'Sheep dip', one-size-fits-all management courses do not inspire doctors to become leaders. Instilling true leadership skills is much more complex, says Jenny Simpson
When I was at medical school, on Tuesday afternoons we had statistics. It was very hard for us to foresee a time when this would be useful. Moreover, it was the only subject in which you could achieve a negative exam result. Our usual response was a competition - who could most effectively disrupt the lecture, and who could achieve the greatest negative score.
Clinicians react in much the same way when faced with policy imposed from on high. They may pay lip service, but that will be all. A similar pattern emerges on those sheep-dip, one-size-fits-all management courses. Clinicians sign up, muttering about 'the dark side' and 'waste of time - just here for the brownie points'.
Fit to Lead, the British Association of Medical Managers' programme of management and leadership development, aims to rekindle clinicians' passions and core values. It is intended to release the leadership skills of doctors, other clinicians and managers so they can apply their skills, values and passions to system reform and policy.
We devised Fit to Lead in the full knowledge that sheep-dips do not produce clinical leaders. They do not even produce informed, compliant followers. They only produce well-dipped sheep.
This is because nurturing leadership skills is complex. You can teach management and leadership to doctors, but that will not make them effective managers and leaders.
I have a masters and a doctorate in business administration. I struggled painfully with my MBA and, with the greatest of pride, earned one of the few distinctions. It gave me a great intellectual framework that helps me understand the complexity of the NHS. I use it every day. But it did not make me a good manager or leader. I found out what skills are needed to bring about change from excellent managers and inspirational leaders.
The premise of Fit to Lead is that clinicians need much more than academic knowledge to lead change. Simply giving doctors a new vocabulary of management and leadership is a waste of time. On the other hand, providing the knowledge that makes sense of the complexities of the organisation where they will work for 40 years or more, along with the skills and behaviours they need to be successful in leading change, is hugely important. It is also incredibly valued by doctors.
There are now some 800 doctors and smaller numbers of other clinical professionals and managers on Fit to Lead. That is a lot of people addressing issues like their core values, the nature and culture of the NHS, where the NHS is going, payment by results, the new IT systems, patient choice, clinical effectiveness, best-value healthcare, and commissioning processes.
Participants also look at how all this fits together, how organisations work, and how to be effective leaders of change. They work on leadership styles, as well as on skills such as creativity and influence. They learn about strategy, systems and communication, money, people and policy. They do this not in a lecture theatre with boffins and theory, but with a small group of peers in intensive residential programmes with inspirational leaders and managers - some of whom happen to be distinguished academics.
The programme is underpinned by a meticulously researched set of standards. We took data from our membership of nearly 2,000 medical managers and leaders. We asked them: 'What do you need to be able to do - and know - to perform well in your job?' We grouped the information and consulted with UK medical managers, NHS chief executives, postgraduate deans, presidents of medical royal colleges and the Medical Leaders Professional Council (formed by BAMM and other national medical bodies).
We took help and guidance from the Chartered Management Institute, the Institute of Health Management, the NHS Confederation and a panel of management academics. Finally, we benchmarked our approach internationally. The process took us over three years, and standards are reviewed each year.
Fit to Lead works like this: on signing up for a year, each individual - regardless of background, specialty, seniority or education - assesses themselves against management and leadership standards. This is then challenged by a tutor.
A programme is tailored to the individual. It may involve a BAMM programme or one run by others. As long as the content meets the standards, that is fine by us. We are interested in growth - that the individual fills the gaps in skills, knowledge and behaviours identified in the assessment.
Each participant attends a series of one-to-one tutoring sessions, with a specifically selected tutor. The tutors come from a range of backgrounds. Some are experienced medical managers, some have coaching qualifications, some are chief executives and some are trained personal effectiveness coaches. This year we are running 220 tutoring/coaching clinics, with eight to 10 doctors on each. We are also running 25 'skills factories', with 28 doctors on each.
At the end of the Fit to Lead year, each person is reassessed against the standards, and provides evidence of meeting them at a given level. Those reaching the appropriate level are awarded a certification and honoured at our annual conference. This final assessment and certification is used in the doctor's appraisal portfolio. It also provides a basis for application for a clinical excellence award in medical leadership.
Is all this - changing the NHS one clinician, one manager at a time - labour intensive? Absolutely. Is it commercial? Absolutely not - at£3,500 per person per year, we don't make much in the way of profit. Is it effective? Ask the participants. We do know that great clinicians and managers come back for more and that their level of skills and knowledge are demonstrably higher than at the outset.
The sheep dip is not for us, even if it would be easier to run. We would rather accept the steeper challenges of creating a values-driven movement, making it work and making it brilliant. We are doing it for the people who day in, day out provide front-line services for their patients, organisations and the NHS.
The MLPC has produced a syllabus, What Doctors Need to Know about Management and Leadership - a
syllabus for medical management and leadership education and a further document Professionals, the Public, Management Process and Policy - a new dialogue.
From its earliest days, BAMM has championed management and leadership as something every doctor does - and should have the skills to do well. Now, through the work of the MLPC, we have a framework to help make it happen. We are delighted that the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement support it.
All we would say, based on BAMM's 16 years' experience and three years of work on the part of MLPC is, do not fall for any more reinvented wheels and sheep dips.
Professor Jenny Simpson OBE is chief executive of the British Association of Medical Managers, www.bamm.co.uk