Effective medical leadership for consultants: managing services, improving services, and setting direction
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7845 (Published 28 November 2012) Cite this as: BMJ 2012;345:e7845
- Matt Green, director of professional development,
- Lynne Gell, director of nursing and healthcare education
- mattgreen{at}bpp.com
Abstract
In their second article, Matt Green and Lynne Gell explore how consultants can apply the final three domains of the Medical Leadership Competency Framework
Leadership is a key requirement of doctors’ professional work, as laid out in the General Medical Council’s publications Good Medical Practice, Tomorrow’s Doctors, and Management for Doctors.123 The BMA’s Central Consultants and Specialists Committee is clear on the importance of leadership in a consultant’s role.4
The Medical Leadership Competency Framework (MLCF), developed by the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement, describes the leadership competences that doctors need to become more actively involved in the planning, delivery, and transformation of health services. The framework, first published in May 2008, was developed following a review of literature and key publications, a comparative analysis of other leadership competency frameworks, and an analysis of medical curriculums, as well as consultation with members of the medical and wider NHS community.5
We have previously looked at how consultants can use the “Demonstrating personal qualities” and “Working with others” domains of the MLCF to assess and improve their leadership skills.6 In this article we consider how consultants can apply the three remaining domains of the framework: “Managing services,” “Improving services,” and “Setting direction,” which deal with leadership at a service and organisational level.
Managing services
The third domain of the MLCF, “Managing services” (fig 1⇓), comprises four subdomains: planning, managing resources, managing people, and managing performance.5 Consultants are key players in clinical teams in the NHS and are essential to manage and lead the service.4 Ensuring the correct processes and infrastructure are in place will help to ensure that the services you oversee are fit for purpose.
Failing to prepare is preparing to fail
The contribution of consultants to the planning and enhancement of current services, and to the introduction of a new service, is paramount to the delivery of quality care.4 Having a clear understanding of best practice principles for service planning will give you the best possible chance of success for a given project.7 These include process mapping, action planning, and employing root cause analysis principles.
Any business planning process should be informed by patient or service user feedback, audit results, commissioners’ intentions, staff input, and best practice evidence. You should consider what a successful outcome will look like, including the most appropriate key performance indicators, and what the benefits and risks of the various options open to you are.
Managing resources to reduce unnecessary waste
In the current austerity climate, the need for consultants to work closely with business managers to increase efficiencies is more pertinent than ever before. Having a clear understanding of the budgetary processes within your organisation will help you to identify opportunities to minimise waste and to improve efficiencies. Your priority must be continually to review the most appropriate level of resources required to deliver safe and effective services. Setting aside time for regular meetings with your team to review financial performance against the budget will help you to tackle any inefficient uses of resources as they arise and implement corrective measures.
Managing people effectively
Line management responsibilities can pose one of the biggest challenges to consultants. As a consultant you should contribute to refining the various human resources processes that affect your department—such as recruitment and selection, appraisal, and mentoring—to ensure they are fit for purpose.4 Formal training on how to conduct appraisals effectively should be sought, and the benefits of multisource feedback as part of the appraisal process should be explored.8
Managing performance to achieve exceptional results
Consultants can use performance management techniques to support, energise, and empower staff to improve their performance. A clear understanding of the principles of performance management of individuals should be sought, such as supporting poorly performing colleagues to improve through regular competency based review meetings to monitor progress. Clear communication and monitoring of goals and targets is a key principle to encourage colleagues to take personal responsibility for outcomes.
Consultants may also find themselves in charge of managing the performance of a particular project. When doing so, you must ensure that you have access to the relevant information and key performance indicators so that you can make informed decisions.
Improving services
The fourth domain of the MLCF, “Improving services” (fig 2⇓), comprises the following four subdomains: ensuring patient safety, critically evaluating, encouraging improvement and innovation, and facilitating transformation.5
As well as providing leadership of services and staff, consultants are also expected to pioneer and drive forward new models of service delivery.4 Consultants should work to develop critical evaluation skills, improve risk management strategies, and manage change effectively to facilitate the improvement of healthcare services.
Patient safety is at the heart of leadership
As a consultant you have ultimate responsibility for the care of patients treated by your team. Ensuring that systems and processes are in place to identify and reduce risks to patients is one of your key responsibilities. When was the last time you performed an audit with your team or actively contributed to the formulation and implementation of clinical governance strategies? Promoting a culture of transparency to ensure staff raise any concerns immediately in relation to patient safety is also paramount.9
Critically evaluating information
The ability to collect and critically evaluate patient, carer, and colleague feedback, together with departmental performance data, forms one of the cornerstones to successfully leading service improvement initiatives. In addition, ensuring that decisions are based on relevant and accurate data is vital to effective service delivery. When reviewing performance data you must always be clear on the source of the information and any limitations associated with the data that could negatively influence your decision making process.
Encouraging improvement and innovation
Developing an inclusive culture in which staff feel safe to contribute and debate ideas on how to improve services should be a key priority for consultants. This can be achieved through a variety of approaches such as regular “open door” meetings, a dedicated email address to submit suggestions, and the inclusion of service improvement as an item on the agenda in staff meetings. Acting as a positive role model for championing improvement and innovation, and ensuring suggestions are considered fairly, will encourage further contributions.
Facilitating transformation through effective change management
Transforming any service requires change, which staff can find difficult. Service innovation therefore requires strong leadership from senior doctors to see any project through.
It is important to acknowledge the impact that changes in the workplace can have on staff morale and performance. A clear understanding of the principles of effective change management will give you the skills required to facilitate what can often be an arduous journey towards achieving successful change. A clear explanation of why change is needed and how this will impact on staff will eliminate many of the problems that can arise when change is managed poorly.
Setting direction
The final domain of the MLCF, “Setting direction” (fig 3⇓), consists of the following four subdomains: identifying the contexts for change, applying knowledge and evidence, making decisions, and evaluating impact.5 Effective leadership in setting the direction of healthcare provision forms the pinnacle of how a consultant’s leadership activities can drive forward the enhancement of services.
Identifying the contexts for change
Effective leadership by consultants must be underpinned by a clear understanding of the bigger picture in terms of current and emerging political, organisational, and professional factors to contribute to the future direction of their organisation.
What departmental systems or processes do you have in place to appraise the environment of your organisation to respond to these factors and identify areas for improvement? Clearly and consistently communicating your vision and aspirations with both medical and NHS management colleagues will ensure that you are all pulling in the same direction.
Regular contribution to, and attendance at, conferences and workshops will help you to identify emerging trends and best practice principles that you can use to influence the development of future service provision within your organisation.
Applying knowledge and evidence to enhance care
The concept of evidence based practice resonates more with consultants than with senior professionals in non-healthcare arenas. Using evidence in your approach to leadership is just as important. As a consultant it is your role to use audit outcomes to challenge current practice and to influence decision makers to implement changes to enhance care.
Making informed decisions
Consultants are responsible for setting priorities for change through departmental and organisational business plans. When participating in strategic decision making, at departmental and organisation level, you must be consistent with the values and priorities set down by your organisation and your profession.
Informed decisions require appropriate and accurate collation of information and effective analysis against agreed key performance indicators. It is also your responsibility to engage with decision makers to ensure that their decisions are made on an informed basis.
In addition, decision making should be an inclusive process whereby you engage key stakeholders to gain their input and to ensure they are clear on the clinical implications of a given service redesign project and any impact on the patient experience.
Evaluating the impact of service improvement
Overseeing the successful implementation of a new or enhanced service requires consultants, who are often the project lead, to ensure processes and agreed key performance indicators are in place to measure the impact of the change. It is also important to note that once a successful enhancement has been made, it is your responsibility to coordinate the dissemination of this success to a wider audience through speaking at conferences, submission to journals, and contribution to updating or introducing guidelines.
Conclusions
Modern healthcare requires strong leadership by consultants to ensure that the quality of care received by patients continues to be improved. The MLCF can be used by consultants to enhance their own leadership skills and to promote shared leadership within a team, department, and organisation. The next decade will be no different, and we will continue to see changes in the provision of healthcare in which leadership by consultants will play a key role.
Footnotes
Competing interests: MG and LG are employed by BPP University College School of Health, which provides leadership and management courses for NHS organisations across the United Kingdom.