLM has attracted over 2,000 members across the whole medical career spectrum with roughly half the membership being junior doctors or medical students. Two prime objectives of the organisation are to ‘professionalise’ medical leadership and to redress the inadequate evidence base regarding the nature and value of medical leadership.
Leadership outside medicine has been studied extensively but there has been little focus on medical leadership and hence knowledge of its nature and value is patchy.
A neat definition of leadership is ‘getting results with and through people’ – leadership without results has little value and committed action by ‘co-workers’ is essential. Successful teams – the bedrock of successful delivery – have increasingly become collections of leaders sharing the leadership baton rather than followers simply taking orders.
Big ‘L’ and small ‘l’ leadership
A commonly held belief is that leaders are only the people at the top of an organisation. Clearly, there are medical leaders for who leadership is a significant and defined part of their job – some term this big ‘L’ leadership. By contrast, the junior doctor overseeing a cardiac arrest is aiming for devastatingly important results and cannot succeed without others. Applying the simple definition above is perhaps small ‘l’ leadership, and supports the notion that all doctors are leaders some of the time.
Aspiring to excellence
Aspiring to excellence in clinical medicine unites the profession and is underpinned by defined standards and a training and education system honed over centuries. Given the strong and growing evidence base linking good leadership with better outcomes for patients, it is time to apply the same approach to professionalising medical leadership.
Already stretched curricula face further challenge if we are to support doctors at all career stages in a crucial element of their practice. Finally, more research is necessary to better understand how leadership improves care and how doctors can best be helped to develop the requisite skills.
Leadership and improved patient care
A growing body of evidence links leadership directly or indirectly with the quality of care for patients. In broad outline, generic studies have shown:
- the quality of leadership by executive teams is inversely associated with the number of patient complaints in NHS hospitals
- good teamwork in general practice is associated with better patient experience
- good teamwork in NHS hospitals is associated with lower mortality.
Specific to doctors, medical engagement (which itself is dependent on leadership), has been shown to be positively associated with higher quality, as defined by the Care Quality Commission’s NHS performance rating.
Developing leadership in physicians
Leadership development opportunities for doctors led by colleges are now plentiful through the NHS nationally and locally, and via postgraduate medical training bodies. Also available are opportunities not specifically designed for health eg MBAs (Masters in Business Administration) offered by business schools and universities.
The rise in development opportunities over the past decade has been accompanied by significant investment, but there is little guidance or knowledge on what works best for who at what career stage. A joint review published by FMLM highlighted the paucity of, and the difficulty in obtaining, high-quality evidence. The situational (and therefore changing) nature of leadership and the huge variation in leaders and their teams poses a major challenge to studying the effectiveness of leadership development.
Some argue that individuals can drive their own leadership development, and the following is a high level guide to the most common techniques on offer.
- Personal reflection on personal leadership experiences with and without challenge – the bedrock of appraisal and revalidation.
- Mentoring. Ideally the mentor is trained and the service is usually free – it can be a valuable opportunity to reflect, see things differently and discuss alternative approaches, often with someone who has ‘been there before’.
- Coaching shares many characteristics with mentoring but is a more formal process and is usually not free. Coaching commonly addresses attitudes, behaviours, and knowledge, as well as skills, and can also focus on physical and spiritual development. In its purest sense, a coach will not offer advice but will help the coachee – through a variety of techniques – to reach his or her own solution.
- Formal leadership programmes offer hugely variable content and have their place, but you need to be discerning and make sure the content is what you need. A major limitation of courses is their relevance to your specific circumstances and the people you work with. The greatest impact comes when a programme addresses your team in your context.
- The vast range of psychometric tools can be powerful, but their administration requires appropriate expertise and experience. These are summarised for doctors in the ‘Further reading’ section.
- 3600 feedback is now mandatory for doctors wishing to revalidate. Many with significant leadership roles will need to assess their leadership and management performance and many small ‘l’ leaders will benefit from an enhanced knowledge of how their leadership is perceived. FMLM has developed a bespoke 3600 feedback tool for doctors which covers four different ‘levels’ of experience, from team members to strategic leaders.
- Formal qualifications. There is a growing trend to achieve a formal management qualification, with MBAs being the most popular. None are cheap and few focus specifically on healthcare or medical leadership and management. Aspiring leaders should carefully evaluate the opportunities, as well as the significant time and financial outlay.
- Professional qualifications. In 2016 FMLM will launch a three-level certification process akin to traditional college fellowship/memberships. This will be based upon the leadership and management standards for medical professionals.
The UK medical profession will only accept the highest quality of medical care as benchmarked against agreed standards.
In order to help medical leaders benchmark their performance, FMLM has published the leadership and management standards for medical professionals under three broad headings:
- Self-awareness and self-development.
- Personal resilience, drive and energy.
- Team player / team leader
- Effective teamwork.
- Cross-team collaborations.
- Corporate responsibility
- Corporate team player.
- Corporate culture and innovation.
In 2016 UK doctors will be able to apply for certification in medical leadership by demonstrating their leadership competence and achievement. Three leadership levels will apply covering team, operational e.g. clinical director and strategic eg medical director.
Guidance for the appraisal and revalidation of doctors engaged in medical leadership and management is also available.
- Medical chief executives in the NHS: facilitators and barriers to their career progress, 2010 (opens PDF, 390KB )
- The future of leadership and management in the NHS (King’s Fund website)
- Shipton H, Armstrong C, West M, Dawson J. The impact of leadership and quality climate on hospital performance.Int J Qual Health Care 2008;20(6):439–445.
- West M, Borrill C, Dawson J, Scully J, Carter M et al. The link between the management of people and patient mortality in acute hospitals.Int J HR Mgt 2002;13:8 1299–1310.
- Healthcare Leadership Model, Nine leadership dimensions (NHS Leadership Academy website)
- Clinical leadership (King’s Fund website)
Psychometric tools for doctors
- The role of psychometric tests in the assessment and development of medical leaders (FMLM website)
- Psychometric testing for doctors and medical leaders: do they add value? (FMLM website)
- Assessment and diagnostic tools (FMLM website)