Medical Leadership Dr Chris Clough Chair, National Clinical Advisory Team Neurosciences Advisor, DH Consultant Neurologist, King’s College Hospital

Medical Leadership Why did we do it? Why did we do it? What did we do? What did we do? Where are we at? Where are we at? What do we need to do now? What do we need to do now?

Problems of leadership (not just us!) Problems of leadership (not just us!) –Tooke, Darzi, Medical professionalism Need for medical engagement Need for medical engagement –Performance directly related to engagement Can do → will do Can do → will do Build basic skills Build basic skills – Team playing – Management – Followership – shared leadership Not just last year’s fashion Not just last year’s fashion – QIPP - ↑ quality; ↓ costs – Move from state provision to state commissioning Medical Leadership Why did we do it?

Engagement (Medical Engagement Scale) Correlation between performance of a Trust (CQC and Dr Foster) and medical engagement –ie better clinical leadership = better quality of care

The table below illustrates this quantitative data in more concrete terms by showing the difference in performance level achieved on Care Quality Commission ratings by those Trusts in the top 10 and bottom 10 on the MES. CQC Ratings Against Top/Bottom MES Scores

Stuff I’ve heard - sound familiar? The trainee – have you got the blood result? – have you got the blood result? Don’t know Don’t know No No The phlebotomist didn’t come The phlebotomist didn’t come The porter didn’t pick up the blood The porter didn’t pick up the blood The lab lost it The lab lost it Won’t be ready for weeks Won’t be ready for weeks There’s always a problem with getting results back There’s always a problem with getting results back

Not my fault Not my fault I’m not responsible I’m not responsible The managers should fix it The managers should fix it learned helplessness Yes, you are responsible (at least for the care of this patient) Yes, you are part of a complex disorderly world where it’s difficult to make changes happen Find out what the problem is and fix it Can do → will do

The consultant ITU – “the neurophysiology dept give us a bad service” ITU – “the neurophysiology dept give us a bad service” –Don’t respond, or not in a timely way –Ask questions – “why do you want an EEG” ↓ Have you talked to neurophysiology – “no” ↓ How about a joint solution?! Simple leadership skills

The medical director What do you think of the PCTs plans for children’s services? ↓ Its up to them; what they…. want to do Expert Expert Disappointment Disappointment Lack of engagement with the broader health agenda Lack of engagement with the broader health agenda

Challenges and perceptions Medical issues not admin/managerial Medical issues not admin/managerial Understand teams and changing roles Understand teams and changing roles Individual patient in front of me Individual patient in front of me Lack leadership skills or do not see need for them Lack leadership skills or do not see need for them Feel disempowered – them not us Feel disempowered – them not us Not engaged with the Trust/DH/Health Not engaged with the Trust/DH/Health

Why all the Fuss? International concern International concern –Projects in Australia, Sweden, Denmark Changing relationships Changing relationships – with patients –With employers Need to work in teams Need to work in teams Improve quality and control costs (QIPP) Improve quality and control costs (QIPP)

All about quality Patient Safety Patient Safety Patient Outcomes Patient Outcomes –PROMS –Clinical Patient Experience Patient Experience –Access –Environment –Behaviours Cannot ignore value for money and setting priorities Cannot ignore value for money and setting priorities

Medical Leadership Curriculum - Rationale Leadershipis a key part of a doctor’s role regardless of specialty Leadershipis a key part of a doctor’s role regardless of specialty Both leadership and management skills are required for doctors to become more actively involved in the planning, delivery and transformation of health services through their day to day practice Both leadership and management skills are required for doctors to become more actively involved in the planning, delivery and transformation of health services through their day to day practice

Presentation title: 32pt Arial Regular, black Recommended maximum length: 1 line Enhancing Engagement in Medical Leadership Academy of Medical Royal Colleges Council What did we do?

Medical Leadership Competency Framework

Undergraduate Undergraduate Postgraduate Postgraduate –all specialty training post foundation Post CCT Post CCT

Medical Leadership Competency Framework Personal Qualities Personal Qualities Doctors showing effective leadership need to draw upon their values, strengths and abilities to deliver high standards of care. Doctors showing effective leadership need to draw upon their values, strengths and abilities to deliver high standards of care. This requires doctors to demonstrate competence in: This requires doctors to demonstrate competence in: Self awareness: being aware of their own values, principles, assumptions, and by being able to learn from experiences Self awareness: being aware of their own values, principles, assumptions, and by being able to learn from experiences Self management: organising and managing themselves while taking account of the needs and priorities of others Self management: organising and managing themselves while taking account of the needs and priorities of others Self development: learning through participating in continuing professional development and from experience and feedback Self development: learning through participating in continuing professional development and from experience and feedback Acting with integrity: behaving in an open and ethical manner Acting with integrity: behaving in an open and ethical manner

Medical Leadership Competency Framework Working with Others Working with Others Doctors showing effective leadership by working with others in teams and networks to deliver and improve services. Doctors showing effective leadership by working with others in teams and networks to deliver and improve services. This requires doctors to demonstrate competence in: This requires doctors to demonstrate competence in: Developing networks: working in partnership with colleagues, patients, carers, service users and their representatives within and across systems and improve services Developing networks: working in partnership with colleagues, patients, carers, service users and their representatives within and across systems and improve services Building and maintaining relationships: listening, supporting others, gaining trust and showing understanding Building and maintaining relationships: listening, supporting others, gaining trust and showing understanding Encouraging contribution: creating an environment where others have the opportunity to contribute Encouraging contribution: creating an environment where others have the opportunity to contribute Working within teams: to deliver and improve services. Working within teams: to deliver and improve services.

Medical Leadership Competency Framework Managing Services Managing Services Doctors showing effective leadership are focused on the success of the organisation(s) in which they work. Doctors showing effective leadership are focused on the success of the organisation(s) in which they work. Doctors are required to demonstrate competence in: Doctors are required to demonstrate competence in: Planning: actively contributing to plans to achieve service goals Planning: actively contributing to plans to achieve service goals Managing resources: knowing that resources are available and using their influence to ensure that resources are used efficiently and safely Managing resources: knowing that resources are available and using their influence to ensure that resources are used efficiently and safely Managing people: providing direction, reviewing performance and motivating others Managing people: providing direction, reviewing performance and motivating others Managing performance: holding themselves and others accountable for service outcomes Managing performance: holding themselves and others accountable for service outcomes

Medical Leadership Competency Framework Improving Services Improving Services Doctors showing effective leadership make a real difference to people’s health by delivering high quality services and by developing improvements to service. Doctors showing effective leadership make a real difference to people’s health by delivering high quality services and by developing improvements to service. Ensuring patient safety: assessing and managing risk to patients associated with service improvement. Ensuring patient safety: assessing and managing risk to patients associated with service improvement. Critically evaluating: being able to think analytically, conceptually and to identify where services can be improved. Critically evaluating: being able to think analytically, conceptually and to identify where services can be improved. Encouraging innovation: creating a climate of continuous service improvement. Encouraging innovation: creating a climate of continuous service improvement. Facilitating transformation: actively contributing to change processes that lead to improving healthcare. Facilitating transformation: actively contributing to change processes that lead to improving healthcare.

Medical Leadership Competency Framework Setting Direction Setting Direction Doctors showing effective leadership contribute to the vision and aspirations of the organisation and act in a manner consistent with its values. Doctors showing effective leadership contribute to the vision and aspirations of the organisation and act in a manner consistent with its values. Identifying the contexts for change: being aware of the range of factors to be taken into account Identifying the contexts for change: being aware of the range of factors to be taken into account Applying knowledge and evidence: gathering information to produce an evidence-based challenge to systems and processes in order to identify opportunities for service improvements Applying knowledge and evidence: gathering information to produce an evidence-based challenge to systems and processes in order to identify opportunities for service improvements Making decisions: integrating values with evidence to inform decisions Making decisions: integrating values with evidence to inform decisions Evaluating Impact: measuring and evaluating outcomes, taking corrective action where necessary and by being held to account for their decisions. Evaluating Impact: measuring and evaluating outcomes, taking corrective action where necessary and by being held to account for their decisions.

Medical Leadership Competency Framework Example: Working with Others Example: Working with Others Doctors show leadership by working with others in teams and networks to deliver and improve services. Doctors show leadership by working with others in teams and networks to deliver and improve services. This requires doctors to demonstrate competence in: This requires doctors to demonstrate competence in: –Developing networks –Building and maintaining relationship –Encouraging contribution –Working within teams

Medical Leadership Competency Framework Example: Working with Others Example: Working with Others Doctors show leadership by developing networks: working in partnership with colleagues, patients, carers, service users and their representatives, within and across systems to deliver and improve services. Doctors show leadership by developing networks: working in partnership with colleagues, patients, carers, service users and their representatives, within and across systems to deliver and improve services. Competent doctors: Competent doctors: –Identify opportunities where working with others can bring added benefits –Create opportunities to bring individuals and groups together to achieve goals –Promote the sharing of information and resources –Actively seek the views of others

What did we do? Medical Leadership Curriculum Medical Leadership Curriculum –approved by PMETB 2008 –All Colleges to integrate within specialty curricula – August 2009 –COPMED – all deaneries to ensure implementation

Where are we at Good progress Good progress Variable integration of MLC into specialties Variable integration of MLC into specialties –Competencies –Assessment Variety of initiatives at Deanery level Variety of initiatives at Deanery level Lack of consistent implementation Lack of consistent implementation –Resources –Time

What do we need to do? Reflect on progress – identify good practice Reflect on progress – identify good practice Commit to full implementation Commit to full implementation Colleges Colleges –Review curriculum Is it all there? Is it all there? How can you integrate? How can you integrate? What assessments? What assessments? Deans Deans –Implementation –Training requirements GMC GMC –How will you know MLC is in operation?

Medical Leadership and Management Curriculum MLC For all doctors in specialty training For all doctors in specialty training From Foundation to Specialist Registration From Foundation to Specialist Registration (ST1 to CCT/CESR) Core to all curricula Core to all curricula Delivered by blended learning Delivered by blended learning – E-learning – Specific course – in workplace Assessed within workplace Assessed within workplace formative → summative formative → summative

Discussion

Leaders v Managers Cotter Cotter Leadership produces change and movement Leadership produces change and movement Management produces order and consistency Management produces order and consistency –Doctors need both! Shared or Distributive Leadership Shared or Distributive Leadership

Leadership comes from anyone who wants to make a difference to the thinking and action of others (Idenk)

Daniel Goleman– 6 Leadership styles Coercive -“do what I tell you” Coercive -“do what I tell you” –Demands compliance Authoritative-“come with me” Authoritative-“come with me” –Mobilise people towards a vision Affiliative-“people come first” Affiliative-“people come first” –Creates harmony and emotional bond Democratic-“what do you think” Democratic-“what do you think” –Forges consensus through participation Pace setting-“do as I do now” Pace setting-“do as I do now” –Sets high standards for performance Coaching-“try this” Coaching-“try this” –Develops people for the future

Supporting Excellence In Medical Education 9th National Multi-specialty Conference for Heads of Schools, Programme Directors, Directors of Medical Education 25 & 26 th January 2011 C O G P E D