Effective medical leadership for consultants: personal qualities and working with others
Authors: Matt Green, Lynne Gell
Publication date: 14 Nov 2012
In the first of two articles on the Medical Leadership Competency Framework, Matt Green and Lynne Gell introduce two of its domains
The link between effective medical leadership and innovation and improvement in service delivery is well documented.   Engaging staff through effective medical leadership to maintain wellbeing, morale, and alignment with the values of the organisation is key to delivering high quality care and a positive experience for patients. 
In the past decade there has been a focus on the importance of encouraging consultants to embrace leadership to enhance the quality of patient care. The BMA’s Central Consultants and Specialists Committee, for instance, is clear on the importance of leadership in the consultant’s role.
The Medical Leadership Competency Framework
A key tool to support doctors in developing and enhancing their leadership competencies is the Medical Leadership Competency Framework (fig 1 ), produced jointly by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges. Each of its five domains—demonstrating personal qualities; working with others; managing services; improving services; and setting direction—is further divided into four subdomains. These subdomains outline the competencies that doctors at undergraduate, postgraduate, and senior level should strive to develop to become more effective in the planning, delivery, and transformation of health services.
A common misconception among doctors is that you either specialise in leadership within your role as your career develops or you avoid it. The Medical Leadership Competency Framework promotes the idea that leadership is the responsibility of all doctors at every stage of their career through a shared leadership approach. Research has shown that, within healthcare, shared leadership delivers the best results through a shared sense of responsibility for the success of the organisation and the quality of the services provided. The framework is built on this concept, whereby at whatever level, be it within a ward based team or the directorate: it is not just those in designated leadership roles who contribute leadership behaviours.
Not only can the framework be embraced by consultants to further their own leadership development; it can also be used as a vehicle—through appraisal and workplace learning—to enhance effective team working through a clearer understanding of the competencies that support effective shared leadership.
Demonstrating the personal qualities of an effective leader
The first domain of the framework, “Demonstrating personal qualities,” comprises four subdomains (fig 2 ): developing self awareness, managing yourself effectively, continuing personal development, and acting with integrity. Many consultants have not experienced the self reflection process that current junior doctors go through in the development of their portfolio, so for consultants this domain can be an excellent reference base against which to appraise personal qualities and determine areas that can be developed.
Developing your self awareness
One of the foundations of effective medical leadership is the development of a deeper awareness of your own self through reflective practice. Gaining a clearer understanding of how your own values, principles, and assumptions influence your day to day behaviour and decision making, and the manner in which you interact with others, will give you a solid foundation on which to develop your leadership skills.
The ability to reflect and to acknowledge how your own values, principles, and assumptions can differ from those around you is a key step towards developing self awareness. Feedback through self assessment tools, psychometric testing, and multisource feedback, such as “360o appraisal,” is a highly effective way to gain a clear view of your current leadership behaviours and of what areas you can seek to develop.
Managing yourself effectively
The ability to manage efficiently and effectively the myriad of clinical, personal development, and extracurricular activities that many consultants are involved in is pivotal to supporting your development as an effective leader. When was the last time you took a step back and reviewed in detail how you plan, prioritise, and undertake your own day to day activities and those of your team or department? What are your short, medium, and long term goals, personally and for your department?
Appreciating how poor time management can contribute to stress and reduce your ability to lead effectively is vital. In a given situation, do you find yourself taking things personally, or do you eliminate emotional bias and respond constructively? Efficient planning of your time will invariably reduce your stress levels and enable you to perform optimally as a leader.
Developing your leadership skills through continuing professional development
Is your personal development plan, created as part of your own appraisal process, up to date? Does it include development actions in relation to improving your leadership skills? With the imminent introduction of revalidation for all doctors, and given the central role of appraisal in this process, now is a good time to consider how developing your leadership skills will form part of your continuing professional development activities.
Accessing a mentor or coaching scheme is a good way to develop your leadership skills and well worth exploring. Also, attending a leadership course can be beneficial. The course’s duration, assignments, use of real life medical leadership case studies, and action learning should all be considered when reviewing the course programme. 
Acting with integrity—being a role model
How many times have you heard the leadership mantra, “Do as I say, not as I do?” How disengaged did you feel? The importance of leading by example and demonstrating professional values, principles, and ethics in your day to day practice as a consultant should not be underestimated. As a good role model who inspires those around you, you must be prepared to lead with integrity, to support those around you, and, where you identify incompetent behaviour or poor quality care, take the appropriate corrective course of action.
Working effectively with others
The framework’s second domain, “Working with others,” comprises the subdomains of developing networks, building and maintaining relationships, encouraging contribution, and working within teams (fig 3 ). Consultants’ ability to engage, inspire, and get the best out of those around them is pivotal to delivering high quality care, but being the most senior person in a team can be a lonely and sometimes daunting challenge.
Developing your networks—breaking down barriers
When was the last time you led an initiative to promote collaborative interdisciplinary working? The ability to break down barriers diplomatically within your organisation and to facilitate collaboration and sharing of resources between teams and across departments is one of the key challenges that consultants face today, thanks to the traditional divisions between professional groups in the NHS.
Working to change the culture of an organisation to promote interdisciplinary working can be a huge challenge that requires determined leadership. Seeking the views, and ideally the involvement, of the wider healthcare team, together with patients’ representatives, to improve and develop services together is an important step towards achieving this.
Building and maintaining productive relationships
An important component of effective leadership is being approachable. When a member of staff comes to you to discuss a confidential matter, are you dismissive or do you listen and show empathy when responding to any concerns raised?
Being a consultant with a supportive attitude rather than a mentality of “I had it tough so need to make it tough for those around me” is much more conducive to gaining the best out of those around you and winning their respect. Treating colleagues with respect and humility will enable you to build and maintain productive relationships, engage those around you, and ultimately improve patient care.
Encouraging contribution from others
How do you actively encourage those around you to contribute to service innovation and improvement? As a consultant leading your team, one of your key responsibilities is to encourage contributions from those around you to improve services. Are you receptive, and do you consider all suggestions made to you with equal measure, or are you prone to dismissing suggestions out of hand because you are too busy to listen?
Engendering an inclusive culture that reflects a primary focus on service innovation and improvement will encourage those around you to pull in the same direction when contributing to a particular project. You should consider taking steps to encourage feedback and suggestions from staff and other service users to support you in your goal of improving the quality of care.
Working effectively within teams
Getting the best out of your team can be the difference between acceptable performance and exceptional performance. When leading a team it is important to ensure that team members are clear on their role, responsibility, and purpose within the team. How often do you make sure that your team is clear about what the ultimate goal is in a given situation or project?
Developing a greater awareness of your personal qualities and the current approaches you take to leading your team will enable you to identify areas you can develop to enhance your leadership skills. Embracing effective leadership will increase job satisfaction for yourself and those in your team and contribute considerably to the improvement of care in your organisation. In the next feature we will explore the remaining three domains of the Medical Leadership Competency Framework.
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.
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- NHS Institute for Innovation and Improvement. Medical Leadership Competency Framework. 3rd ed. 2010. www.institute.nhs.uk/assessment_tool/general/medical_leadership_competency_framework_-_homepage.htm.
- McKimm, J, Spurgeon P, Needham G, O’Sullivan H. Clinical leadership: the challenge for senior leaders. Br J Hosp Med 2011;72:525-8.
Matt Green director of professional development
Lynne Gell director of nursing and healthcare education BPP University College School of Health, London, UK
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