Developing the leadership skills of junior doctors is essential if the quality of care is to be protected in the future, write Joe Rafferty and Alex Till

Alex Till

Alex Till

Alex Till

Leadership matters.

Whilst many healthcare leaders are proving an ability to lead their organisations to survive and thrive within an increasingly complex political and economic environment, to some, leadership within healthcare is thought to be in crisis and we have seen tragedy as a result of poor leadership.

Joe Rafferty

Joe Rafferty

Joe Rafferty

In order to move forward, we must understand the reasons for this variation, explore the key trends of the successful few, and begin to shape future leadership development based on these findings in order to safeguard the quality of healthcare within the United Kingdom.

Collapsing hierarchies and flattening organisational structures is critical for a collaborative, safe and high quality healthcare culture. Similarly, our leadership style must reflect this. We must value all healthcare professionals, irrelevant of seniority or discipline, as having the potential to be exemplary leaders.

Early investment in leadership talent encourages individuals to stay and nurture their skills within the organisations that are forward thinking enough to support, value and appreciate them

Within postgraduate medical training, there is a leadership gap which should be addressed. Junior doctors have a poor understanding of the organisations within which they work; organisations which, in the future, they will help lead, operate and redesign.

Whilst the Medical Leadership Competency Framework (MLCF) has been embedded into training curricula and will be further strengthened by the generic professional capabilities framework, there is no systemic approach to proactively address and nurture leadership talent.

Without this, we are likely to fail on delivering the calibre of leadership required to lead healthcare services and build the confidence and skillset required for junior doctors to lead.

The art of leadership development is complex: it does not grow passively through osmosis over time. Nor can it be addressed through standalone courses, events and the provision of new content alone.

Vertical leadership

Wherever possible, leadership development should occur within the context that the leader operates, where the eccentricities and nuances of individual teams, organisations, and cultures can be learnt.

Organisations should embrace this opportunity. Junior doctors are not merely ‘birds of passage’ but highly valuable future assets who should be developed alongside and with the same credence as their inter-professional colleagues.

Whilst all junior doctors should develop basic leadership skills, and be assessed on this, not all will want to pursue a career in healthcare leadership, prioritising clinical care, education and/or research ahead of this – of course, we vitally need these skills too.

‘Unnatural collisions’ between junior doctors and those within the organisation at a higher developmental level, with differing perspectives, should be encouraged

However, for those with leadership and management aspirations, organisations should help them ‘strengthen their wings’ but not allow them to ‘fly the nest’.

This is of mutual benefit. Early investment in leadership talent encourages individuals to stay and nurture their skills within the organisations that are forward thinking enough to support, value and appreciate them.

To help achieve this, organisations should embrace the concept of vertical leadership development, and help junior doctors realise self-actualisation. This in turn, improves performance and secures leadership talent for the future.

Through the three primary conditions: heat experiences, colliding perspectives and elevated sensemaking, the optimum conditions for personal and professional growth can be created, where the developmental process itself is held as a core feature.

Through this mechanism, initiating, enabling and integrating developmental activities within their practice requires little resource expenditure and junior doctors will develop their leadership skills, their understanding of healthcare organisations, and what is considered one of the best predictors of leadership success, ‘learning agility’.

Collapsing hierarchies and flattening organisational structures is critical for a collaborative, safe and high quality healthcare culture

‘Unnatural collisions’ between junior doctors and those within the organisation at a higher developmental level, with differing perspectives, should be encouraged. Developing organisational and leadership insights through this mechanism, opens ‘a door of curiosity’ for further development, where the junior doctor should then proactively ‘seek the heat’ by pursuing additional opportunities.

Caution should be exercised however, to avoid ‘spoon feeding’ activities. They should rather be encouraged to navigate the organisational network and build relationships themselves. This is a key aspect of their development.

Markers of this success can be seen through initial introductions blossoming into a series of interconnected developmental activities throughout the organisation at multiple levels.

Aspirations and progression

Ranging from 1:1 interviews, management tutorials, board observations, team development sessions, care pathway designing and the like, a variety of activities provides a systems perspective on the complexity of healthcare and the very nature of leadership.

Whilst quantifying objective outcomes for the effectiveness of leadership development is notoriously challenging and limits the evidence base that we can draw upon, observation of junior doctors’ career pathways and the opportunities that they seek, provides an insight into success whilst more measurable mechanisms are developed.

In times of austerity, we must adapt, innovate, and expand to survive and to continue providing the perfect care our patients deserve

Alongside observing continued engagement with the organisation over time, a thirst for development in an individual can also be observed whereby further leadership activities are pursued outside the boundaries of the organisation itself at a local and / or national level, such as progression onto the National Medical Director’s Clinical Fellow Scheme.

In times of austerity, we must adapt, innovate, and expand to survive and to continue providing the perfect care our patients deserve. Utilising the latent leadership talent that lies dormant within our organisations and developing existing human capital is vital in achieving this.

Regardless of whether junior doctors hold future aspirations to attain formal leadership and management roles or prefer to devote their time to front-line clinical care, they are a key component of our healthcare system and should be viewed as leaders of today that we can develop further to address the needs of tomorrow.

Joe Rafferty is chief executive, Mersey Care Foundation Trust, and Alex Till is psychiatric trainee, national medical director’s clinical fellow