Tuesday, 5 April 2011

Leadership and Followership - my thoughts

In Spring 2007, I was working as a registrar at a teaching hospital in North West London. Tellingly, this was my first registrar job, and having got an old fashioned training number, I was feeling pretty smug about having avoided the looming fiasco of MTAS. This was not, however, how everyone else in the hospital felt: daily life was taken over by discussing how to navigate the system, and morale had imploded in the face of the realisation that SHOs no longer had the opportunity to try out different specialties by applying for a range of different 6 month posts. There was a real sense that choice and autonomy had been undermined, and it wasn’t clear to anyone that all of this would result in a better overall training experience. I remember having a look at the forum on doctors.net.uk, and seeing page after page of bitter and scathing diatribe outlining the concordant views of numerous junior doctors, voicing their disdain for the changes to medical training and the application process.

I also remember one lunch time being charged with leading a SHO teaching session on some geriatric issue (I can’t remember whether I was talking to them about falls or dementia or incontinence, but then that’s not really the point of this story): as I came in, conversation revolved around MTAS and its impact on them. Sensing that this was a more popular topic to talk about than the one that I had prepared, I asked the assembled SHOs what actions they had taken to address their concerns. Silence. Nothing.

This was a powerful moment for me: in a room of 10 or so SHOs, at one of London’s most famous teaching hospitals, not one of the talented and intelligent SHOs had had the wherewithal to write to their MP, to email their BMA rep, to discuss their concerns with the educational lead in the hospital, to write to their local newspaper or to write to their favourite national paper. All of their intellectual effort had been directed towards the moaning that they did with each other. Many of them had contributed to the forum on doctors.net.uk, but that was as focused as their efforts got. I was disappointed, but not surprised that this was the response to the question that I asked, because as a junior doctor I was already well familiar with the prevailing attitudes that circulated among junior doctors in London. I had the sense at the time that their was a prevailing mood that doctors were not really players in the politics of healthcare, certainly not at a junior doctor level. In many ways, it was an extension of the viewpoint that one often hears from junior doctors (in fact, I remember saying it myself), that if they weren’t slumming it in the NHS they would be earning fortunes in the city.  It was my perception at the time, that many were disbelieving of the affront of the government to meddle with junior doctor training programmes, when they were donating their time and effort to the cause of the NHS. The idea that doctors are not public servants, but are pro bono professionals who are donating their skill and time when it could be put to more profitable use elsewhere is an insidious and dangerous viewpoint. But it only captures part of the point.

I was reminded of the story I give above by Paul Corrigan’s excellent blog on the need for followership as well as leadership (http://ht.ly/4eETj in the BMA. This made me recall a recent conversation with one house officer; I asked him what leadership was. He replied that leadership was getting people to agree with you and then getting them to follow you. Now this particular doctor was one of the current crop of junior doctors who has shown an applied interest in leadership development, by attending relevant programmes, getting involved in quality improvement projects, and showing a great deal of entrepreneurialism in creating changes within a hospital environment. My assumption with such doctors has always been that they are the more enlightened ones, and yet this was a tellingly self-centred approach to leadership and change agency. Since that day, I have been on the lookout for this kind of attitude, and it’s a bit like looking out for tardive dyskinesia on the tube - once you are aware of it, you see it everywhere. And this was just the kind of attitude that Paul Corrigan alluded to in his blog, and represents a challenge for those interested in medical leadership: the goal is not just to create
leaders amongst junior doctors, but to also instill the idea, that doctors do not always need to be at the front of the cavalry charge, but rather that sometimes, the most powerful form of leadership can be to follow someone else’s good idea. Much of the talk that I hear directed towards junior doctors and their role of leadership revolves around how talented they are, and how much insight and expertise they have to offer the system. I have myself bought into this idea, and until recently honestly believed that the NHS was lucky to have me. But this attitude deserves challenge - as members of this health service which puts equity at its heart, all doctors should recognise that we are lucky to be able to work in a health system that allows us to practice in such a financially unfettered way. Few of us know what it is like to have clinical decisions ruled by financial imperatives. With such freedoms, comes the responsibility to play our part in creating success in our organisations. At times, this might involve us driving change, and at others, it might involve us following change. This needs to be emphasised.

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