A framework for nurturing leadership skills in doctor training
Doctors’ postgraduate training is the perfect time to nurture an understanding of the leadership framework, explain Amy Brockbank and her North Western deanery colleagues.
The introduction of the leadership framework has the potential to bring enormous benefits in terms of creating consistency in the understanding of leadership across professions, promoting a common language and abolishing any perceived inequalities surrounding leadership responsibility.
However, to be effective there needs to be an understanding of the framework and an engagement with staff across all professional groups.
One method to promote leadership development and positive multi-professional working may be to develop multidisciplinary leadership training during the postgraduate medical education of doctors. A joint leadership training initiative for doctors and trainee managers, established in the North Western Deanery, is doing just that.
Although joint leadership development is often the aim, in reality it is difficult to facilitate over the long term. Part of the problem could be perceptions of difficulties in the relationship between doctors and other professional groups and, in particular, managers. Another issue could be the structure of training itself, especially considering the rotational nature of postgraduate training.
Whatever the reason, it appears that to date the majority of comprehensive leadership development appears to remain in professional silos.
In the medical profession, the introduction of specified curricula, defined periods of training and working time regulations have resulted in increased pressure to ensure time is used effectively. Not surprisingly, postgraduate training has traditionally focused on the achievement of clinical competencies, yet there is an acknowledgment that from undergraduate level all doctors need to develop multi-professional team working and leadership skills alongside other professional attributes.
Leadership competencies as outlined by the Medical Leadership Competency Framework have been approved for incorporation into undergraduate and postgraduate curricula but work on developing programmes with specified outcomes is still in the early stages. The leadership development of managers in the NHS varies dramatically and can range from “on the job” to substantial programmes.
Breaking down barriers
The North Western Deanery has created multiple routes to advance the engagement of doctors in leadership during postgraduate medical education. Opportunities range from programmes designed to engage all doctors at specific points during training, to the heightened development of a small cohort with an identified special interest.
The latter, the Medical Leadership Programme (MLP), provides one route for leadership development which is structured and focused on the achievement of leadership competencies as outlined in the MLCF/LF over a period of two years.
Unlike other clinical leadership programmes, the MLP keeps the trainee doctor in clinical training while allowing engagement in leadership activities that link directly to patient care. The other unique part of the MLP is that it links with the Graduate Management Training Scheme to enable doctors and managers to train, work and learn alongside each other. Since the pilot in 2008, three cohorts of specialist trainees from the North Western Deanery have joined the MLP and worked alongside graduate management trainees.
After three years, the MLTs frequently refer to the joint working with the GMTs as the highlight of the MLP and “absolutely invaluable”. Despite initial scepticism about the perceived age and experience gap between graduate managers and doctors in higher specialist training, there was an awareness of a need to break down barriers relating to knowledge, relationships and training which were perceived to have separated doctors and managers in the past.
Understanding backgrounds and how doctors and managers “come to understand the NHS” was considered to enable appreciation of different perspectives. Importantly, when considering the aims of the Leadership Framework, having the same grounding in leadership provided a neutral platform on which perspectives could be explored and understood better.
A key turning point was described as the realisation that doctors and managers are working towards the same patient-centred goal – improve the NHS, improve patient care – but the professional track taken alters the approach to reaching that goal. Leading from this, the medical leadership trainees describe a learning environment where ideas are freely shared and challenged; where the ability to tap into the knowledge of people working in different areas of the NHS is seen as a benefit; and where joint leadership development fostered mutual respect as well as an acknowledgment of professional strengths and respective limitations. In this sense, barriers were reframed as boundaries and used to their advantage.
The trainees’ view
Feedback from current and alumni medical leadership trainees highlighted the following aspects of joint leadership training with the NHS graduate management trainees:
- Cross fertilisation of ideas
- Breaking down barriers
- Correcting misconceptions
- Influencing behaviour
- Improved understanding of difficulties faced by both parties
- Enhanced understanding of common goals eg patient safety, improving patient care
- Appreciation of each others’ roles in service delivery
- Complementing each others’ skills, thus ensuring the development of sustainable teams with the appropriate skill mix
Some medical leadership trainees described how the joint working made them reflect on their own role as a doctor, specifically how they interact with colleagues. Making multi-professional contacts and building relationships was considered not only to be the catalyst for changing current practice but also for assisting working in future roles.
The experience of the joint working between the medical and graduate trainees on the MLP is overwhelmingly positive and can be seen as an example of professions bonding through joint leadership training.
Setting up joint training schemes has huge potential in terms of better patient care and improving the culture within organisations. Links could be explored between managers and doctors in training via formal or informal buddy schemes, action learning sets or locally organised joint leadership development sessions.
With the leadership framework, there is an urgent need to consider the way we train doctors, managers and indeed other clinical and allied health professionals in order to develop a culture of mutual appreciation and collaborative working. This may mean overcoming years of mistrust and misconceptions but if a common grounding is needed to provide a platform to build relationships, then the Leadership Framework may be the very catalyst needed to ensure leadership is developed and relationships are fostered. In order to meet the challenges of a dramatically changing NHS, it is imperative doctors and managers work together effectively under one framework towards one goal.
Duncan Bland explores the results of nine leadership focus groups held across the UK with around 70 doctors from general practice and secondary care. The findings reveal doctors’ definitions of clinical leadership, the skills they believed were important to clinical leaders and the potential barriers and enablers of leadership they perceived in the health system.
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