Attaining clinical leadership skills through continuing personal and

professional development (CPPD)

Dr Charu ChopraSpecialist Registrar Clinical Immunology

Objectives

What do we mean by clinical leadership?

Can leadership skills be learned (“innate vs acquired”)?

Medical Leadership Competency Framework (July 2010)

What are the barriers to good clinical leadership?

How can CPPD help overcome these?

What is Clinical Leadership?What is Clinical Leadership?What is Clinical Leadership?What is Clinical Leadership?

Leadership is about setting direction, Leadership is about setting direction,

influencing others, managing changeinfluencing others, managing change

Northouse “A process whereby an Northouse “A process whereby an

individual influences a group of individuals individual influences a group of individuals

to achieve a common goal”to achieve a common goal”1. PROCESS 2. 1. PROCESS 2.

INFLUENCE INFLUENCE

3. GROUP CONTEXT 3. GROUP CONTEXT

4. GOAL 4. GOAL

ATTAINMENTATTAINMENT

The roles of a clinical leader

Leading on call/ take

Leading ward rounds

Facilitating clinical decision making as part of a team (multi-disciplinary teams, staff meetings)

Negotiating and persuading

Dealing with complaints

Training/ supervising

Leadership skills not just important medical/ clinical directors but are relevant for many health care professionals

Setting the scene...

2007: Ara Darzi appointed health minister: A High Quality Workforce:NHS next stage review published. Darzi’s vision - quality at the heart of health care provision. “Engaging clinicians to implement change”

Clinician as practitioner, partner and leader

New emphasis on clinical leadership

Good clinical leaders and managers are central in instrumenting effective changes/ developments in NHS organisation.

Similar leadership emphasis seen with other health care providers eg Kaiser Permanante in USA.

Is “leadership” more about having certain “traits” (innate) or can certain “acquired” competencies constitute good clinical leadership?

Innate - you’ve either got it or you haven’t! Early 20th Century emphasis on charisma, intelligence, energy and dominance

Literature reviews in 1970’s - no correlation between personality traits and leaders vs non-leaders

2002: weak positive correlation between successful leaders and extraversion, conscientiousness and openness to experience

weak negative correlation with neuroticism

Kouzes and Posner: assert that leadership is an observable, learnable set of practices.

Personality traits, behaviour and leadership

Publication of UK-wide Medical Leadership Competency Framework by the Academy of Medical Royal Colleges and with the NHS Institute for Innovation and Improvement.

Shared leadership: “A dynamic, interactive influencing process among individuals in groups in which the objective is to lead one another to the achievement of group goals.”

Applicable to all medical undergraduates, post-graduates and Consultants

Medical Leadership Competency FrameworkEnhancing engagement in medical leadership,

2010

Demonstrating personal qualities: developing self awareness, managing yourself, CPD, acting with integrity

Working with others: developing networks, building and maintaining relationships, encouraging contribution, working within teams

Managing services: planning, managing resources, managing people, managing performance

Improving services: ensuring patient safety, critically evaluating, encouraging improvement and innovation, facilitating transformation

Setting direction: Identifying the contexts for change, applying knowledge and evidence, making decisions, evaluating impact

Medical Leadership Competency FrameworkEnhancing engagement in medical leadership,

2010

Continuing personal

and professional development

“This way..... I’ll show you how to lead....” How can “leadership” be taught and learned?

CPPD and leadership

MCLF is a useful “framework” to encourage debate about learning and what leadership is.

How do we implement this form of learning from undergraduate to postgraduate years and beyond? How do we assess it?

E-learning: www.e-lfh.org.uk

Reading/tutorials about leadership, insight into own practice, reflection, scenarios, videos

360 degree feedback, peer learning, case conferences, presentations, engage in reflective practice, psychometric testing, patient surveys, mentoring, leading MDTs, involve patients/carers/others in decision making, inter-professional learning etc

Developing leadership skills throughreflective practice

Styles of leadership

Many models/ styles described in the literature

Flexibility in leadership styles required - mould to the situation

Balance needs of patients, the organisation, team, resources

“shared leadership”

How to cope in times of continuous change

Transactional (more managerial / planning) approaches not sufficient in times of change

What are the barriers to effective clinical leadership? - the effects of “power”?

Recent media “doctors are arrogant so and so’s.......”

“Toxic” leaders (Jean Lipman Blumen)

Commissioning to be in control of doctors (= more power?)

Hubris Syndrome (Lord Owen)

“Hubris” Syndrome... Do some clinical leaders risk exhibiting these traits ?

Linked to power

described in politicians, dictators (in the absence of mental illness)

narcissistic propensity to see the world... arena to exercise power and seek glory

take actions to cast themselves in good light

excessive confidence in themselves/ own judgement

loss of contact with reality

restless, reckless, impulsive

HOW CAN WE AVOID THIS: EFFECTIVE CPPD?

Summary

Clinical leadership is an important emerging theme throughout clinical training for all doctors

The MLCF, adapted to the wider context, is a useful foundation to guide training and CPPD

Flexibility in leadership styles ---> more effective

The dangers of bad/ toxic leadership ?hubristic leadership - is this a real problem in the clinical world?