Disenchantment is rife among established NHS consultants.
And it is not surprising. Even at my own fledgling stage, through contact with those working across numerous NHS organisations in various parts of the country, I’ve become acutely aware, alarmingly quickly, of a worrying malaise reflecting all that might best be summed up by there being “room for improvement” in the NHS.
So the notion that an NHS organisation should demonstrate how much it values its new consultant recruits, and the potential contribution they can make as emerging clinical leaders, is truly refreshing.
Lancashire Teaching Hospitals Foundation Trust (LTHFT) launched its Consultant Leadership Programme in late 2009 and I was fortunate to be among the first cohort to complete the programme.
This new Consultant Leadership Programme, targeted specifically to appointed consultants at LTHFT, is anticipated to run over successive years for each new cohort. I started the six month programme within my first year as a consultant, after enthusiastic encouragement from the medical director, who was instrumental in its initiation.
The aims of the programme were for consultants to:
- Take a holistic leadership approach by considering patients, staff, processes and equipment in how they deliver the service
- Understand their role in cultivating a culture and work environment that is focused on quality and continual improvement
- Be better able to empower their staff to make decisions and encouraging them to be more involved in changes that affect them
- Build a network of support and develop effective working relationships across the Trust that encourages an exchange of ideas, learning and experience
- Be equipped with the skills, knowledge and understanding that will help them to effectively adapt to an ever changing work environment
- Understand their own leadership style and to have increased awareness of how their behaviour impacts on those around them
The programme took the form of six, monthly, half day workshops, entitled managing services, setting direction, improving services, working with others, personal qualities, and delivering the service.
These workshops were facilitated by members of the trust leadership and organisational development team, joined by senior managers for some sessions. Preparatory work was expected of participants before workshops, as well as completion of a project development proposal. The latter culminated in a presentation to colleagues, trust executive and board representatives.
The programme also included access to mentoring and coaching, personality profiling using the 16 Personality Factors (16PF) questionnaire and 360°appraisal. The 360°appraisal was designed using the Academy of Royal Colleges - Medical Leadership Competency Framework and was used to provide participants feedback on their leadership effectiveness and style.
Inevitably the programme did involve some additional work, with preparation necessary for workshops, work on the project development proposal and presentation, completion of the 360°appraisal and personality questionnaire. The workshop sessions themselves were ‘ring-fenced’ as part of supporting professional activity (SPA) time, although of course, with so many important activities falling within SPA time this meant compromises had to be made, with some further spill-over of work on the programme into participants’ own time.
Leadership programmes for doctors in training – and indeed now consultants – appear to be on the increase. At the current time, with some pairing down of NHS non-clinical managers seemingly inevitable, it seems particularly appropriate that consultants are indeed better equipped to take on leadership roles.
Participants were invited to take part in a formal evaluation of all aspects of the programme. The results, compiled by the programme lead, have been very encouraging. 100% of participants who responded to the questionnaire either strongly agreed or agreed that the programme has enabled them to:
Have a greater understanding of what effective leadership means
- Have the opportunity to reflect on their leadership style and identify what they could do differently in the future
- Build up a network of support within the Trust
- Enhance their levels of self awareness
- Learn from colleagues
- Feel equipped with a range of tools and techniques that can be used in the workplace
When asked ‘which areas of the programme have you benefited from the most?’ participants reported:
“360 degree appraisal and personality questionnaire – perfect timing for me as I’d been in post a year and it was a good time to reflect on my impact and how I was perceived by others. Early enough to change if I needed to and late enough to know that I’m tackling change in the right way with my new team.”
“Meeting colleagues and building a network”
“The project has been most useful, it has provided me with a chance to make a change and improve my service”
“Overall concept of leadership and improving services”
While there has been a great deal of positive feedback, the evaluation has identified a number of learning points for facilitators and areas for further development:
- Sessions need to be practical and task focused, with lots of opportunity for exercise based learning and discussion.
- The content needs to focus on equipping Consultants with practical skills such as how to write a business case, how to deal with conflict, how to manage performance and manage a project.
In conclusion, it appears that programme participants and facilitators considered the leadership programme to have been effective and to have been able to fulfil its original aims and objectives. Future programmes of this nature need to focus on equipping new Consultants with the skills they need to lead often complex teams in challenging and pressurised environments, but most importantly they need to engage Consultants, inspire and empower them that they can make a difference and hopefully prevent them from having the levels of disenchantment of some of their colleagues.
Acknowledgement. I’m grateful to Louisa Wright, programme lead and head of leadership and organisational development management, Lancashire Teaching Hospitals Foundation Trust, for providing the summary and interpretation of participant evaluation.
Hedley Emsley is a consultant neurologist at Royal Preston Hospital