In the calls made for an increase in the quantity, quality and capability of clinical leaders there is a fundamental challenge. How to bridge the gap between clinical training and developing clinical leadership capacity for the future?

What we describe here is an innovative pilot programme commissioned by the director of postgraduate medical education at UCLH with the specific aim of bridging that gap with a cohort of SpRs on the brink of consultant posts.

Lesley Bromley, director of postgraduate medical education says “increasingly I noticed that SpRs exist in a training ‘bubble’. They push themselves very hard to reach the peak represented by their first consultant post – only to find that they do not understand what they can create beyond it. 

“As a result they sometimes become arrogant and insular, regarding leadership as something managers alone can do: this is not a good landscape in which to practice and is a waste of talented people. Additionally I believe that Trusts need to focus and motivate their workforces so that the individuals get what they want out of their careers and at the same time deliver what the trust wants for optimum patient care.”

In autumn 2008 Dr Bromley commissioned a pilot programme for 12 SpRs and newly-qualified consultants within UCLH foundation trust, to address these very issues. The programme was to be delivered by a small team of external facilitators and coaches. Its objective was to help these doctors to take responsibility for managing their careers. 

Specifically the design was to enable better understanding of current and emerging medical career pathways and so shape their future progression by identifying and evaluating their options and create the basis for their own career plan. The intention was to provide benefit at both a personal level and an organisational level by helping individuals to:

  • understand their own motivations and needs, and how to meet them
  • understand how they can make better use of their strengths
  • understand the context in which they are working and how they can manage it
  • become more fulfilled; and
  • achieve and maintain a sense of direction and focus on an ongoing basis. 

The intention was not only to raise the quality of their leadership and thus to motivate, inspire and help grow those around them, but also in due course to stem the flow of early retirements and support the trust’s succession planning.

The intended consequence of this would be a better match between the strategy of the organisation which will have invested heavily in them, and their own aspirations and potential.

The problem appeared to lie in fundamental questions which doctors seem rarely invited to explore for themselves but which underlie how successful they are: Who am I? What makes me tick, and what do I need in order to be fulfilled? What does that mean about the choices I make now – and how can I make the right choices in the future? What can I do to influence the development of my service in the complex political world of the NHS? How can I become the kind of leader that I’m expected to be or indeed want to be? How can I prepare for my next move and how can I plan further into the future?

Dr Bromley believed that the solution lay not in the didactic approach which characterises many of the training programmes that doctors are exposed to. Rather, it lay in experiential and reflective learning to enable doctors on the cusp of becoming consultants to broaden their horizons to broaden their horizons and facilitate them to manage their circumstances (both personal and external) more effectively.

This meant facilitating them to understand their own individual needs, strengths and development areas and to understand with greater insight the system in which they work. The intention was to provide benefit at both a personal level and an organisational level by helping individuals to:

  • understand their own motivations and needs, and how to meet them
  • increase their self-awareness and help them make better use of their strengths
  • understand the NHS context in which they are working and learn practical tools and techniques to help them manage within it
  • become more confident in being part of a team
  • develop tools and techniques for developing their services; and
  • achieve and maintain a sense of direction and focus on an ongoing basis.

The programme consisted of five one day modules delivered over an eight month period. The programme was delivered by three highly experienced coaches and facilitators from A New Kind of Leadership, with deep knowledge of the NHS and the challenges of clinical leadership. Modules combined specialist input, development of self awareness, distribution of knowledge and focused action planning. The modules were supported by the administration and use of the Myers Briggs Type Indicator (MBTI), a 360 feedback tool, The Strengths Finder and critically 3 individual coaching sessions for each participant at approximately six to eight week intervals.

Modules were: Introductory session including NHS context and MBTI, Personal Career Development including a consideration of leadership styles and attributes, Service Development, Effective Teams and Optimising Relationships.

Feedback from participants has been overwhelmingly positive and is coupled with a strong sense of realisation that this is a really important intervention for their future careers. Participants have reported a deeper self-confidence, heightened self awareness, a greater ability to take more control of career choices and a real shock about how much they have learned both about themselves and the wider NHS they are committing to. Some have clearly stated their desire and intention to work towards clinical leadership roles in the future.

 As facilitators our lessons are:

  • that a greater understanding of NHS context and structures is critical for this group of trainees;
  • that programme design needs to be flexible to keep up with a very intelligent and sharp group of participants;
  • that MBTI was the right tool;
  • that eight months was too long for the programme given participants were applying successfully for locum and substantive consultant posts at the same time;
  • that the 360 tool was particularly disliked by participants and dismissed by many of  their assessors and did not add any value to the process.

This has been a successful intervention and worthwhile investment of both time and finance. UCLH is commissioning a revised version of the programme for two larger cohorts and preceding it with a broader introductory programme Getting to Grips with the NHS.

Individual participants are committing to new roles with more clarity about their strengths, more confidence in working in teams and much greater leadership capacity. The intention is to provide ongoing support, updating on context and policy, and introducing additional tools and techniques through half yearly alumni events.

Dr Bromley says “I am delighted with the outcomes and am reinforced in my conviction that this kind of programme is critical for doctors to emerge from training as rounded individuals capable of taking on important leadership roles in the future”.