Weak chainconnectionsFocus on medical leadership has been increasing in recent years. The benefits are well documented. It is well accepted that good leadership brings mutual benefits for patients, organisations and individual doctors. However the concept of leadership varies to some extent between different authors. I’d summarise it as ‘getting things done through other people’. That’s a simple memorable statement which could easily be accused of disguising the complexity of the challenge. The overall intention of medical leadership is fairly easy to define: effective, efficient and compassionate patient care. That’s the end result. The big question is, ‘how to achieve this?’

The direction of leadership development

Much leadership discussion and development is directed toward the human interaction between leader and follower. This idea would seem to sit very comfortably with the concept of ‘getting things done through other people’. However, the concept of leader and individual follower misses the point that the follower will, more often than not, have to work with others to achieve the desired outcome. Modern healthcare is delivered via groups of people, rather than by individuals. A single patient is likely to be cared for by a consultant plus ST and Foundation doctors from the same specialty. They may well require care of doctors from more than one specialty. They have their own GP. Locums cover holidays and absences. Nurses and a broad range of other health or social care specialists could be involved. For the patient’s care to be efficient and effective these various professionals must act together as one functional team.

The problem

Groups of people do not automatically form coherent teams. It requires dedicated focus. As such, this is a matter for medical leadership. My peer reviewed research into the team interaction behaviours of over 200 doctors has now been published in BMJ Leader. It identifies a number of issues. The self-assessment of the participating doctors indicates:

  • 45% are not challenging or giving feedback to their colleagues
  • 42% are not proactively seeking honest feedback
  • 40% are not discussing progress toward goals
  • 39% are not discussing the support they require to fulfill their role
  • There are also significant mismatches in perception. Attitudes of “I am committed but others are not” and “I am willing to help others but they are not willing to help me” are also apparent.

There must be questions here about the Duty of Candour. The suggestion is that doctors are seeing things which are not good enough, even wrong, yet not discussing this with their colleagues. At what point does the Duty of Candour actually begin? The shortfall’s in team interaction must have direct on the delivery of patient care, efficiency of organisations and the day to day experience of individual doctors.

 The challenge

Efficient, effective, compassionate patient care is the headline goal. To achieve this, leaders must focus on teams as much as they focus on individuals. Great teams don’t just happen. They have to be consciously nurtured and maintained.  Leadership development must therefore go beyond the ability to influence and support individual followers. Great leaders take proactive steps to gain insight into the complexities of team interaction and communication skills.

What steps are you taking to improve your team leadership?

Stephen McGuire – Head of Development