Leadership skills

Successful leadership header

The importance of medical leadership is now widely acknowledged. Leadership encompasses a range of skills including people management and service design and delivery, which can be developed and improved.

Why develop leadership skills?

The GMC's guidance Good medical practice (2013) and Leadership and management for all doctors (2012) both recognise leadership as a key part of doctors' professional work, regardless of specialty and setting. 

Leadership forms a natural part of medical practice, so your skills in the clinical arena can be transferred into the area of leadership when working with others to provide care. You will already have been developing leadership skills during your training, but there are a number of specific skills associated with leadership that you can work on and improve. 

There are three general approaches to developing your leadership skills. You can consider leadership from the point of view of:

  • what leaders do - a competency - based approach
  • how leaders lead - an engagement approach
  • why leaders lead - a moral leadership approach

Competency leadership frameworks

This approach is typified by the NHS Leadership Academy's Healthcare Leadership Model. By concentrating on nine leadership dimensions you can direct your development to acquire specific competencies to help you lead. Developing your skills will allow you to develop your career as a consultant adding value to the work you do and allowing you to develop interests in new areas.

Table 1 The leadership dimensions

1. Inspiring shared purpose
2. Leading with care
3. Evaluating performance
4. Connecting service
5. Sharing vision
6. Engaging the team
7. Holding to account
8. Developing capability
9. Influencing for results


Engaging leadership

It is arguable that leaders can only be successful if others want to follow their lead. This is more than merely acquiring competencies. It requires the development of a leadership style, which engages and motivates others so that they will follow your lead. It also means developing your emotional intelligence. Dr Daniel Goleman describes a series of leadership styles shown in table 2.

Table 2 Six leadership styles at a glance

Coercive
Authoritative
Affiliative
Democratic
Coaching
Pacesetting

Goleman further argues that successful leaders do more than identify their preferred style. They are adaptable, selecting the style appropriate to the circumstances in order to be effective. For example, a coercive or authoritative style will help achieve results when leading a team undertaking cardio-pulmonary resuscitation. It will be less effective when leading a team working on clinical pathway development. Here a coaching or democratic style might give better results. 

Learning to grow your emotional intelligence isn't easy, but it can be done. Many leaders find that leadership coaching helps them to develop a portfolio of styles and to use them to adapt their approach.


Moral leadership

The final thing to consider if you want to develop as a successful leader, is why leadership is important. This requires a moral approach to leadership. The moral leadership approach requires you to consider the ethical conflicts, which arise in leading health services when making leadership decisions

Table 3 The five leadership proprieties

Fiduciary propriety Patients first
Collegial propriety Colleagues first
Bureaucratic propriety Organisation first
Inquisitorial propriety Knowing why things went wrong
Restorative propriety Acting to make amends

Balancing the needs of your patients against those of your colleagues or the organisation you work for is critical for successful leadership, and failure to get the balance right may lead to problems not just for you and your team, but for patients and more widely. For instance, placing colleagues' needs above the organisation may lead to conflict, whereas placing the organisation above colleagues and patients may lead to poor motivation and poor care. Placing colleagues and the hospital above patients' needs when things go wrong may lead to defensiveness or even the temptation to cover up errors. 

To develop a better understanding of the issues of conflicting ethical proprieties in medical leadership you may wish to read Moral Leadership in Medicine by Dr Suzanne Shale.

As a consultant others will expect you to act as a leader. Thinking about the competency framework described here will allow you to reflect and identify specific skills you may wish to acquire or develop. However, to be an effective leader it is more important to understand your leadership style, and learn to adapt it to the circumstances of the situation where your leadership is needed. An understanding of the ethical conflicts which arise in healthcare will also allow you to ensure you work within a framework of moral leadership. 

Mr Mike Roddis
MJ Roddis Associates Limited 
mjroddis.com

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