Management Topics and Leadership Skills for Doctors

Matt Green, Director, Apply2Medicine

The relevance of management competence

All doctors have an obligation to be aware of the principles of effective management and to work cohesively in multidisciplinary teams. They must be able to draw upon a variety of resources, play a role in setting and developing priorities, and take the lead in improving the provision of healthcare within their practice.

The Guidelines from the GMC1 suggest that management within healthcare may be defined as: ‘Getting things done well through and with people, creating an environment in which people can perform as individuals and yet co-operate towards achieving group goals, and removing obstacles to such performance.’

It quotes ‘selflessness, integrity, objectivity, accountability, openness, honesty and leadership’ as its seven principles of effective management.

Historically, incentives for doctors to become engaged in management issues were not obvious. Managers would unquestioningly deal with the whims of Consultants, around whom the NHS was moulded. In contrast, NHS modernisation and improvement is associated these days with non negotiable targets and codes of practice. We are therefore encouraged to mix managerial skills with clinical expertise in order to achieve patient benefit, establish authority, facilitate change and equip ourselves to deal with crises. Indeed without these skills, there is the risk that our clinical objectives will not be met, and that our authority will be lost.

Therefore, the philosophy of ‘management being too important to ignore’ seems to be increasingly germane, while the contrarian approach that ‘I’m too busy to deal with management’ increasingly is not.

Numerous strategies have been initiated in an attempt to increase doctors’ involvement in management. Applicable topics are beginning to be included in the undergraduate curriculum; junior trainees are progressively more exposed to management lectures; senior trainees are often required to have fulfilled management objectives prior to Completion of Specialist Training. Even those newly incumbent in established Consultant posts, who have ‘slipped through the net’ are frequently instructed by their employers to satisfy management goals. The latter is often best achieved by way of practical experience; duties acquired by delegation are probably more useful than shadowing a manager for a day.

An understanding of the structure of the health service, both local and national, is fundamental to understanding the framework within which to apply management and leadership skills.

History and current affairs

Never before has this been more pertinent to clinical practice. The broadsheet newspapers and some professional publications (such as BMA News) contribute to our understanding of topics which include the following:

• The evolution of the NHS in 1948; the implementation of ‘Working for Patients’ in 1989; the conception of the NHS Plan in 1998; the model for performance indicators in 2001 and 2002.
• The definitions of and relationship between, the Houses of Parliament, Secretary of State, Strategic Health Authorities, Independent Regulators (for Foundation Trusts), Primary Care Trusts, Acute Trusts (including NHS Foundation Trusts) and Non NHS institutions.
• The remit of and individuals involved in, the Department of Health; this would include the  Secretary of State, NHS Chief Executive, Permanent Secretary, Chief Medical Officer, other members of the Board and other ministers for Health.
• The concept of modernisation, and the birth of the Modernisation Board and Modernisation Agency.
• The important roles of the Special Health Authorities, namely National Institute of Clinical Excellence (NICE), National Clinical Assessment Authority, National Patient Safety Agency (NPSA), National Blood Authority and the NHS Information Authority.
• The concepts of quality standardisation: National Service Framework and Healthcare Resource Groups.
• The theories behind NHS performance ratings.
• Financial issues for Primary Care Trusts and providers, including: Service Level Agreements, Payment by Results.

Local management topics

A working knowledge of issues within the acute Trust will help develop an understanding of perpetual pressures on key personnel:

• The makeup of the Trust Board (‘Clinical Board’), with models for delegation of duties
• The management structure of a Directorate and the impact of the Department
• Financial and Corporate Governance; reminder of the collective responsibility to avoid loss
• Planning: Long Term Service Agreements
• Standards of business conduct
• Data protection
• Clinical Governance forums
• Complaints handling
• Risk Management strategies; NPSA tools
• The usage of clinical audit to improve quality and clinical effectiveness
• Appraisal, job planning and (re)validation
• Why Business Cases succeed or fail

Efficient time management

This is vital for dealing with onerous administrative duties; many courses and seminars exist to help develop this skill. There should be rapid identification of the type of action required for each task – this may include the disregarding or delegation of the job (‘do it, dump it or delegate it’). The entire institution should be taken into consideration; meticulous mono-tasking may improve a specific situation, however this may lead to the lack of appreciation of concurrent issues requiring attention. Skills acquired may be applied to clinical practice; conversely, valuable time-organisation skills applicable to management may already have been achieved in the clinical field.

Prioritisation

Expertise in this area will help give a sense of direction to your colleagues, who would have hopefully been included in the decision making. The rationale behind the thinking should be clear.

Identification of the best resources in order to achieve goals

If done rapidly, this is the basis for the saving of much time and effort. The resources may be in the form of written material or expert personnel.

Effective leadership

This involves the adoption of simple, yet important, principles. Staff and colleagues need to feel valued; this may be achieved by the regular assessment of their work, the creation of a co-operative atmosphere, and reinforcement of their importance to the team. The setting of standards and targets may help provide development opportunities. Training and practice development is often best facilitated while performing day to day clinical duties (‘real time’ training). On occasions the skills of the staff will need to be stretched. Achievements of colleagues need to be recognised, success should be praised, and consideration should be given to publicising the individual or team’s accomplishments. Challenges may be provided by increasing each individual’s responsibilities. The airing of new ideas from all personnel should be encouraged.

Leadership Styles

Although several methods may be adopted, four main categories may be identified:

• The directive leader: finds aspects to positively acknowledge and give direction, and ensures that those under their management understand what is expected of them.
• The supportive leader: coaxes ideas from those working under them, listens and encourages, and keeps the decision-making process collaborative by asking open questions.
• The coaching leader: finds topics to praise, leads with novel ideas, explains the rationale, consults and listens before arriving at a final decision.
• The delegating leader: allows others to take the lead, asks to be kept informed and challenges those working under them to excel.

The approach one chooses to adopt should be tailored towards the particular situation, individual or goal in question. Effective leaders use more than one style to maximise the competence and commitment of the people they work with.

Effective team working

It is common knowledge that working effectively as part of a team is vital to delivering high quality treatment to patients. All doctors must demonstrate an appreciation of what makes a good team and good team players. Some desirable characteristics required to achieve this include:

• Clear understanding of the overall goals of the team.
• Clear understanding of your own individual responsibilities within the team.
• Ability to clearly communicate with your team members.
• Ability to listen to the views of others.

Motivating your colleagues

Motivation enables individuals to act and behave in the way they do. Hence it follows that in order to best influence your colleagues, their motives (and therefore scope for motivation) need to be identified. A highly motivated doctor is more likely to acquire new skills or make changes to improve performance.

Conclusion

Doctors of all degrees of seniority are responsible for running teams, departments, directorates or Trusts. Effective team working is underpinned by effective leadership and management, and is central to the goal of delivering first-rate patient care. Doctors, as leaders and managers, should understand the value of motivation, and vary their leadership style according to the demands of the task and the needs of the individuals within the practice. A working knowledge of current affairs, topics of national relevance and local issues provides a framework within which to exercise management and leadership skills.

References

1: General Medical Council Guide – Management for Doctors

Acknowledgement: The authors would like to thank Dr John Coakley, Medical Director, Homerton University Hospital for his valuable input.

Conflicts of interest: Dr Ghosh delivers courses on Management Topics and Leadership Skills on behalf of Apply2Medicine (0800 612 1135 or email info@apply2medicine.co.uk).

Matt Green is the director of Apply2Medicine, a company which specialises in providing career development courses for doctors (matt.green@apply2medicine.co.uk)

Robert Ghosh, Consultant Physician

mailto: Homerton University Hospital, London

irghosh@aol.com