Ready Doctor? Er… No!

Traffic lights at amber

New junior doctors feel unprepared for work. That’s the stark headline in HSJ where they report on an interview with Professor Wendy Reid, Medical Director and Executive Director of Education, Health Education England. Dr Reid goes on to describe the problems being encountered by new doctors as they leave medical school and take up their first roles in hospital.

It’s more than just finding themselves in a new hospital environment. It’s more than finding themselves working with new people they have never met before. It goes well beyond just moving to a new town or city away from family and friends – and that’s a major life transition if ever there was one. Professor Reid is making a point about how well medical schools are preparing students to actually work as doctors.

But let’s concentrate on the human aspects of the new doctors’ experience. Let’s consider the culture they discover when they arrive in their new placement.

Problematic subcultures

The General Medical Council recently published a report titled, “How doctors in senior leadership roles establish and maintain a positive patient-centred culture.” This document describes five problematic subcultures which exist in many areas of the NHS. It includes:

  • Diva subcultures where self-centred dominant people are allowed to get away with inappropriate behaviour while everyone else make adjustments to avoid confrontation.
  • Factional subcultures where mismanagement of disagreements lead to people choosing sides and organising themselves around the conflict.
  • Patronage subcultures where there is reluctance to challenge highly respected, well-liked and/or supportive individuals through dependence or loyalty.
  • Embattled subcultures where the constant pressures have led to collective feelings of being under attack and/or hopelessness.
  • Insular subcultures where people have become isolated from the mainstream, either geographically or psychologically, leading to deviations from accepted standards.

Any of those sound familiar? It’s worth thinking of this list as a Venn Diagram because it’s not unusual to find more than one of these subcultures existing within one single group of people.

Now pause and think. What impact are these subcultures having on the latest cohort of new junior doctors? In the short term, will they simply join in and participate in these problem groups? Long term, what will they “learn” from experiencing bad examples? Some of them may recognise this is not how things should be and take positive action. Unfortunately, many may simply learn how to become part of the problems. If this is the case, then the subcultures will not only persist. They will grow. The cycle goes on. Year after year after year.

Breaking the cycle

Let’s return to that HSJ interview with Professor Reid. “Positive investment [in education] and training is how you get the workforce you need.” “It’s not just about recruiting more medics but also how they can be used differently in the system.”

Healthcare workforce education and training has to go beyond the natural sciences and technical sciences. There is a wealth of social scientific development which has great benefit to patients, workforce and organisations alike.

There’s a popular drive toward development of leadership skills for doctors. This should be applauded. But are we developing people to lead individuals or to lead teams? If the toxic subcultures are to be addressed, then there’s a need for both. Leading people requires you to develop clear understanding of them as individuals. Leading teams requires you to develop clear understanding of team dynamics.

You have to learn the differences between healthy teams and dysfunctional teams. You have to learn how teams develop and why they can go wrong. And you have to learn how to resolve problems when they occur.

The best leaders don’t just strive to develop both their individuals and their teams. They recognise that they are not alone. So, they recognise they must form and participate in leadership teams. Team communication skills are therefore a fundamental building block of great leadership skills.

What steps are you taking to develop your team communication skills?

Stephen McGuire – Managing Director