‘Leaders are made, they are not born. They are made by hard effort, which is the price all of us must pay to achieve any goal worthwhile.’
Leadership within the NHS has never before received so much attention! Recognition that leaders who understand relevant issues and have the required skills and characteristics to run services while retaining and developing a stressed workforce is long overdue, but welcome.
The relevant issues relate to the delivery of safe care to individuals and populations, some of whom are vulnerable, in a complex, commonly high risk and rapidly developing environment with limited resources.
This complexity, driven by clinical demand and new medical developments has emphasised that clinical leadership has not only become essential but it is the responsibility of those who are delivering front line care. Up to date professional knowledge is the only workable route to improving current, and developing new, ways to deliver care for the people who need it. The available choices and apparently impenetrable variation in options, systems and outcomes can only be navigated by suitably experienced clinicians. Clinical leadership has a positive impact on the quality of health care being provided, a hospital’s social performance and the optimal use of financial and operational resources.
Medical leadership, as compared with generic clinical leadership, specifically has been shown to improve organisational performance, patient satisfaction and to reduce morbidity rates; reducing the number of doctors on boards has been shown to have a markedly negative consequence on hospital performance. In short, there is good evidence of a positive link between doctors at senior strategic and organisational governance level with fewer serious incidents, better delivery of targets and core standards, lower mortality rates and sounder financial status being reported.
The reasons for this are not known but it has been suggested that the emphasis of clinicians on quality rather than targets, and on compassionate care rather than competition and regulation may be important factors.
However, it is not only at a senior level that clinicians can effect change through good leadership; in fact, most improvements occur within individual departments or units driven by those who recognise what needs to change and how to do it – bringing their colleagues with them. Leadership is everyone’s business! In order to help foster such skills it is absolutely clear that leadership training needs to be incorporated into all medical curricula – from the early stages of under-graduate to all levels of post-graduate training. Medical leadership is one of the GMC’s general professional capabilities and as such it is required to be part of the post graduate curricula of all Medical Royal Colleges; and a leadership framework for medical schools is now also available. In addition, high quality educational and experiential learning opportunities should be made available routinely for those interested in becoming medical directors or CEOs.
The Faculty of Medical Leadership and Management (FMLM) has been instrumental in promoting training for medically well led services. However, this is the responsibility of many groups including educators, employers, standards setters, regulators and negotiators to provide support, time and funding if the full leadership potential within the medical profession is to be realised. Never before has the opportunity to work together been so evident.