Intended for healthcare professionals

Careers

Will professional standards for medical managers improve patient care?

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6411 (Published 29 October 2014) Cite this as: BMJ 2014;349:g6411
  1. Matthew Limb, freelance journalist
  1. 1London, UK
  1. limb{at}btinternet.com

Abstract

Matthew Limb looks at the first UK professional standards for medical leadership and management

For the first time, professional standards for medical leadership and management in the United Kingdom have been developed, and they are currently open for consultation.1

The standards have been developed by the Faculty of Medical Leadership and Management in a bid to improve patient care. The consultation is designed to establish “comprehensive, high quality, aspirational standards of medical leadership that will contribute significantly to the enhancement of patient care.”

The faculty said that doctors were increasingly being judged on their skills in leadership and management and that they needed to know what was expected of them. Until now, doctors applying for leadership and management roles have had no “gold standard” of achievement to hold themselves to and be measured against, it said.

“We believe the definition of the professional standards of medical leadership and management is long overdue, given the correlation between effective leadership and the quality of patient care, and the increasing accountability and responsibility faced by medical leaders,” it said.

The consultation document recognises that doctors exercise leadership and management in formal and informal roles. It describes the standards that medical leaders must uphold to operate as individuals, as leaders of teams, and as strategic leaders of organisations. “Effective medical leaders must know and understand themselves, their impact on others and be constantly striving to improve.”

The document says that leaders must demonstrate the energy and drive to lead and work with others, understand their strengths and weaknesses, and be accountable for their actions and “emotionally resilient.”

Other qualities listed include acting with empathy, integrity, and humility; showing “moral courage to do what is right”; and encouraging and respecting the contribution of others.

The standards are derived from, and build upon, research on medical leadership, management, and engagement, and earlier work from a range of bodies, including the General Medical Council and the NHS Leadership Academy. Concerns have grown that many doctors are being put off medical leadership roles, and there have been calls for concerted action to “professionalise” medical management careers and boost recruitment to these roles. Factors such as unclear career routes, a lack of support, insufficient training, and unsatisfactory pay or reward disincentives are thought to deter doctors from pursuing such roles.

Robin Cordell, the faculty’s deputy medical director, told BMJ Careers, “The purpose of the standards is to enable any doctor with a leadership and management aspect to their scope of practice to benchmark their effectiveness in this role against an agreed standard for medical leadership.” He said the standards should be seen as “an enabler, not a hurdle,” for someone considering taking up leadership or management roles.

Membership of the faculty

One idea being considered is to award membership of the faculty, or another type of designation to provide doctors with a “marker” for their suitability for senior medical leadership roles, he said. There could also be a diploma or similar award to those “progressing on the pathway” to gain this level of capability and a higher award to recognise contributions made by medical leaders already established at a senior level.

Cordell said that doctors, in achieving the benchmark standard, would be expected to present evidence of their effectiveness in, for example, leadership and management initiatives, knowledge of the area, and outputs from appraisals.

A former medical director’s view

Mark Scriven, who quit his job as an NHS medical director because of severe stress, is keen to see more being done to support people in medical leadership posts. “The whole business of being a medical director has evolved too quickly for any proper response,” he says. “The more medical leaders step up and discuss the stresses and strains, the more people will understand these problems and make appropriate changes.”

Scriven welcomes the Faculty of Medical Leadership and Management’s launch of its consultation on new professional standards for doctors in management and leadership. He says that the faculty is “a very powerful group in terms of pushing the agenda and making boards realise that being a medical director is different from other directors.”

Scriven, who is a consultant vascular surgeon at Wrexham Maelor Hospital, contacted BMJ Careers after reading about barriers deterring doctors taking up leadership posts.2 He described the difficulties he faced as a medical director between 2007 and 2012, a time of “unprecedented” organisational upheaval in the Welsh NHS. He said that pressures with which many medical managers would be familiar built up, leading to two breakdowns and many months off work. “It’s something people don’t talk about,” he said. “I’m from a surgical background and it throws people if you talk about things that you can’t cope with. People somehow think you can cope with anything and, to be honest, I really thought I could.”

He recalls being told quite early on in his career, “If you want friends at work among your colleagues then don’t become a medical director.” He says, “I never really worried about that … but it is a really good way of losing your friends.”

In 2007, Scriven was medical director of the former North East Wales NHS Trust and, when this merged with a neighbouring trust a year later, he became deputy medical director in the enlarged organisation. But the restructuring didn’t stop there. In 2009 he was again medical director, at Betsi Cadwaladr University Health Board, when the board took over the running of most of the local health economy. “I was responsible for 2000 doctors and shared responsibility for a budget of £1.2 billion,” he says. “The enormity of the organisation was predictable, but I underestimated the impact of it.”

Scriven says he had no formal training to deal adequately with the complexities, pressures, and workload brought by the role. He says that he was given flak for financial matters and unpopular service decisions and was not prepared for the levels of “personal vilification” he experienced.

There were also damaging professional and personal rivalries amid differing expectations and levels of understanding about how the new organisation would work. Some doctors with whom he had not worked clinically “turned against” him, he says, while other staff with grievances linked to revalidation or industrial relations disputes also turned hostile.

“Increasingly I felt I was being asked to take responsibility for everything,” he says. “I suspect other medical directors get that, especially in times of austerity, because people think ‘He’s in charge so he’ll make sure we’ll get the money we need,’ but you have no ability to do that.”

Scriven says he was left badly shaken when a number of villagers at one public meeting waved their fists and shouted their disgust, and he requested an escort to his car at one demonstration where he feared he might be attacked. “Some of my colleagues appeared to be able to cope with it and put it in a box and leave it behind,” he says. “It took me about two weeks to get over just that and we had more meetings to do.”

One day in September 2010, after his secretary inquired “innocently” about a family member who had been experiencing problems, he says “my whole brain fell apart.” “I’ve heard the term nervous breakdown and I didn’t know what it meant. But it was just like that. I cried for about five hours and I could barely do anything. I went home and couldn’t leave the house for about two weeks. It was a total collapse of my ability to think or cope.”

He was off work for four months. He had some access to support, but believes more would have been beneficial. He says that at one point he was asked by an occupational health doctor why someone hadn’t spotted what was happening to him. “My answer, without even thinking about it, was, ‘Everyone else is near that point.’ So everyone is trying to cope themselves and there’s nothing left to help anyone else.”

Scriven returned to work in January 2011 and “got a few things sorted out,” working with his executive team whom he found very sympathetic. But the problems built up once more, with “more fights, more problems with money, more consultation,” he says. “It just happened again. Everything fell apart in my head. But that episode was much more dominated by depression; I didn’t really have much anxiety, which is slightly odd.”

His second break lasted 11 months. He has now left management altogether and, following his recovery, has resumed his surgical work in a new role. He says that, although he doesn’t blame anyone for his difficulties, he believes doctors who take up management posts get a raw deal—invariably longer hours, more pressure, and less pay. “You’re trying to do what you feel is a very worthy job, but you’re not given the tools and, in all sorts of different ways, you feel as if you’re punished for doing it,” he says.

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