Despite high levels of job satisfaction, the NHS is failing to convince doctors to take up leadership roles – such as medical directors. Here Greg Pitcher reports on an HSJ and Hunter Healthcare survey that explores why
Sponsored comment from Hunter Healthcare
The move to engage doctors in leadership roles is well known and long running. But what are the barriers and opportunities in attracting and retaining talent in the increasingly complex role of medical director?
According to an HSJ and Hunter Healthcare survey, the increasing burden of regulation and high workloads were cited as ongoing concerns.
Thirteen out of the 24 medical directors surveyed said their workload was too high and more than half said red tape was having a negative influence on their job satisfaction.
Royal Free London Foundation Trust medical director Ian Mitchell said the role of medical director was becoming harder to perform well.
‘There is an anxiety now about whether the job is doable. If you get it wrong you can go to jail’
“There is an anxiety now about whether the job is doable,” he said. “If you get it wrong you can go to jail. People ask why they want to do that to themselves. One chief executive told me that he recognised that the medical director role was impossible.
“You have to break it down into things you have to do; things you will do; things you would like to do; and things you won’t be able to do unless someone helps you. It’s important to prioritise.”
Medical directors should not be expected to carry out these demanding roles without proper support, said Dr Mitchell.
“Most people have an office of the medical director, where they lead a team,” he said. “That needs funding and, given the financial crisis in the NHS, that can be difficult.
‘It will become increasingly difficult to attract people into the job. There is a feeling that their neck is on the line’
“I think it will become increasingly difficult to attract people into the job. There is a feeling that their neck is on the line – the role needs to be funded and people need to be encouraged to have a department around them.”
Despite the anxieties, 80 per cent of the medical directors questioned rated their job satisfaction at seven out of 10 or higher.
Just two out of the 22 people giving their work fulfilment a score said it was below five out of 10.
Finding the work interesting and making a difference to patients were rated as the joint most important factors that boosted job satisfaction. Good working relationships were also cited by two thirds.
Encouragingly, poor working relationships, or lack of support from senior colleagues, were only seen as problems reducing job satisfaction by a minority.
Peter Lees, medical director and chief executive of professional development body the Faculty of Medical Leadership and Management, said the high levels of job satisfaction were “massively encouraging”.
“It’s a huge credit to medical directors that they can stay positive when the job is becoming so difficult,” he said. “There are statutory responsibilities and if quality is found wanting they are in the firing line.
“Medical directors are expected to know what medication Mrs Jones was prescribed at 2am and these are the things you can lose sleep over. On the other hand you have the opportunity to influence and to carry out research. Data shows that organisations that engage doctors, particularly at board level, do better.” Mr Lees said more had to be done to encourage clinicians to become medical directors when they could easily stick with their clinical careers.
‘If a nursing director and a finance director have drawn claws, often a medical director needs to step in’
“There is not enough competition for the job,” he said. “We have to make it more attractive. “The NHS is the most wonderful organisation on the planet but there are things it could do to help people with the challenges they face on a daily basis.”
Four in five medical directors said delivery of safe care was the number one priority for boards. Staff engagement came a distant second, with no one surveyed opting for financial sustainability or patient experience.
Courage to have difficult and honest conversations was the main attribute that medical directors considered made them good at their jobs. This was closely followed by the ability to hold colleagues to account, and the capacity to spend time networking and influencing others to drive change.
Close attention to detail, setting deadlines and applying pressure were seen as the least important factors medical directors would look for in their replacements.
Medical directors felt that strong personal resilience and the ability to inspire others were the joint top factors that made them suitable for what they do. Being good at listening and making decisions were also seen as important.
According to Dr Mitchell, forming good relationships with peers is critical to success as a medical director.
“I found that I had a key role in getting people together,” he said.
“If a nursing director and a finance director have drawn claws, often a medical director needs to step in and sort things out. You need the ability to interact with people and help others develop working relationships.”
‘In most NHS trusts only a small minority of doctors are involved in formal leadership roles’
Vijaya Nath, director of leadership development at The King’s Fund, lauded the positive style of leadership embodied by the results. “It is welcome to see medical directors see communication and influence as more important to good leadership than controlling behaviours,” said Ms Nath. “Research shows that leaders who adopt supportive and inclusive styles have more engaged staff, which in turn is associated with delivering better outcomes for patients and better care.
“The best example of this approach is collective leadership where all staff are supported to play leadership roles, encouraging all staff to take responsibility for the success of the whole organisation, not just their own job or area.”
Ms Nath said the NHS did not do enough to encourage doctors into leadership roles and that time pressures are also making it harder for doctors to step into these jobs.
“Our research suggests that in most NHS trusts only a small minority of doctors are involved in formal leadership roles, and those who do generally only commit one day per week to these roles,” she said.
“The reasons for this are complex – a preference among most doctors for clinical work, rather than management roles; a lack of adequate training and support; an absence of defined career paths for clinicians; and a culture within the NHS that fails to value and reward clinicians who take up leadership roles.”
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