Thursday, 27 January 2011

Clinical Leadership

One of the weirdest ideas of leadership and leaders is about being a 'senior', board member, top management, etc. Please let me explain. Leaders by default definition have followers; no followers - no leaders. Leaders become and remain leaders because followers allow them to do so. This does two things - the leaders begin to believe that they belong where they are (in leadership positions) due their 'own' and followers become passive because they put the leaders in there in the first place and do not want to admit wrong judgement. Further factors are mathematical politics, allowing time and running on reputation. There are glaring examples in politics that many of us would be aware of.

Once this happens, leaders begin to believe a bit too much in their own credentials. They forget that the fundamental source of all leaders and leadership is followers. The leaders who are by this time out of touch, deluded and completely in their own world begin to substitute the power of followers by the power of rules, law, agenda, reward, punishment and so on. Interestingly and correctly these are the tools of managers/administrators. The tension starts building, leaders become ineffective, leaders and followers become frustrated, external pressures build on what is perceived as 'failing' leaders, leaders use even more top down management methods because this is seen as going 'forwards' rather than stopping and getting back in touch with what put them there.

So the perpetual confusion between the roles of leaders and senior managers results in the unwillingness to recognise that all managers are NOT leaders and not all leaders will have good managerial skills (try telling that to any of your board members, medical directors, clinical directors or similar, that they are a 'director' or 'senior management' but not a leader). Some are blessed with both, both need some of the other's skills; what is crucial to understand is that leadership and management are fundamentally different. The sources of power of the managers are authority, position and mandates; the drivers are policy, guidelines, targets and the deliverables are the successful completion of what they are required to do. For managers failure is something to avoid.

The sources of power of leaders are first and foremost their followers; the background is usually due to knowledge, expertise, passion, and deliverable for leaders is their ability to bring people together for a cause if possible with success. Failure of a task is a learning experience for leaders and a true leader will rejoice the coming together of their followers irrespective of the eventual outcome.

In this context I would suggest that doctors are in a unique position. Doctors would and should quite simply be able to differentiate between managerial role and leadership role. Doctors due to their power of knowledge and skills in their chosen field need to aim to deliver the best care in the pursuit of clinical excellence that will actually be their 'management' role. Doctors as managers as currently taught in deanery 'management' courses completely miss this point. Doctors need to manage their time and resources to provide clinically superior care, that is the success of a doctors real management role; the management of their own clinical care delivery. That is the role of every doctor including the clinical director and the medical director. I could argue that for doctors good clinical management is the only management that is relevant.
We have to understand that most of us will not be leaders and we have to develop good followership traits along with management skills. Even those who are leaders must support other leaders whole-heartedly. Some doctors would demonstrate leadership. In my view the leadership is not really linked to any title or position in their place or work. These leaders should be recognised and supported. This would usually but not all the time be based on good clinical management but not necessarily related to it.
One of the first things to do therefore is to de-link managerial hierarchy from leadership situations. That does not mean that some managers would be good leaders or some leaders would be good managers; it simply means that there is no formal link or requirement for managers to be leaders or vice versa. The next step is to recognise that leaders could be anywhere in the hierarchy and create an obligation on managers to recognise and enable these persons to be effective.
These would result in Successful Healthcare.