South Thames Foundation School Faculty Briefing 29 th January 2010

Clinical Leadership in Foundation

“ The doctor's frequent role as head of the healthcare team and commander of considerable clinical resource requires that greater attention is paid to management and leadership skills regardless of specialism. An acknowledgement of the leadership role of medicine is increasingly evident. " Aspiring to Excellence, Prof John Tooke, 2008

Hospitals where clinicians are engaged in strategic planning and decision making are better performers than those where clinicians are alienated from the strategic processes of the hospital (Goldstein and Ward 2004). ‘Significant change in clinical domains cannot be achieved without the cooperation and support of clinicians... (Bowns and McNulty, 1999, 66–7)

A Staffordshire NHS trust whose standard of emergency care led to patients dying needlessly showed a "lamentable failure of clinical leadership"

There is a need for clear and visible leadership at the top but this has to be linked with the development of leadership at all levels, especially clinical leadership in both primary care and hospitals. Chris Ham - Professor of Health Policy and Management 2003

Doctors in society: medical professionalism in a changing world We recommend that the General Medical Council revises its important document, Tomorrow’s doctors, to strengthen leadership and managerial skills as key competencies of professional practice. We recommend that the General Medical Council revises its important document, Tomorrow’s doctors, to strengthen leadership and managerial skills as key competencies of professional practice. Report of a Working Party of the Royal College of Physicians of London. London: RCP, 2005 Report of a Working Party of the Royal College of Physicians of London. London: RCP, 2005

Doctors in society: medical professionalism in a changing world Report of a Working Party of the Royal College of Physicians of London. London: RCP, Report of a Working Party of the Royal College of Physicians of London. London: RCP, CHMS particularly welcomes the recommendations to strengthen clinical leadership. Medical Schools firmly believe that good leadership is fundamental to the role CHMS particularly welcomes the recommendations to strengthen clinical leadership. Medical Schools firmly believe that good leadership is fundamental to the role of each and every doctor and that all doctors should demonstrate the potential to act as leaders when required. of each and every doctor and that all doctors should demonstrate the potential to act as leaders when required. Professor David Gordon, Chair of The Council of Heads of Medical Schools

Next stage review For those at a postgraduate or equivalent stage in their careers, we will explore ways to ensure that both the curricula and appraisal processes reflect the importance of learning leadership skills. Ara Darzi

Defining clinical leadership “The essence of clinical leadership is to motivate, to inspire, to promote the values of the NHS, to empower and to create a consistent focus on the needs of the patients being served. Leadership is necessary not just to maintain high standards of care but to transform services to achieve even higher levels of excellence.” “The essence of clinical leadership is to motivate, to inspire, to promote the values of the NHS, to empower and to create a consistent focus on the needs of the patients being served. Leadership is necessary not just to maintain high standards of care but to transform services to achieve even higher levels of excellence.” (Department of Health, 2007) (Department of Health, 2007)

Defining clinical leadership “ Driving service improvement and the effective management of teams to provide excellence in patient / client care” Scottish Executive, 2005, p4

‘Teaching leadership in clinical settings  Curricula will have leadership competencies embedded  Local clinical and managerial champions to set up teaching leadership initiatives  Use of Local faculty structures  Development of local resources  Development of ES and CS in teaching and assessing leadership competencies.

Leadership Frameworks  BAMM  NHSII  AMRoC Medical Leadership Competency Framework April 2008  AMRoC common competency framework based on good medical practice  May 2009 specialty curricula

KSS leadership St Richard’s Hospital Western Sussex Hospitals Trust December 2009

Current leadership activity  Trainees encouraged to Engage in Audit Engage in Audit Research Research Represent their peers Represent their peers Take on roles of responsibility Take on roles of responsibility Teach Teach

More recently…  Expose trainees to variety of leadership learning opportunities Taster days Taster days HImP (Health Improvement Projects) HImP (Health Improvement Projects) Provision of medical Student OSCE Provision of medical Student OSCE Highlight influence of external drivers eg NICE, CNST and NPSA Highlight influence of external drivers eg NICE, CNST and NPSA

Taster Days  Obtain consent from Trust Leaders  Explain aims to CEO etc  Provide feedback form  Highlight opportunities to trainees via Educational Supervisors  Trainee to impart experience to peers at later date

HImP  Open forum to highlight areas for improvement  Identify most significant issues  Summarise  Feedback actions required  Facilitate project management  Present findings/solutions

Medical Student OSCE  Familiar to all junior doctors  Encourages overall leadership to coordinate the whole session  Encourages “micro” leadership to set up and design individual stations  Encourages need for professionalism, time management, assessment and feedback

Leaders in the NHS  NICE  CNST  NPSA  KSS Highlight the influence of agencies and how they effect Junior Doctors working lives Highlight the influence of agencies and how they effect Junior Doctors working lives Opportunities to corroborate or refute guidelines and policies Opportunities to corroborate or refute guidelines and policies

Summary  Are there better ways?  Does everyone have to “do” Leadership or just be exposed?  Leadership in bite sized bits (OSCE)  Leadership in context/relevant to NHS agencies