Disruptive behavior its impact on staff & patient safety
Cppd leadership
1. Attaining clinical leadership skills
through continuing personal and
professional development (CPPD)
Dr Charu Chopra
Specialist Registrar Clinical Immunology
2. Objectives
What do we mean by clinical leadership?
Can leadership skills be learned (“innate vs
acquired”)?
Medical Leadership Competency Framework
(July 2010)
What are the barriers to good clinical
leadership?
How can CPPD help overcome these?
3. What is Clinical Leadership?
Leadership is about setting direction,
influencing others, managing change
Northouse “A process whereby an
individual influences a group of individuals
to1. PROCESS
achieve a common goal” 2.
INFLUENCE
3. GROUP CONTEXT
4. GOAL
ATTAINMENT
4. The roles of a clinical leader
Leading on call/ take
Leading ward rounds
Facilitating clinical decision making as part of a team (multidisciplinary teams, staff meetings)
Negotiating and persuading
Dealing with complaints
Training/ supervising
Leadership skills not just important medical/ clinical
directors but are relevant for many health care professionals
5. Setting the scene...
2007: Ara Darzi appointed health minister: A High Quality
Workforce:NHS next stage review published. Darzi’s vision quality at the heart of health care provision. “Engaging
clinicians to implement change”
Clinician as practitioner, partner and leader
New emphasis on clinical leadership
Good clinical leaders and managers are central in
instrumenting effective changes/ developments in NHS
organisation.
Similar leadership emphasis seen with other health care
providers eg Kaiser Permanante in USA.
6. Personality traits, behaviour and leadership
Is “leadership” more about having certain “traits” (innate) or can
certain “acquired” competencies constitute good clinical leadership?
Innate - you’ve either got it or you haven’t! Early 20th Century emphasis
on charisma, intelligence, energy and dominance
Literature reviews in 1970’s - no correlation between personality traits
and leaders vs non-leaders
2002: weak positive correlation between successful leaders and
extraversion, conscientiousness and openness to experience
weak negative correlation with neuroticism
Kouzes and Posner: assert that leadership is an observable, learnable set
of practices.
7. Publication of UK-wide Medical Leadership
Competency Framework by the Academy of Medical
Royal Colleges and with the NHS Institute for Innovation
and Improvement.
Shared leadership: “A dynamic, interactive
influencing process among individuals in
groups in which the objective is to lead one
another to the achievement of group goals.”
Applicable to all medical undergraduates,
post-graduates and Consultants
9. Demonstrating personal qualities: developing self awareness,
managing yourself, CPD, acting with integrity
Working with others: developing networks, building and
maintaining relationships, encouraging contribution, working
within teams
Managing services: planning, managing resources, managing
people, managing performance
Improving services: ensuring patient safety, critically
evaluating, encouraging improvement and innovation,
facilitating transformation
Setting direction: Identifying the contexts for change, applying
knowledge and evidence, making decisions, evaluating impact
11. “This way..... I’ll show you how to lead....”
How can “leadership” be taught and learned?
12. CPPD and leadership
MCLF is a useful “framework” to encourage debate about learning
and what leadership is.
How do we implement this form of learning from undergraduate to
postgraduate years and beyond? How do we assess it?
E-learning: www.e-lfh.org.uk
Reading/tutorials about leadership, insight into own practice,
reflection, scenarios, videos
360 degree feedback, peer learning, case conferences,
presentations, engage in reflective practice, psychometric testing,
patient surveys, mentoring, leading MDTs, involve
patients/carers/others in decision making, inter-professional
learning etc
14. Styles of leadership
Many models/ styles described in the literature
Flexibility in leadership styles required - mould to the
situation
Balance needs of patients, the organisation, team,
resources
“shared leadership”
How to cope in times of continuous change
Transactional (more managerial / planning)
approaches not sufficient in times of change
15. What are the barriers to effective clinical leadership? - the effects
of “power”?
Recent media “doctors are
arrogant so and so’s.......”
“Toxic” leaders (Jean
Lipman Blumen)
Commissioning to be in
control of doctors (= more
power?)
Hubris Syndrome (Lord
Owen)
16. “Hubris” Syndrome... Do some clinical leaders risk exhibiting
these traits ?
Linked to power
described in politicians, dictators (in the
absence of mental illness)
narcissistic propensity to see the world...
arena to exercise power and seek glory
take actions to cast themselves in good light
excessive confidence in themselves/ own
judgement
loss of contact with reality
restless, reckless, impulsive
HOW CAN WE AVOID THIS: EFFECTIVE
CPPD?
17. Summary
Clinical leadership is an important emerging theme
throughout clinical training for all doctors
The MLCF, adapted to the wider context, is a useful
foundation to guide training and CPPD
Flexibility in leadership styles ---> more effective
The dangers of bad/ toxic leadership ?hubristic
leadership - is this a real problem in the clinical
world?
Editor's Notes
Management is concerned with the marshalling and organisation of resources and maintaining stability. Distinct but complementary to leadership and the both go hand in hand.
Recent article Morrow et al., - (Clinical Teacher) : New Consultants felt relatively well prepared with respect to clinical skills from their SpR training but less well prepared for the management and leadership roles demanded by their roles. These should be explicit parts of the curriculum and assessed with same emphasis as there is on clinical skills.
Non-clinical skills such as chairing meetings, persuading and negotiating, dealing with complaints are all parts of the consultant’s role. Skills based training should be introduced to address these aspects.
Quintax day - interesting as all the group except 2 were classified as “introverted”
Correlation with Y chromosome
behaviour style: concern for the task vs concern for people
Kouzes and Posner: assert that leadership is an observable, learnable set of practices
1. articulate own values, principles and understanding how these may differ from those of other individuals and groups
own strengths and limitations, impact of own behaviour on others, effect of stress on behaviour
identify own emotions and prejudices and how they affect judgement/ behaviour
get feedback from others
Range of CPPD activities - journal club, feedback, audits, peer learning
I actually think this framework encompasses many of the aspects we associate with C -P-P-D as a whole for health care professionals - and if one is a “good, effectual leader” is probably a hallmark of professionalism...
It is through reflection, and experiential learning (which is at the heart of CPPD), can we further explore our own ideas of what “good leadership” is and how we can become effective clinical leaders. Having a framework to focus on areas of professional development in a holistic way is a useful aid for CPPD.
Kurt Lewin: Autocratic, Democratic, Leissez-faire (decision-making)
Transactional leadership - where leader makes explicit bargains with the team member about what they will receive in exchange for their work/ achievements. Clear goals are set and work delegated. vs Transformational leadership - where the leader inspires and motivates others to achieve a common goal/ purpose.
Awareness of the various styles/ behaviours associated with leadership can allow us to reflect and probe into whether our adopted “style” of leading was the most appropriate in a given situation. And if so - why and how could the outcomes be further improved.
I am sure that programmes like Holby City portray Drs in an unfavourable light with respect to leadership.
Toxic leaders: characterised by : making decisions alone, evasive, self-centred, excessive competitiveness, arrogance and pride vs “ethical leaders”.
