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There has been a great deal said, at BGS Scientific meetings and elsewhere, about “leadership”. I welcome the fact that the BGS is taking an interest in this issue.

I feel that modest and gentle souls like geriatricians, mistaking certain leadership attributes for arrogance or aggression, may have overlooked its importance. I also fear that modern training, with its emphasis on competence, risks encouraging new trainees to be foot soldiers rather than the leaders that consultants in the NHS need to be in order to protect and develop the care for our patients. One cannot help but use military analogies here, but if we do not defend the needs of our patient group, sure as heck some other well led group will succeed at the expense of them.

I suspect that all doctors, by and large being intelligent, dedicated, talented and able communicators, may find leadership quite natural. Of course doctors are not the only people with these attributes. And not all doctors have them. Doctors, whether leading a clinical firm, or ward care, a general practice, or an operating theatre, need to be leaders in much of what they do. Leadership skills in medicine are not solely for clinical directors.

The old fashioned military analogy does not quite hold true in medicine, I believe. A military leader relies, I presume, to a large degree upon hierarchy, a top-down approach, with a strong power relationship. Clinical directors cannot courtmartial errant consultants, nurses or therapists, even though they might at times wish they could. In military settings it is likely that the top brass have the most intelligence (in both senses of the word perhaps). In medicine, this is less likely to be true: clinical directors are peers of the consultants they manage, and those working in clinical settings are party to intelligence (information) that their managers might be unaware of. In medicine and the health and social services (as I suspect, in reality it is also in the military), the process is more subtle and consensual.

All leaders have to know their job. Competence is necessary but far from sufficient. Having a vision, understanding it, analysing and being able to communicate it is critical. This requires intellectual intelligence. I have always been impressed with native quick wittedness of everyone I have met in leadership positions and I am sure this is not a coincidence. But this too is not sufficient. Some degree of drive, focus, competitiveness and, perhaps, some degree of aggression are necessary. Certainly I have also seen these attributes in leaders I have met, and again this is not accidental.

The more subtle attributes relate to team work. Here I would like to quote what was just a throw-away comment from Professor Peter Fentem, previous Dean of Nottingham Medical School, that teamwork was “taking pleasure in the success of others”. Here was an internationally renowned scientist, not striving for self achievement at the expense of others, but achieving it through the success of others. Looking at top people and how they deal with others is instructive, and I hope to learn from more such observations. To summarise what I think I’ve seen: choose good people to be in your team (that is a skill in itself). Next, work out what they want and need, and why they want and need it, and that takes time. Look for their strengths and weaknesses, without being judgmental. This is equally important when working with those who you did not choose or do not have direct responsibility for. Take a reflective stance so as to encourage it in them. Where it is yours to give, delegate responsibility, let them make mistakes and respond to the consequences of their actions. The standard to uphold is the highest possible: nihilism and defeatism help no-one.

Training and developing leadership is something that should not be overlooked, but can’t be taught or tested in the way that a technical skill can be. I do not think leadership training should be confined to a minority, nor to senior staff only. In SpR training, for example, the first steps might be to spend some time looking at how teams function and considering examples of successful and failed teamwork. The old fashioned apprenticeship model, which modern training may sometimes make difficult, allows a trainer to show a trainee what goes on behind the scenes to make a service work, intellectually and practically. Recently there has been talk that junior consultants should receive mentorship from senior consultants. Certainly, I think all staff should aim to seek out people who can be their mentors. This is crucial, as mentors cannot be imposed. Perhaps everyone should be both a mentor for some else, and have a mentor themselves.

John Gladman
Head of Division of Rehabilitation and Ageing
Queens Medical Centre
Nottingham

BGS Newsletter, July 2009
Issue 22 ISSN 1748-6343 22