Toby Hillman: Why do doctors get involved in leadership?

There can be a lot of disagreement when it comes to healthcare management and leadership. There are competing views about how far all doctors can be trained to be leaders, and how much impact leadership training can have on clinical outcomes.

There are some studies and reports which suggest that organisations with a higher degree of medical engagement with leadership and improvement have better outcomes, and better ratings from regulators. More recently the question was posed about what doctors getting involved in leadership training are motivated by—is it for improving patient care, or is it for their CV?

At a workshop introducing medical students to the theory of quality improvement last year, there was a moment which has made me think quite deeply about the motivation that I have for being involved in “leadership” or “management” in healthcare—not that I would claim to be an accomplished leader or manager.

Following the group work on some of the principles of introducing change to a system, and in particular how to address problems in the healthcare setting—one of the participants raised the question:

“If we are not directly improving individual patient care, or saving lives, and are not responding to outside instruction (e.g. from government), then why do we, as doctors, need to attempt to make change in the health service?”

I may not have represented the exact wording of the question, but as far as I could tell, this was a fairly direct question which goes to the very heart of why we have become involved in the “change process” within the NHS. Essentially, why bother?

The interesting thing about the question was the very direct nature of it—it is not often that someone questions your motivation for doing something—especially if you move in circles where everyone is signed up to the same ideals. The question did not leave very much wriggle room to skirt around with vague platitudes, but demanded what, on reflection, turns out to be a very personal response.

So what is my response—if you don’t have to be involved in a change process, why do it?  Why go through the additional pain, frustration, heartache, late nights, early mornings, written reports, presentations and everything else which goes with “change” or “improvement?”  After all, you could be an excellent doctor, dedicate your life to the practice of clinical medicine, do your contracted job, go home, and develop yourself outside of the work environment.

For me—it is because I truly believe that there is more to being a doctor than treating the one patient in front of you for the short period of time that you interact with them. There is more to being a healing physician than “just” assessing, investigating, and treating diseases and symptoms.  I train to be as good as possible in my chosen field.  However, I hate it when I can see that my efforts are being frustrated by a system – or that my patients are being short-changed because the service I can offer is not a perfect one.  Is it not my role to elevate the standard of care that I can offer to that patient sitting in front of me?  And if the standard is inadequate for that individual, what about for those who I won’t see personally, and come through these clinic doors in the days, weeks, and years to come?  If I can make a change, improve the service, make it more efficient, make the patients experience better and safer, then I feel it is my duty as a doctor to get involved, learn about where the errors might be, and work with those who can change them to do so.

I, like many others came into medicine with the lofty ideal of wanting to “help people.”  I can help people in a one-on-one consultation, and that is very satisfying, but having glimpsed the potential that even simple changes within a system can have, I feel more fulfilled when I can consider that I have left a legacy of higher standards of care.

It is a useful exercise to take a step out of your comfort zone, and really examine the driving force behind your attitudes, and actions.  It is not something that we as clinicians are often comfortable doing, and is all the more difficult to do effectively if you exist in a world where there is an overall approval of what you are doing. This paper encourages just that and is well worth a read.

Toby Hillman is a respiratory registrar, London