Leadership at all levels
By 8pm in most departments in most UK hospitals, the majority of people whose title implies a leadership or management role are on their way home, returning the following morning at, let’s say, 8am plus or minus one hour. Does this imply that for around half the average day, our great NHS hospitals are ‘un-led’?
Or does the mantle of leadership pass to another group who lead without access to fancy titles?
Asking the general question “who leads in the NHS?” usually points back to the fancy title brigade, adding weight to the assumption that there is no leadership during unsocial hours. To compound the felony, ask those who appear to be running the show if they are leaders (and I have done many times) and anecdotally, only around 15% confess.
Does this matter?
Firstly, consider the research evidence: poor team working is associated with higher mortality; poor medical engagement is found in trusts which CQC adjudges to be delivering lower quality and both are known to be the product of leadership. Hence the emphasis in the Francis and Kirkup recommendations on professionalising leadership.
Secondly, look at the profound disparity in the time and resource devoted to enhancing a doctor’s clinical skills versus enhancing their leadership skills. What quality premium are we missing by not helping our title-less leaders to become better leaders?
It is surely time that individuals, professions and the healthcare system recognised that, without diminishing the importance of clinical competence, leadership saves lives too and that many of those lives are saved by people without leadership training or fancy titles.
It would seem obvious that the training deficit must be addressed but that is unlikely to happen without a significant change of attitude within the profession towards leadership, perhaps starting with dropping the unhelpful expression ‘going over to the dark side’!
Accepting the busy curriculum argument, effective and creative ways of offering leadership development need to instituted at scale without falling foul of the tenets in the wonderfully named Harvard Business Review article The Great Training Robbery!
Peter Lees is Chief Executive and Medical Director of the Faculty of Medical Leadership and Management.