Management and leadership skills for doctors
Authors: Robert Ghosh, Matt Green
Publication date: 23 Bal 2008
Robert Ghosh and Matt Green run leadership seminars for doctors. Here they give some of their top management tips
The management landscape
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 health care within their practice.
The guidelines from the General Medical Council say that management within health care can be defined as: “Getting things done well through and with people, creating an environment in which people can perform as individuals and yet cooperate 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 have not been obvious. Managers would unquestioningly deal with the whims of consultants, around whom the NHS was moulded. But NHS modernisation and improvement is associated these days with non-negotiable targets and codes of practice. So we are encouraged to mix managerial skills with clinical expertise 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 relevant, 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 before 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, 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 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, the 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, the NHS chief executive, the permanent secretary, the 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 the Modernisation Agency and its successors
The important roles of the special health authorities, namely the National Institute for Health and Clinical Excellence (NICE), the National Clinical Assessment Authority, the National Patient Safety Agency (NPSA), the National Blood Authority, and the NHS Information Authority
The concepts of quality standardisation: national service frameworks and healthcare resource groups
The theories behind NHS performance ratings
Financial issues for primary care trusts and providers, including service level agreements and 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 make up of the trust 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
Clinical governance forums
Risk management strategies; National Patient Safety Agency tools
The use 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 monotasking may improve a specific situation, but this could lead to the lack of appreciation of concurrent issues that need 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.
Expertise in this area will help give a sense of direction to your colleagues, who will hopefully have 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 saving much time and effort. The resources may be in the form of written material or expert personnel.
This involves the adoption of simple, yet important, principles. Staff and colleagues need to feel valued; this can be achieved by the regular assessment of their work, the creation of a cooperative atmosphere, and reinforcement of their importance to the team. The setting of standards and targets can 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 can be provided by increasing each individual’s responsibilities. The airing of new ideas from all personnel should be encouraged.
Although several methods may be adopted, there are four main categories:
The directive leader—finds aspects to acknowledge positively 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 are:
Clear understanding of the overall goals of the team
Clear understanding of your own individual responsibilities within the team
Ability to communicate clearly 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. 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.
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.
Acknowledgment: The authors would like to thank John Coakley, medical director, Homerton University Hospital for his valuable input.
Competing interests:Dr Ghosh delivers courses on management topics and leadership skills on behalf of Apply2Medicine, a company that specialises in providing career development courses for doctors (0800 612 1135 or email firstname.lastname@example.org). Matt Green is the director of Apply2Medicine ( email@example.com).
- General Medical Council. Management for doctors. 2006. [Link] .
Robert Ghosh consultant physician and director of intensive care
A1 Homerton University Hospital, London
Matt Green director Apply2Medicine A2 Nottingham