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Follow the leader

Dr Leila Touil and Dr Yasmin Ahmed-Little call all junior doctors to rise to the leadership challenge. Here they show you howFollow-the-leader

What is leadership? Leadership is about creating a vision; engaging others, and motivating them to be part of it. It is a dynamic process, even more so in a diverse environment such as the NHS.

The hallmark of good leadership is accountability and self-awareness. Other qualities of a successful leader include the ability to listen to, motivate and inspire people.

Why is leadership so important?

Lord Darzi said that strengthening leadership across the NHS is vital for the future. His Next Stage Review established a shared vision of an NHS with quality of care at its heart; clinical leadership is an essential ingredient of this success.1

Building on Lord Darzi’s work, the NHS White Paper Equity and Excellence: Liberating the NHS sets out the government’s long-term vision for the future of a more patient-centred NHS; in which patients are empowered to share in decisions about their care. Innovation has a vital role to play.

As junior doctors, we are on the frontline – our daily decisions have a significant impact on patient outcomes. We don’t need to look far to find areas where we could make a positive impact on our services.

Do you ever think to yourself: “There has got to be a better way of doing this?!” Many of us have ideas of how to improve efficiencies on the hospital floor, but feel our enthusiasm is isolated, and don’t know where to take our ideas. But we are ideally placed within the medical framework to be agents for change – see BMJ blogs for more information.

"No decision about me without me" - Department of Health2

Taking the lead

In the workplace 

By getting involved in sustainable and meaningful projects, we can improve the health service not just for those that use it, but also for those who work within it.

There are a number of ways to develop your leadership style during each rotation:

  • Shadow seniors to identify effective styles and behaviours
  • Attend a management or directorate meeting to get a better understanding of your workplace
  • Join local committees, eg, Local Negotiating Committee
  • Seek opportunities to undertake additional leadership activities in your department, eg, improving the handover system.

Also, always be on the lookout for local sources of funding to support bigger ideas. Many regions now run Dragons Den style events to help allocate resources to junior doctors with a good idea for quality improvement.3

Don’t be shy in approaching suitable individuals as potential mentors. If you have significant experience, why not train to be a mentor to someone else? The NW Mentoring Scheme has supported many junior doctors to do just that.

If you do have an idea about implementing change that has been realised in your workplace – shout about it. One good way is to share your idea across the NHS as a case study.4

Networking

Joining a network of like-minded enthusiastic leaders of tomorrow can take your projects to the next level. Joining networks of other junior doctors will keep you up-to-date with what is happening in the world of leadership and management, and will enable you to make contact with inspiring clinicians. Examples of a few such networks are listed below:

Regionally

The North Western Deanery is an example of a deanery that has developed many opportunities for junior clinicians to engage in NHS leadership and management.

Another example is the North West Medical Leadership School, which hosts regular evening events that bring junior doctors together to network and meet senior leaders from the system. The ‘Buddy Scheme’ is the first to bring together junior managerial and clinical leaders and build better relationships for the future.5,6

Explore what is going on in your region. If schemes do not exist set up your own network or scheme.7

Many regions now run Dragons Den style events to help allocate resources to junior doctors with a good idea for quality improvement

Nationally

Apply for a Fellowship. The NHS has a Leadership Academy with a specific work stream focusing on emerging leadership within the NHS.

Other national programmes include the NHS Medical Directors’ Clinical Fellows Scheme.

Junior clinicians have also published reflections from their experiences on such programmes.8

Develop a ‘leadership style’

There are many leadership styles – these are influenced by our personal attributes and the experiences that make us unique. Effective leadership styles are best developed by engaging in leadership experiences in the workplace.

Situation and context certainly influence the effectiveness of leadership styles in the NHS

The ‘visionary model’ of leadership suggests that a leader can be influential by creating a vision with which others can identify and by inspiring and motivating them.

The ‘traits theory’ identifies personality traits associated with successful leadership, such as intelligence, whereas the ‘situational approach’ proposes that no single style of leadership is appropriate to all situations. Situation and context certainly influence the effectiveness of leadership styles in the NHS.9
In day-to-day management people generally prefer a relaxed democratic leadership style. However, during times of crisis staff may prefer strong, authoritarian leadership. Explore opportunities and look for situations where you can practise different styles and evaluate your leadership style by completing a self assessment questionnaire, such as Myers Briggs.10

Leadership challenges

Culture

Leadership training does not rank highly on the medical training agenda; as a result there is a lack of education about the organisational structures of hospitals, trusts, practices and the NHS as a whole. The mindset among junior doctors is often that “it doesn’t apply to me”. However, at some point in our careers we may be responsible for the budget and resources in our directorate.

The mindset among junior doctors is often that “it doesn’t apply to me”

Change

The ability to adapt positively to a changing role, organisation and environment, is crucial to becoming effective leaders of the NHS. We need to equip ourselves with the tools to respond to future challenges and change, to recognise what kind of leaders the NHS needs now and in the future and what qualities we need to develop.

Service commitments

It is difficult to deliver improvements for the future at the same time as managing today’s services with all their pressures and demands. Systems do not simply stop to allow change to take place; therefore developing leadership skills needs to be incorporated into our training. The short rotational nature of our posts also makes it difficult to see change initiatives through to completion. However, we could use this to our advantage and share our experiences of successful initiatives across trusts.

Rise to the challenge

Junior doctors are the future of the NHS. It is therefore essential that the natural leadership qualities we all possess are developed to equip us with the essential skills to be proactive in changing the way our NHS is run. Are you willing to rise to the leadership challenge?

Leadership in practice

Systems do not simply stop to allow change to take place; therefore developing leadership skills needs to be incorporated into our training

During the care of an acutely unwell patient we need clinical judgment to recognise early warning signs, order appropriate investigations and initiate treatment effectively. We have to be self aware and know our limitations. We must communicate effectively to our team, get others to help and also delegate tasks in order to achieve our aim. In essence this is leadership.

Dr Touil is a core surgical trainee in plastic surgery in the North Western Deanery and Dr Ahmed-Little is a specialty registrar in public health in the Mersey Deanery.

References

1. DH, High Quality care for All: NHS Next Stage Review Final Report (2008)
2. DH, Equity and Excellence: Liberating the NHS, HMSO (2010)
3. Stokes M, Ahmed-Little Y, Kendall D, Harrop J, Collum J, Making Ideas Reality, BMJ Careers (22 May 2010)
4. Ahmed-Little Y, Kanani N, Hillman T, Bethune R, Brown B, Sharing Good Practice – made Easier, BMJ Careers (15 Oct 2011)
5. Ahmed-Little Y, Dunning J, Love Your Enemy, HSJ (15 April 2010)
6. Ahmed-Little Y, Holmes S, Brown B, North West Buddy Scheme, BMJ Careers (18 June 2011)
7. Kadir S, Nazir T, Ahmed-Little Y, Meet the Management: A Local Initiative, British Journal of Healthcare Management (2010)
8. Moll S, Ahmed-Little Y, Brown B, Abdalla H, Owen E, Emerging Clinical Leadership Development in the NHS, BJHM (2011)
9. Mullins LJ, Management and Organisational Behaviour – Eighth Edition, Pearson Education (2007)
10. Briggs MI, Myers P, Gifts Differing: Understanding Personality Type, Davies-Black Publishing (1980, 1995)