Developing psychiatrists as clinical leaders

Dr Lenny Cornwall

Deputy Medical Director, TEWV NHSFT

SummaryWhat is a clinical leader?

My personal development

Leadership programme for SRs in TEWV

Leadership competencies for consultants

Leading the clinical team

What is a clinical leader?What does the GMC say?Leadership (all doctors)

Most doctors work in multidisciplinary teams. The work of these teams is primarily focused on the needs and safety of patients. The formal leader of the team is accountable for the performance of the team, but the responsibility for identifying problems, solving them and taking the appropriate action is shared by the team as a whole.

You must be willing to work with other people and teams to maintain and improve performance and change systems where this is necessary for the benefit of patients.

You should respect the leadership and management roles of other team members, including non-medical colleagues.

What is a clinical leader?What does the RCPsych say?OP74 The role of the consultant psychiatrist (2010)

a consultant psychiatrist can, and indeed is uniquely positioned to, lead a team in such a way that practice and outcomes for patients are good and are continuously improving

the seniority of the consultant within the multi-disciplinary team can confer accountability for clinical leadership, but it is not automatic

Why is this so difficult?

The meaning behind medical language

Making doctors

Simon Sinclair (1951-2014) “The psychiatrist is thus the lowest form of medical life, but is joined in the first circle of medical student hell by psychologists, sociologists, and general practitioners. In Sinclair’s jargon, they lack proper Knowledge (“hard facts”), do not give proper Experience (finding physical signs or learning practical procedures), and do not have proper Responsibility (going on as they do about multidisciplinary teams).”

Book review by Simon Wessely (1998)

What is valued in medical culture?

High valueKnowing stuff

Certainty

Clinical experience

Individual responsibility

Competition

Practice

Low valueFinding things out

Uncertainty

Academic practice

Team working

Co-operation

Theory

Think like a patient, act like a tax payer

My personal historyHigher training

chair of RCPsych PTC during Calmanisation

Early years as consultant

Leading a adult psychiatry sector team

different Trust, different culture

DME

leadership training for SRs

DMD

competency framework for consultant recruitment

Medical leadership competency framework

Healthcare leadership model

Effective leadership of clinical teamsLeading to quality report (Yorkshire MH trusts, 2013)

Characteristics of leaders of effective teamsPassionate about providing quality service

Democratic but decisive leadership

Focused on team as a unit and individuals within it

Willing to manage performance

Able to balance needs of team and of the organisation

Vary approaches to manage change

Alimo-Metcalfe et al (Bradford University, 2013)

Healthcare leadership modelInspiring a shared purposeLeading with careEvaluating informationConnecting our serviceSharing the visionEngaging the teamHolding to accountDeveloping capabilityInfluencing for results

What should happen?What the MLCF says

Undergraduate

Demonstrating personal qualities, Working with others

Postgraduate

Managing services, Improving services

Continuing practice

Setting direction

What can happen?A realistic approach to training: registrars

Demonstrating personal qualities

Self awareness & reflection

Plan own workload

Audit own practice

Working with others

Being part of the team (for 6 months)

Valuing the contribution of other professionals

Giving feedback to others

What can happen?A realistic approach to training: senior registrars

Managing services

Attend service management meetings

Manage resources you control

Highlight waste

Supervise more junior staff

Improving services

Participate in clinical governance process

Undertake complex audits

Lead a change project

OP80 (RCPsych, 2012)

Translating the MLCF competency framework to the psychiatry curriculum

Organising clinics

Carrying out supervision

Prioritising work

Dealing with concerns

Delegating to the team

Leading change

Leadership training for SRsTEWV leadership training programme

6 x full day workshops over 12 months

Doctors as leaders

The NHS

Managing change and service improvement

NHS financing and commissioning

Personal effectiveness

Emotional intelligence and team working

Leading a change project with a “leadership champion” (voluntary component)

Leadership competency for consultantsTEWV recruitment model

4 competency domains

Clinical knowledge, skills and experience

Academic skills & life long learning

Personal & professional qualities

Leadership

Leadership

Self awareness & openness to change

Influencing & persuading

Commitment to quality

Organisational commitment

Job descriptions & job planning Clinical duties of post

Educational & academic duties

General professional duties

Leadership duties

Provide leadership to MDT alongside team manager

Contribute to service development

Contribute to clinical governance & responsibility for setting and maintaining standards

Show commitment to quality improvement

Leading a clinical teamPsychiatrists as leaders of the clinical team

Self awareness

Seek & act on feedback

Influencing & persuading

Use power & influence appropriately

Work within organisational constraints

Commitment to quality

Learn from mistakes

Work with team manager to develop service

Organisational commitment

Understand & accept Trust priorities

A new example to consider

Bridging the clinical - leadership gap

AoMRC guide to effective use of resources in everyday clinical practice

Written by 2 SRs

Published this week

Promoting valueHow reducing waste leads to higher value care

20% of clinical practice brings no benefit to the patient (Berwick, JAMA, 2012)

A cultural shift is required which calls upon doctors and other clinicians to ask, not if a treatment or procedure is possible, but whether it provides real value to the patient and genuinely improves the quality of their life

3 key areas

Overuse of medication

Overuse of diagnostic or monitoring tests

Unplanned admissions

ConclusionsPsychiatrists should be and must be clinical leaders

Medical training means leadership development does NOT happen automatically

Competency based curriculum may have made the situation worse rather than better (discuss!)

Disconnect between clinical and leadership curricula

Leadership skills are the key to consultant appointment (in TEWV at least)