Healthcare professionals believe creating brighter leadership opportunities is essential for emerging leaders to transform NHS services, says Jennifer Trueland
BR8JG2 A physician catching a shooting star
This time last year Patricia Miller was named one of HSJ’s Rising Stars. A few short months later she was promoted from the post of director of operations to chief executive of Dorset County Hospital Foundation Trust.
‘I’ve had very good senior leadership support, mentoring and coaching; I’ve had quite a lot of investment in my development’
Ms Miller believes she owes her rise to the support and development she has had from the NHS, and is now trying to do the same for those who are coming up behind her.
“I’ve been lucky,” she says. “I’ve had very good senior leadership support, mentoring and coaching; I’ve had quite a lot of investment in my development. But I’ve had to work hard for that, and I’ve also invested in my own development - for example, I took a three year career break to do a business degree.”
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Now as chief executive she sees it as part of her job to nurture and develop future leaders. Among various initiatives, her trust operates a talent mapping programme, and she personally encourages staff to network, and to take managed risks.
As an emerging leader, Ms Miller might have felt nurtured and supported, but is it the same for those who are coming through now? What does the NHS need to do to create the right conditions for leaders to thrive?
Produce initiatives for leaders
According to Anne-Marie Archard, head of the London Leadership Academy, recognition of the issue at the most senior level has been crucial in getting to where we are today, and she believes it is vital that it continues.
“What’s coming through is that the NHS has really grasped that there is a need to support and nurture leaders,” she says. “Sir Nigel Crisp and [Sir] David Nicholson both got that, and supported that. But there’s lots more that needs to be done and I’d urge Simon Stevens to keep leadership high on the agenda. I believe that leaders need to be given the development and the space that they need to lead.”
She fears that as austerity and the budget squeeze continues to hit health services, leadership initiatives might be a casualty.
“When the going gets tough, it’s one of the things that goes,” she says. “But actually, these are the circumstances where it’s even more important to create the time and space for leaders to raise their gaze up to think about how they can be a leader. It’s hard to do that when you’re fire fighting.”
‘I believe that leaders need to be given the development and the space that they need to lead’
Finding the time to have a reasonable work-life balance is challenging for leaders, says Claire Lemer, another of last year’s Rising Stars.
“It’s a thing on my to do list, to remember to breathe,” she laughs. “I’m guilty of stretching the working day, but that’s unsustainable in the long term. I want people to be in leadership positions who have a life outside work. We should create the right conditions so that people do not have to go above and beyond the job to make a real difference.”
Transformational change requires transformational leaders
The HSJ Rising Stars list showcases the potential that the NHS has among its aspiring leaders. Despite this energy, the NHS still provides little in the way of continuing support or development for these high potential leaders. At present, our would be leaders can whet their appetite with a year long fellowship or a distance learning leadership course but are then left to return to the “real” world and convince some of their colleagues that they still are “real” clinicians.
Apprehension from parts of the clinical community in developing clinical leaders may extend from the number of actors involved in the NHS leadership scene. Leadership schemes are being delivered by a multitude of providers from local trusts to national arm’s length bodies, and are varying in quality. This fragmented approach has left us unable to provide adequate pastoral support or connect young leaders with service improvement opportunities.
In the current economic climate, financial performance and clinical outcomes must improve in tandem; clinical leadership is integral to achieving this. Simon Stevens’ ambitions for integrated care models will require a population view of health, and delivering care for the complex needs of diverse populations will require clinicians to take a leading role in resource allocation and business operations.
Earlier this year NHS England announced a review of its “improvement architecture”. The creation of a national clinical leadership pipeline, with defined exit points, must feature in this. A system-wide approach to developing leaders should be coupled with greater alignment with local education and training boards (former deaneries) to ensure our aspiring leaders are sufficiently supported in pursuing their ambitions of becoming excellent clinicians and world class leaders.
What can the Rising Stars do in the absence of a structured clinical leadership pathway?
- Seek out mentors: Find a senior clinical leader who will understand your ambitions and can advise you. Almost all clinical leaders have faced similar challenges.
- Continue to be an excellent clinician: Keep providing the best possible patient care, both by directly seeing patients and through your leadership interests. You add value as a clinical leader when you can translate experiences at the sharp end of delivering care into service improvement projects.
- Create a network: “Alone we go faster, together we go further”. A network of like minded individuals can provide support, advice and constructive criticism in a safe space.
- Keep carving out opportunities: Despite the current lack of a structured pathway, take up opportunities to gain management experience. You will find support within every healthcare organisation if you can lead in helping to make high quality care happen.
In the NHS Five Year Forward View, Mr Stevens outlined intentions to redesign the healthcare landscape. There are plans to introduce new ways of providing care through multispecialty community providers and accountable care organisations. This envisaged transformational change will require transformational leaders - policymakers must act quickly to ensure our Rising Stars and other aspiring leaders are identified, trained and supported in preparation for this role. l
Dr Na’eem Ahmed is an associate at the Health Innovation Network and a radiology specialty registrar in London. @DrNaeemAhmed
Dr Lemer, a consultant paediatrician at Guy’s and St Thomas’ Foundation Trust, believes that aspiring leaders should be given the opportunity and proper support to take on responsibility for projects leading to change and improvement, so that they can learn “on the job”.
Her own trust has a Dragons’ Den type set up where people can bid for resources to make ideas happen.
“It’s not just about money, it’s about giving them time and support as well,” she says.
Another of 2014’s Rising Stars, Nikita Kanani, a GP in south east London, a clinical commissioning group vice chair, and quality lead for the Faculty of Medical Leadership and Management, says that attitudes to work-life balance need to change.
“Before, many high achieving women in healthcare accepted that family life came second to career,” she says. “Now, the more we talk about a ‘work-life merge’, the more we normalise making it to our children’s sports days, the more we have the magical (though chaotic) ability to seamlessly be present in both our family life and our careers.”
‘I really don’t think we should have a reductionist approach - it’s not a “tick box” exercise’
But what role does training and education play in developing leaders? Emma Stanton, chief executive of Beacon UK and a practising psychiatrist, says that leadership is not something you can learn about solely in a classroom setting.
“If we think about training future healthcare leaders, it’s about exposure and being able to navigate the world beyond the NHS,” she says. “I really don’t think we should have a reductionist approach - it’s not a ‘tick box’ exercise. Healthcare should look at other industries and see how to work with talented emerging leaders; it’s not just about having a fellowship for one year then being dumped back where you came from. It’s about ongoing support and opportunity.”
Damian Rowland, a consultant and honorary senior lecturer in paediatric emergency medicine in Leicester, and another of last year’s Rising Stars, believes that there is a risk that something important can be lost in the drive to create great leaders.
“There’s very little attention paid to personal and professional behaviours, and internal reflection,” he says. “Many people, and I include myself in this, can come across differently than they intend to. One of the greatest challenges is getting the workforce to work together, and we need to understand ourselves as part of the process of understanding how we affect others.”
It is important to encourage internal reflection across the workforce, not just in “emerging” leaders, he says. “Sometimes there’s a sense that we’re almost waiting for another generation of people to come along, but that means you’re perpetuating the problem. We need the role models today to get the leaders of tomorrow.”
What are the skills needed by next generation leaders to ensure the NHS is fit for the future?
To ensure the NHS is fit for the future, the next generation of leaders won’t need a long list of skills. Rather, to ensure it is fit for the future, the NHS chiefly needs those who are deeply passionate about it and can lead. Colleagues will see their passion, believe in it and make it their own.
First, to declare an interest: I was named an HSJ Rising Star in 2014. I’ve now come to realise the first job of any good leader is to inspire trust. Trust is confidence born of two dimensions: character and competence. Character includes your integrity, motive and intent with people. Competence includes your capabilities, skills, results and track record. Both dimensions are vital and you only have to look in health service website comment sections to see what people make of the two current dimensions.
So, exactly what type of leaders need to exist in the future NHS?
To begin with, I believe there are subtle differences between clinical and managerial leadership, and the former is more important. Clinical leaders who can lead people or systems with gratitude, as well as the aforementioned trust and compassion (whilst not being pushovers), will ensure the NHS is fit for the future.
Admittedly, compassion is weak and irrelevant in organisations that indirectly punish honesty and transparency. However, in the future of empowered patients and an increasing duty of candour amongst all staff, let us remember it takes strength to show compassion, and only the strong will survive.
Indeed, compassion takes time, energy and patience that non-clinical leaders will also need but in a slightly different guise. Here, non-clinical leaders will need to discuss issues with colleagues and help them find their own solutions.
Don’t solve it for them; that’s the true leadership skill. The skills needed by the next generation of NHS leaders are ones where their own earlier struggles are remembered and whilst holding high standards, they guide others to raise their game.
Leading with compassion includes managing out those who don’t fit the team objective or are underperforming. The 2014 winter of discontent and strikes experienced by many NHS staff proves the tricky relationship with the British electorate. Future leaders must be careful not to extend compassion to excuse makers and blamers unless they want more blame and excuses.
And finally, extend compassion after struggle or failure, not before. Don’t protect people; enable them.
So, how do you become a stronger, better leader? Behave your way into gratitude; start saying thank you.
Try this. Begin your day by expressing gratitude to three people, then get to work. Pick up the phone or walk down the hall. Stress, self-importance and discontent are all lessened, lightened and weakened with gratitude. I’m grateful we have a strong cohort of Rising Stars to make an NHS fit for the future.
Adebusuyi Adeyemi is chair of the Young Fabians Health Network
Rising Stars: Help emerging leaders to shine
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Rising Stars: Help emerging leaders to shine