Transcript Medical Leadership

Medical
Leadership
Dr Chris Clough
Chair, National Clinical Advisory Team
Neurosciences Advisor, DH
Consultant Neurologist, King’s College Hospital
Medical Leadership
• Why did we do it?
• What did we do?
• Where are we at?
• What do we need to do now?
Medical Leadership
Why did we do it?
• Problems of leadership (not just us!)
– Tooke, Darzi, Medical professionalism
• Need for medical engagement
– Performance directly related to engagement
• Can do → will do
• Build basic skills
– Team playing
– Management
– Followership – shared leadership
• Not just last year’s fashion
– QIPP - ↑ quality; ↓ costs
– Move from state provision to state commissioning
Engagement
(Medical Engagement Scale)
Correlation between performance of a Trust
(CQC and Dr Foster) and medical
engagement
– ie better clinical leadership = better quality of
care
CQC Ratings Against
Top/Bottom MES Scores
The table below illustrates this quantitative data in more concrete terms by showing the difference
in performance level achieved on Care Quality Commission ratings by those Trusts in the top 10
and bottom 10 on the MES.
Trust ID
.
(Trus t nam e s
w ithhe ld for
confide ntiality)
Overall
Medical
Engagement
Scale
Index
.
(in de s ce nding
orde r)
CQC - NHS performance ratings 2008/09
Overall
quality
score
Financial
management
score
Core
standards
score (as a
provider of
services)
Existing
commitment
s score (as a
provider of
services)
National
priorities
score (as a
provider of
services)
Good
Excellent
Fully Met
Fully Met
Good
21
65.8
12
65.2
Good
Good
Fully Met
-
Good
15
63.4
Excellent
Good
Fully Met
Fully Met
Excellent
Excellent
5
62.0
Excellent
Excellent
Fully Met
Fully Met
24
60.8
Good
Excellent
Fully Met
-
Good
1
60.4
Excellent
Excellent
Fully Met
Fully Met
Excellent
10
59.9
Good
Excellent
Almost Met
Fully Met
Good
16
59.8
Good
Fair
Fully Met
Almost Met
Excellent
14
59.7
Excellent
Excellent
Fully Met
Fully Met
Excellent
11
58.8
Excellent
Excellent
Fully Met
Fully Met
Excellent
25
56.8
Fair
Fair
Almost Met
Fully Met
Poor
4
56.7
Fair
Fair
Almost Met
Fully Met
Fair
22
55.7
Fair
Fair
Partly Met
Almost Met
Good
23
55.3
Fair
Good
Almost Met
Partly Met
Excellent
29
54.4
Good
Excellent
Fully Met
Fully Met
Good
3
54.3
Fair
Excellent
Fully Met
Fully Met
Poor
26
53.1
Fair
Fair
Almost Met
Almost Met
Fair
8
52.7
Good
Good
Fully Met
Almost Met
Good
18
52.1
Fair
Fair
Fully Met
Partly Met
Good
20
47.0
Poor
Poor
Almost Met
Not Met
Fair
Stuff I’ve heard
- sound familiar?
The trainee
– have you got the blood result?
• Don’t know
• No
• The phlebotomist didn’t come
• The porter didn’t pick up the blood
• The lab lost it
• Won’t be ready for weeks
• There’s always a problem with getting results
back
• Not my fault
• I’m not responsible
• The managers should fix it
learned helplessness
Yes, you are responsible (at least for the care of this
patient)
Yes, you are part of a complex disorderly world where it’s
difficult to make changes happen
Find out what the problem is and fix it
Can do → will do
The consultant
• ITU – “the neurophysiology dept give us a
bad service”
– Don’t respond, or not in a timely way
– Ask questions – “why do you want an EEG”
↓
Have you talked to neurophysiology – “no”
↓
How about a joint solution?!
Simple leadership skills
The medical director
What do you think of the PCTs plans for
children’s services?
↓
Its up to them; what they…. want to do
• Expert
• Disappointment
• Lack of engagement with the broader
health agenda
Challenges and perceptions
• Medical issues not admin/managerial
• Understand teams and changing roles
• Individual patient in front of me
• Lack leadership skills or do not see need
for them
• Feel disempowered – them not us
• Not engaged with the Trust/DH/Health
Why all the Fuss?
• International concern
– Projects in Australia, Sweden, Denmark
• Changing relationships
– with patients
– With employers
• Need to work in teams
• Improve quality and control costs (QIPP)
All about quality
• Patient Safety
• Patient Outcomes
– PROMS
– Clinical
• Patient Experience
– Access
– Environment
– Behaviours
• Cannot ignore value for money and setting
priorities
Medical Leadership Curriculum
- Rationale
• Leadership is a key part of a doctor’s
role regardless of specialty
• Both leadership and management skills are
required for doctors to become more actively
involved in the planning, delivery and
transformation of health services through their
day to day practice
What did we do?
Academy of Medical
Royal Colleges Council
Enhancing
Engagement in
Medical Leadership
Medical Leadership
Competency Framework
• Undergraduate
• Postgraduate
– all specialty training post foundation
• Post CCT
Medical Leadership Competency
Framework
•Personal Qualities
•Doctors showing effective leadership need to draw
upon their values, strengths and abilities to deliver
high standards of care.
•This requires doctors to demonstrate competence
in:
•Self awareness: being aware of their own values,
principles, assumptions, and by being able to learn
from experiences
•Self management: organising and managing
themselves while taking account of the needs and
priorities of others
•Self development: learning through participating
in continuing professional development and from
experience and feedback
•Acting with integrity: behaving in an open and
ethical manner
Medical Leadership Competency
Framework
•Working with Others
•Doctors showing effective leadership by working
with others in teams and networks to deliver and
improve services.
•This requires doctors to demonstrate competence
in:
•Developing networks: working in partnership
with colleagues, patients, carers, service users and
their representatives within and across systems and
improve services
•Building and maintaining relationships:
listening, supporting others, gaining trust and
showing understanding
•Encouraging contribution: creating an
environment where others have the opportunity to
contribute
•Working within teams: to deliver and improve
services.
Medical Leadership Competency
Framework
•Managing Services
•Doctors showing effective leadership are focused on
the success of the organisation(s) in which they
work.
•Doctors are required to demonstrate competence
in:
•Planning: actively contributing to plans to achieve
service goals
•Managing resources: knowing that resources are
available and using their influence to ensure that
resources are used efficiently and safely
•Managing people: providing direction, reviewing
performance and motivating others
•Managing performance: holding themselves and
others accountable for service outcomes
Medical Leadership Competency
Framework
•Improving Services
•Doctors showing effective leadership make a real
difference to people’s health by delivering high
quality services and by developing improvements
to service.
•Ensuring patient safety: assessing and
managing risk to patients associated with service
improvement.
•Critically evaluating: being able to think
analytically, conceptually and to identify where
services can be improved.
•Encouraging innovation: creating a climate of
continuous service improvement.
•Facilitating transformation: actively
contributing to change processes that lead to
improving healthcare.
Medical Leadership Competency
Framework
•Setting Direction
•Doctors showing effective leadership contribute to the
vision and aspirations of the organisation and act in a
manner consistent with its values.
•Identifying the contexts for change: being aware
of the range of factors to be taken into account
•Applying knowledge and evidence: gathering
information to produce an evidence-based challenge to
systems and processes in order to identify
opportunities for service improvements
•Making decisions: integrating values with evidence
to inform decisions
•Evaluating Impact: measuring and evaluating
outcomes, taking corrective action where necessary
and by being held to account for their decisions.
Medical Leadership Competency
Framework
•Example: Working with Others
•Doctors show leadership by working with
others in teams and networks to deliver and
improve services.
•This requires doctors to demonstrate
competence in:
–
–
–
–
Developing networks
Building and maintaining relationship
Encouraging contribution
Working within teams
Medical Leadership Competency
Framework
• Example: Working with Others
• Doctors show leadership by developing networks: working
in partnership with colleagues, patients, carers, service users
and their representatives, within and across systems to
deliver and improve services.
•
Competent doctors:
– Identify opportunities where working with others can bring
added benefits
– Create opportunities to bring individuals and groups together to
achieve goals
– Promote the sharing of information and resources
– Actively seek the views of others
What did we do?
• Medical Leadership Curriculum
–approved by PMETB 2008
–All Colleges to integrate within
specialty curricula – August 2009
–COPMED – all deaneries to ensure
implementation
Where are we at
• Good progress
• Variable integration of MLC into specialties
– Competencies
– Assessment
• Variety of initiatives at Deanery level
• Lack of consistent implementation
– Resources
– Time
What do we need to do?
• Reflect on progress – identify good practice
• Commit to full implementation
• Colleges
– Review curriculum
• Is it all there?
• How can you integrate?
• What assessments?
• Deans
– Implementation
– Training requirements
• GMC
– How will you know MLC is in operation?
Medical Leadership and Management Curriculum
MLC
• For all doctors in specialty training
• From Foundation to Specialist Registration
•
•
(ST1 to CCT/CESR)
Core to all curricula
Delivered by blended learning
– E-learning
– Specific course
– in workplace
• Assessed within workplace
•
formative → summative
Discussion
Leaders v Managers
• Cotter
• Leadership produces change and
movement
• Management produces order and
consistency
– Doctors need both!
• Shared or Distributive Leadership
Leadership comes from anyone
who wants to make a difference
to the thinking and action of
others
(Idenk)
Daniel Goleman– 6 Leadership styles
• Coercive
-
“do what I tell you”
• Authoritative
-
“come with me”
• Affiliative
-
“people come first”
• Democratic -
“what do you think”
• Pace setting
-
“do as I do now”
• Coaching
-
“try this”
– Demands compliance
– Mobilise people towards a vision
– Creates harmony and emotional bond
– Forges consensus through participation
– Sets high standards for performance
– Develops people for the future
Supporting
COGPED
Excellence
In
Medical
Education
9th National Multi-specialty Conference
for Heads of Schools, Programme Directors,
Directors of Medical Education
25 & 26th January 2011