Last weekend, while trying to pretend I wasn’t watching the Royal Wedding, I was genuinely distracted by an unlikely thing: an article by former footballer and Ipswich manager Jim Magilton. For those of you who don’t know me, sporting nirvana is the annual clash between Wales and England on the rugby field. Despite a rather plummy accent, I am in fact half Welsh, and rugby is a passion. Football usually fills me with horror - the spitting, the histrionics, the way they treat the referee. You know what I’m talking about. This doesn’t happen on the rugby field. A good example of the standards of behaviour we expect from our rugby players are well captured by what happened to Gareth Thomas (Welsh rugby legend) after he announced that he was gay: while he may have expected a roughing up from both colleagues and opposition, what he got was the confirmation from his team mates that they had known for ages, and quite frankly, they weren’t sure what all the fuss was about. Now some of this is middle class gentility, but nonetheless, I watch rugby with the confident knowledge that while these chaps may take chunks out of each other during the match, afterwards they will have a chat and a pint (or perhaps these days, it might be an isotonic drink).
So I was quite surprised when I read something insightful and pointed about the nurture of leaders coming from football, where Alex Ferguson has written the text book they all use, and dealing with a problem is defined by how loud they shout at the person to blame. Talented footballers are asked to become managers, while learning on the job, and using nothing more than force of personality to drive them through. Jim Magilton makes the point that footballers aren’t taught how to run the business, manage players or how to run a board meeting. Those players who do manage the transition successfully often do so after a period of apprenticeship under an old hand.
This story resonated with me instantly for its personal relevance: my experience of registrar training has always focused on clinical skills and knowledge, and training in leadership has consisted of learning from the example of consultants, with the in-built assumption that we will be able to both distinguish good examples from bad, and be immune to the influences of negative role models. Judging from the process of socialisation I have seen so many of us go through, from eager idealist to cynical negativist, I am certain that trainees need more guidance on this issue. And this is not a problem that affects just surgeons - it is endemic.
On numerous occasions I have attended conferences which highlight the value of junior doctors as future, and indeed current leaders, but I think we need to be more demanding about what leadership actually entails. Doctors are certainly the technical experts in patient treatment, and this often is assumed to mean that they hold natural authority within hospitals. Often the concept of leadership that prevails is in itself unhelpful. I asked one SHO what leadership meant to him, and he told me that leadership was the skill of getting people to agree with you, and follow you. If this view of leadership is common, and I think it is, then we have a problem.
Find any well functioning unit in a hospital, and I will guarantee that it is a unit which encourages multi-disciplinary contribution in all of its work streams. Leadership will be strong, but it will not be overbearing - it will be inclusive, collaborative and occasionally deferential. Leadership is not about getting everyone to agree with you, it is about finding the best solutions, wherever they may come from, and implementing them. It is not about me, or you, it is about the process needed to achieve the goals we are aiming for.
And this is my point - I had to leave my training programme for a year to find out about leadership, because the leadership examples I was being exposed to didn’t strike me as being either effective or healthy.
We need to be more open about the development of leadership alongside clinical skills, and while this is partly addressed by the Medical Leadership Competencies Framework, there is still some way to go in addressing the language and culture of leadership in play. The Deaneries recognise the importance of developing leadership within junior doctors, but what they don’t perhaps realise it that it can be very difficult to find good role models within the workplace, and it is very difficult to find people who will guide you through your own personal development programme.
Addressing this issue is more than just telling people about it - there is a real need for junior doctors to become familiar with a gentler, less egocentric language of leadership. It is not about success or failure, it is about transparency and openness, and it involves adapting to the individual that you happen to be dealing with. If we start at the bottom with medical students and junior doctors, then I think we can generate a powerful, helpful and lasting change in culture that will result in doctors being leaders who can be valued and respected for their ability to lead, not just their ability to diagnose and treat.