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Clinical leadership in medicine is much talked about, not least in the recent BMJ debate on the topic1. The synopsis of the discussion seems to relate to a ‘them and us’ culture, with doctors blaming managers and vice versa. We will each have our own take based on personal experience of trying to get things done in the NHS.
Perhaps a bit closer to home is what makes a good leader within the medical profession? What are the characteristics which inspire and motivate? Doctors are notoriously difficult to lead, being used to making their own decisions, often based on rapidly synthesised complex information under difficult circumstances. You need only look at the entrance exams into speciality training, such as PACES, to recognise that they are about performing under pressure as much as knowledge, skills and attitude. Doctors are usually intellectually gifted, and able to command any number of reasons as to why they should not follow a certain course of action. They are difficult to persuade, and not free of ego – ‘I know best’. Perhaps things are changing, but slowly. And they are busy people.
So what would persuade you to follow a colleague? I am referring to their personal characteristics, rather than financial inducements! Some thoughts are listed below, in no particular order.
Clinical competence – or better still excellence
It is hard to have respect and therefore follow someone who is not in your view clinically competent. This is the ‘currency’ of medicine, it is what we do. We cannot all be the best clinician, but a clinical leader needs to command the clinical respect of his or her colleagues.
Communication skills
It is self evident (and perhaps a bit boring!) to list communication skills as a prerequisite, but a leader must be able to listen to colleagues if he/she is to engender change. Everyone has their own agenda, and the art of leadership is to align those agendae in the desired direction. Sometimes the time is just not right, and a leader will know when not to push at a closed door. This requires the ability to listen, as well as clarity in delivering messages. The leader needs to be multilingual – being able to understand different jargons and world views, and communicate his/ her vision simply and effectively to others from varying backgrounds. A big dose of charisma helps – Obama’s charm.
Leading from the front
A bit like an army officer, leaders need to be seen to do what they say. It is no good having great ideas, evidence-based or otherwise, and then expecting everyone else to get on with it. If you want change, you need to show how it is done. But it is not all about being ‘stormin’ Norman’. Leading from the front can also mean allowing others to take the lead and knowing when to step aside in the pursuit of a greater goal. Selflessness is important – people will quickly spot and stay away from people whose only ambition is self-promotion.
Challenging discrimination
Especially in geriatric medicine, the leader needs to champion the cause and act as a figurehead. In geriatrics, this often relates to ageism, but might be any form of discrimination. A good leader will not acquiesce or condone bad medicine or bad practice. This is about teaching and training as a part leadership.
Consistency
‘You are only as good as your last patient’ – word soon spreads of errors, inconsistencies or other blemishes, which are part of the human condition, but are readily seized upon. Never mind the 999 decisions that were carefully thought out and justified, get it wrong and you may not be forgiven. Perhaps this is a bit harsh, but perceptions of supra-normal performance are a great boost to a leader’s credentials.
Willingness to change and accept criticism
A good leader listens carefully to colleagues, actively seeking out feedback on how things could be done better or differently. And at the same time he/she is careful about criticising colleagues. A degree of humility and a reflective approach is not a bad thing – certainly arrogance is not helpful.
The ‘vision thing’
A common characteristic of leaders in any sphere is the ability to see the big picture, to have the ‘vision thing’ and display dogged determination, persistence, self belief – but not arrogance, and focus in achieving their goal. But as well as the big picture, a leader needs to be able to switch lens and examine the details when necessary – whether clinically or in evaluating a piece of work.
If some of these attributes are true markers of a leader, then it is clear that it is no easy task! Maybe leaders are born, but many of the characteristics mentioned can be acquired. Ultimately we can all show some degree of leadership, but harnessing that leadership for the benefit of frail older patients is the real challenge!
Simon Conroy
BGS Deputy Hon Secretary
Senior Lecturer/Geriatrician
University of Leicester School of Medicine
1. Imison C, Giordano RW. Doctors as leaders. BMJ 2009;338(apr21_1):b1555-.
BGS Newsletter, July 2009
Issue 22 ISSN 1748-6343 22 |