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Medical leadership - time to get serious

The quality of healthcare experienced by patients is inextricably linked to the climate, culture and development experienced by staff. Good leadership is an essential ingredient of this mix and the new inter-collegiate Faculty of Medical Leadership and Management has embarked on the exciting journey of professionalising and promoting excellence in medical leadership. Its founding director Peter Lees and manager Kirsten Armit explain more.

The Francis report highlighted the importance of effective leadership, and particularly clinical leadership, in safeguarding the NHS against the failings at Mid-Staffordshire. Doctors have a vital role in leadership at a number of levels and it is being increasingly recognised that good leadership is integral to being a safe and effective doctor.

In 2011, the Faculty of Medical Leadership and Management (FMLM) was established by all the medical royal colleges and faculties in the UK, the importance of which was acknowledged by Francis (FMLM is mentioned in Vol 2 p.1327, Vol 3 p.1553, p.1559, p.1583 and p.1590.)

Dedicated to improving patient care through excellence in medical leadership, the FMLM is supporting leadership development for doctors, setting standards and advocating medical leadership as a profession and a legitimate and respected career choice.

FMLM has begun to emphasise the evidence that demonstrates the crucial dependency of quality upon good leadership and wholeheartedly subscribes to the view that leadership style influences the climate and culture which enables staff at all levels to deliver compassionate, safe and high quality care. A systematic review is underway to collate the evidence from the world literature.

FMLM is at odds with what it sees as the overdependence of Francis on criminal sanctions and is concerned about the negative effect this will have on culture and climate.

To emphasise the important link between leadership and culture, FMLM has drawn upon the Harvard Business School analysis of the turnaround of Sears, the North American department store. The study observed that growth, profi tability and improved quality are the natural products of good leadership.

Indeed, the inference is that sustained value (cost plus quality) for ‘customers’ is impossible without effective leadership and good people management.

Crucially, the intermediate step to customer satisfaction, quality and performance was staff satisfaction. The inference for today’s NHS is clear – compassionate care comes from staff who, to paraphrase Pendleton and Furnham, have a great place to work and are treated well.

FMLM has made the simple translation in its adaptation of the Sears Employee-Customer- Profit Chain.

In the post-Francis melee, it is easy to forget that we are battling a recession. Counterintuitive though to may be to some, logic would dictate that we need to improve leadership within healthcare and look seriously at supporting and developing staff. The potential rewards are signifi cant: we know that better teamwork lowers mortality, we know that one standard deviation improvement in appraisal is associated with a reduction of 12.3% of the number of deaths after hip fracture; we know that medical engagement correlates positively with quality in a hospital.

None of these requires a new initiative and the systems are already in place for most – all that seems to be required is the will, recognition and focus or refocusing.

FMLM is actively populating the leadership-culture-outcome model with the evidence linking leadership to the quality and safety of patient care along with tools individuals and organisations can draw on.

The key theme for the second FMLM annual conference later this year will be ‘evidence into action’ and will further build the consensus for action.

In summary, this is a pivotal time for our NHS. Never has the need for leadership been higher. The price of failure is unthinkable, the prize for success a legacy in which the new Faculty of Medical Leadership and Management wants to play its full part.

With 2,000 members joining in the fi rst year, with half of that membership being junior doctors and medical students, FMLM intends to play a vital role in promoting excellence in leadership both now and in the future.

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