Intended for healthcare professionals


Learning to lead in medicine

BMJ 2015; 351 doi: (Published 05 October 2015) Cite this as: BMJ 2015;351:h5252
  1. Clare Price-Dowd, senior programme lead, NHS Leadership evaluation
  1. clare.price-dowd{at}


Clare Price-Dowd describes the leadership development opportunities available to doctors at all stages of their careers

In these times of financial challenge, with the NHS facing a potential deficit of £2.5bn, investing in personal or staff development of any kind is often the last thing occupying our thoughts. Yet without a very real and immediate investment in our staff, the NHS will face the same problem one year from now, and the year after that, and the year after that.

We need to work differently; we need our leaders to lead differently. Crucially, we need leaders who can apply their learning to increase innovation, continually improve, heighten productivity, deal with absence and turnover, and reduce the huge costs they create. And we need to learn from past mistakes so that in a drive to manage costs we don’t miss the point of who we are, why we chose medicine as a career, and what really matters. Increasing grip and pressure won’t do it. But developing a new way of leading will.

Worldwide problem

The Development Dimensions International Global Leadership Forecast 20111 shows a real problem with the perceived quality of leaders globally. There is no evidence to suggest that the high quality leaders we need in the NHS are there to be recruited from elsewhere. We are much more likely to be successful by deploying tactics to ensure we grow our own much more effectively and that routine development of talented individuals, linked to career progression, becomes a core part of our business.

There are some good examples of this in the NHS, but not enough. We have clear examples of the failure of leadership leading to an abject failure in care for our patients and the attendant emotional and financial costs.

The case for leadership development across all sectors is well documented. A strong link exists between leadership skills and organisational performance.2 Good leadership and human resources practice in healthcare are linked to lower patient mortality and morbidity rates—more engaged staff, through better leadership, saves lives.3

The high street follows these examples, with retailers having to redesign who they are and what they do to survive in a changing world. Dorothy Perkins and its parent company Arcadia Group analysed how work climate, most informed by leadership styles and behaviours, related to financial performance, and it found the best leaders delivered 17% lower staff turnover, 40% lower absence rate, 35% lower stock loss, and operating savings up by 10%.4

Yet there is nowhere in any of the regulations or measures currently applied to NHS organisations that seeks evidence about a leader’s ability to lead or an organisation’s approach in continually growing and developing its talent. Doctors will often be asked to take on leadership roles, with responsibility for staff objectives, appraisal, and performance management, as well as all other resource management issues, with no leadership development at all. Leaders will be promoted into ever more senior roles with little more than work experience or workshops to help them make the necessary transformation—something that other successful organisations invest in.

Doctors should consider the leadership development opportunities available to support and develop staff at every level, whether they are new to leadership roles or have just attained the senior job to which they aspired. It is important for doctors to identify their own potential and the potential of others that they lead.

NHS Leadership Model

The NHS Leadership Model and self assessment tool has been developed to help individuals understand that it is not just what we do but the behaviours we display when doing it that is important. Effective self management is a central part of effective leadership.

The recognition of personal qualities like self awareness, self confidence, self control, self knowledge, personal reflection, resilience, and determination is the foundation of how we behave and, therefore, how we lead.

Without this, it is much more difficult to behave in the way that research has shown that leaders should. Working positively on these personal qualities will lead to a focus on care and high quality services for patients.

The nine elements of the NHS Leadership Model examine an individual’s leadership style and preferences, providing a starting point for such considerations. In addition, the NHS Leadership Academy’s talent toolkit and talent management programme support the attraction, engagement, development, management, and retention of talent and help doctors maximise their own potential as well as that of their team members.

Engaged staff can deliver improved performance and better outcomes and are more loyal, more productive, and more customer focused. But there are additional benefits to these performance outcomes, in that giving doctors the chance to progress their career in an environment that is supportive will help an organisation to attract and retain talent.

Having identified a leadership development need, the NHS Leadership Academy has a range of programmes and resources available to support doctors at all levels of their career. These range from totally online programmes for new leaders where development is at the pace of the learner, such as the Edward Jenner programme in leadership foundations, through to those seeking board level positions, such as the Nye Bevan programme in executive healthcare leadership. There are also programmes and resources for those in the middle of their career, those in roles that cut across the public sector.

Most importantly, these programmes are delivering results. Findings from independent evaluations of NHS Leadership Academy programmes show that participants report being more confident, capable, and skilled leaders who are able to make and sustain change.


  • Competing interests: To come