Clinical Leadership - Royal College of Psychiatrists Goldin Presentation final.pdfSir John Tooke, 2008. Aspiring to Excellence Clinical leadership • Need for a culture that recognises

Clinical Leadership

Dr Jon Goldin FRCPsych

Consultant Child and Adolescent

Psychiatrist and Honorary Senior

Lecturer

Different Leadership Styles

• Autocratic leader

• Democratic leader

• Laissez-faire leader

Kurt Lewin 1939

Autocratic Leader

• Gives direct orders

• Does not seek input from others in

decision making

• Decisions can be made quickly

• Junior members of the team can become

demotivated

• Poorer decisions?

Democratic Leader

• Involves all members of the team in

decision making

• Retains the final say

• Group members feel more motivated

• Less productive, but higher quality

output

• Decision making can be slow

Laissez-faire Leader • Offers little / no input in decision making

process

• Decisions left up to group members

• Works well where group members are

highly competent

• Responsibility can help motivate team,

but can also feel demotivated by

perceived absence of leadership

The current NHS context

• Increasing importance attached to the

value of clinical leadership

• The Next Stage Review (Lord Darzi)

aimed to put clinical decision making at

the heart of change in the NHS

Clinical leadership

• Previously a neglected force in the programme

of reform

• There is now a clear commitment to enhance

clinical leadership

• This is now a concern of Government, the NHS,

the clinical professions, and many other

institutions

Aspiring to excellence

• The doctor's frequent role as head of the healthcare team and commander of considerable clinical resource requires that greater attention be paid to management and leadership skills

• Role acknowledgement and aspiration to enhanced roles - in subspecialty practice, management and leadership, education or research - are likely to facilitate greater clinical engagement

Sir John Tooke, 2008. Aspiring to Excellence

Clinical leadership

• Need for a culture that recognises and welcomes the need for

clinical leadership at every level in the NHS, a culture that

naturally sets out to cultivate and support local leaders

• For clinicians this culture should become rooted in education

and training, and brought alive by example

• Aim is to extend this widely into every domain of NHS service

The underlying barriers to clinical

leadership

Mountford & Webb 2009

• Clinicians not selected

for leadership skills

• Not connected to

day job

• Finance

• Lack of career pathway

• Obtaining training

• Not vital to patient

outcomes

• Not vital to

professional

success or a doctor’s

identity

Clinical leadership • Leadership is about seeing what is needed and

making it happen

• It recognises and accepts the bond between improvement and change, managing the threats, disturbance, disruptions

• All improvement demands and derives from change - but not all change leads to improvement. We must learn from mistakes, and share experience

Berwick 1996

Clinical engagement in

financial management

• “To varying degrees, combinations of weak governance, poor management and lack of engagement of clinicians have contributed to financial failures”

• Recommendation: “the Department of Health should identify models of successful joint working between financial and clinical management and promote them across the NHS”

Public Accounts Committee, 2007

The Medical Leadership

Competency Framework Lays out the ‘leadership competencies doctors need to

become more actively involved in the planning,

delivery and transformation of health services’.

A tool to:

• Inform the development of training curricula

• Highlight individual strengths and development areas

through self-assessment and feedback from

colleagues

• Assist with personal development planning and

career progression

NHS Leadership Qualities

Framework

• Personal qualities e.g. self belief, self

awareness

• Setting direction e.g. seizing the future,

Political astuteness

• Delivering the service e.g. holding to

account, empowering others

Management and Leadership

• Management produces order and consistency

• Leadership produces change and movement

• Both are essential

Kotter 1990

Management and

Leadership

• Management : ‘Do the right thing’

• Leadership: ‘Be the right thing’

Tasks of Leadership

• Define the task

• Initiate the action

• Control the action

• Support people to get things done

• Inform people

• Evaluate

What makes a good leader?

• Clear vision/task

• Willingness to learn from experience

• Self-awareness

• Liked but also willing to take unpopular

decisions

• Valuing their team

• Capacity to follow

What makes a good leader?

• Good communicator

• Flexible/adapatable/undogmatic

• Organised

• Capacity to contain anxiety

• Capacity to understand and manage

complexity and conflict

Trust • Leaders must earn their followers’ trust

but followers have to be capable of trust

• Value of open, honest conversations

between team members

• Plan needs co-ownership between

leader and team

• Value of a critical friend

Look after your team

(and yourself)

• Keep in mind less empowered members

of the team

• Listen and try to understand

• If you disagree, do so with respect

• Protect yourself

Systemic awareness

Different levels of the organisation:

• Individual

• Interpersonal

• Group

• Intergroup

• System

Awareness of Group

Dynamics

• Unconscious processes that take place

• Splitting and projection

• Idealisation and denigration

• Envy and jealousy

• ‘Taking the irrational seriously’

Group Relations concepts

• Boundary

• Authority

• Role

• Task

• ‘BART’

A-10 General Systems

Diagram

A-10 Cockpit

Simulation

A-10 Cockpit Diagram

Cockpits are organised with

4 primary groups of panels and instruments

Navigation Instruments: tell your orientation to your goal or destination

Engine Instruments: tell you whether you have the thrust to get there

Control Instruments: tells your 3-dimensional orientation to earth

Communication Equipment: permits you to communicate with others

A-10 Cockpit

Instruments

A-10 Cockpit

Navigation

Instruments

A-10 Cockpit Engine

Instruments

A-10 Cockpit Control

Instruments

A-10 Cockpit

Instrument Groups Navigation Engine

Control Communication

• Vision—(Navigation)

• Communication— (Dialogue)

• Motivation—(Drive)

• Control—(Guidance)

• Context (Situational Awareness)

• Personal Presence (Self Awareness)

Six-Dimensional Leadership

6 Dimensional Leadership:


Vision—Navigation

The Foundations of Leadership

Vision covers the ability to articulate a compelling

image of the team’s primary goal, and to provide

original ideas for achieving it. It also includes the

capacity to remain focused on the ‘big picture’

without getting distracted, lost in irrelevant details,

or sidetracked by personal ambitions.


Communication

Communication includes the skills to

communicate information accurately, clearly and

sensitively within and outside the team. It involves

giving and receiving feedback openly, and

mediating the team’s relations with outside

constituencies, without distorting or

misrepresenting important information.



Motivation—Drive

Motivation includes personal drive and the

capacity to demonstrate commitment and to

inspire others. It involves persuading team

members to work towards achieving a common

goal, and taking initiative without discouraging

others, hanging back, or putting one’s own

individual accomplishments above those of the

team.



Control—Guidance

Control refers to the ability to guide the team’s

efforts with sensitivity and balance. It includes the

capacity to stay attentive to the team’s progress

and take corrective action when necessary,

without being overbearing, or inhibiting the

initiative of other team members.



Context — Situational Awareness

Context covers taking into consideration and

working with the environment in which the team

operates. It involves remaining aware of the

surroundings even under high pressure, and

demonstrating the capacity to deal with external

demands without being excessively compliant or

unnecessarily rebellious.


Know Thyself Inscription above the Temple of Apollo

at Delphi – Greece, IV Century B.C.


Personal Presence—Self Awareness

Personal Presence entails personal integrity, self

awareness, and the courage to take responsibility

for one’s actions. It involves the willingness to take

emotional risks, speak one’s mind, and

demonstrate reliability to the team, while not

blaming others for one’s own mistakes.


• Navigation—Goal (Vision)

• Communication—(Interaction)

• Engine—Propulsion (Motivation)

• Control—(Guidance)

• Situational Awareness (Environmental Context)

• Personal Presence—(Self Awareness)

Six-Dimensional Leadership

Conclusion

• Leadership a very important issue in

today’s NHS

• Importance of both leadership and

followership

• Be clear about the task

• Value of good multidisciplinary

teamwork

Video Clips

• Leadership lessons from dancing guy

• Lessons from geese

Discussion

• Your experience in CAMHS teams

• Tier 3? Tier 4?...

• What kind of Consultant do you want to

be?

Clinical Leadership - Royal College of Psychiatrists Goldin Presentation final.pdfSir John Tooke, 2008. Aspiring to Excellence Clinical leadership • Need for a culture that recognises

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