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At the same time, as folks trained in medicine, we need to be aware that system change is not straightforward. Change has its own discipline and doctors can't expect to come up with a good idea and expect it to take off magically! Read Kotter in Harvard Business Review (or his book) about 'Transformational Change'. Implementation Science is a major frontier that is not covered in medicine.

Fiona, you and folks like Emma Stanton and many others are key leaders in the 'clinician leadership' field — this parallels the innovation of clinician-researchers.Not every clinician can, or wants to, contribute as a leader in research but there are many examples of folks how have. Combining two disciplines is a classic approach to innovation – think biology and engineering leading to bioengineering. Underpinning these creative environments is the science of transdisciplinarity and Prof Daniel Stokols from UC Irvine is a remarkable leader in this field.

My last point is that the 'macro-environment' needs to be conducive to both individual's efforts and those of teams (See Hackmann on how teams work). Fiona you raise the point that the NHS must invest in leadership and it would be a good idea to include doctors among those it invests in. Otherwise the macro-environment will be a limiting factor for the type of healthy change the governments are looking for.

Thanks again for your post and I look forward to your next!

You make some very nice points, essentially about empowering and valuing front-line staff, and developing culture and practices that ensure their perspective is heard.

I understand the link with clinical leadership to an extent, but I can't help but feel that the CL buzzword is muddying the waters not just here, but across a wide range of different current debates. Your point here is entirely cogent and logical without referring to 'clinical leadership', more so in fact. Nobody really seems clear what they mean by CL. It's a bit of a catch-all. I think it is more useful to remain concrete ('train doctors in management' / 'change the term junior' / 'more doctors in management posts' / 'GPs should commission'). These are all quite distinct debates.

I don't particularly think that the NHS should empower its staff because they are “the next generation of leaders”. It should do so because this is valuable and motivationally important in itself.

Thanks for raising this. I look forward to your next blog

Paul

The medical profession is still beset by hierarchy and a system of seniority based largely on years in service rather than actual competence. Thankfully, the hierarchical division between doctors and other health professionals has blurred in recent years, but it still is very much alive within the medical profession itself.

Apart from stifling innovation and creativity in service design and provision, the culture of deference also impacts on the quality and safety of medical care. Many other industries have long ago realised this – witness the rise of “Crew Resource Management” in aviation, in recognition of the fact the fact that idea that “the captain always knows best” costs lives.

Leadership is perhaps not the best word for what is needed. Certainly leadership is required (and not just from those who have been in the job longest) but also a culture of collaboration and teamwork that encourages creativity, confidence and assertiveness in those traditionally seen to be “juniors”.

Perhaps the biggest problem is epitomised by the title ‘junior doctor’ and we would do well to redesign the system in such a way as it would become obvious this title was inappropriate. What we really want is a system that nurtures executive apprentices.

In retrospect I can see what an extraordinary move it was for Liam Donaldson to initiate a clinical leadership scheme and take seriously the views and skills of young doctors. I hope future Chief Medical Officers will continue to make this nurturing of clinical leadership a priority for the future.

Part of the problem with 'juniors' not feeling part of an organisation is due to the rapidity with which they rotate onto another Trust. It results in them never really feeling they are a valued part of an organisation and they have difficulty in developing the working relationships they need to be able to make a real difference on a local level in relation to systems, organisation and operations.

Given that many doctors have found themselves in management positions, with little training in the area, I wonder what's being done in medical schools to ensure that the future clinical leaders have some knowledge in this area before they're thrown in at the deep end.

- There's a lot of talk and debate about 'clinical' leadership, which tends to mean leaders who are also clinicians. What do you think about the artificial distinction between leaders based on their job…nobody talks about administrative leaders, or portering leaders, or even 'managerial' leaders. Agree that good leadership will be crucial, but by elevating leadership from one group over another it feels to me that proper integrated team working will be an uphill struggle

- From my experience the innovation and enthusiasm shown by Junior Docs is as often held back by their consultant than it is by 'managers' (some of whome may also be Drs or nurses btw). It is the same prejudice that stops senior managers from listening to junior administrators about processes and systems. The problem of orgs not using their own frontline staff to drive innovation is a massive OD challenge. It needs passionate people to make it a priority if the NHS is going to meet the £20bn challenge over the next few years.