{"id":43727,"date":"2018-12-17T17:50:36","date_gmt":"2018-12-17T16:50:36","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43727"},"modified":"2019-01-10T11:58:30","modified_gmt":"2019-01-10T10:58:30","slug":"greta-mclachlan-how-to-navigate-the-nhs-towards-good-leadership","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/12\/17\/greta-mclachlan-how-to-navigate-the-nhs-towards-good-leadership\/","title":{"rendered":"Greta McLachlan: How to navigate the NHS towards good leadership?"},"content":{"rendered":"

Leadership skills are still neglected among clinicians, says Greta McLachlan, and the NHS is the worse for it<\/p>\n

The NHS employs approximately 1.3 million people in the UK, making it one of the largest employers in the world. Similar employers in terms of scale<\/a> are the United States Department of Defence, the Chinese People\u2019s Liberation Army, Walmart, China Railway, and McDonald\u2019s<\/span>. <\/span>Approximately 2% of the British population work in the NHS. Put in this perspective, it\u2019s easy to see that the NHS is a behemoth of an organisation. It is a juggernaut<\/span>\u2014and a <\/span>glacial one at that.<\/span><\/p>\n

Matt Hancock, while addressing the King\u2019s Fund about his vision for improved leadership in the NHS, recently commented<\/a> that Mcdonald\u2019s “is nowhere near as important as the NHS . . . Yet they start leadership training at shift manager level. They drive leadership training through every level of their company.\u201d He went on to highlight the need for more leadership training within the NHS and the need for more tech specialism within leadership. He emphasised that while people from a black or minority ethnic (BME) background make up 40% of hospital doctors, they fill only 7% of executive roles<\/span>\u00a0and<\/span> called for more diversity of leadership. All good things then. <\/span><\/p>\n

However, Hancock\u2019s speech only paid lip service to Sir Ron Kerr\u2019s review<\/a>\u00a0Empowering NHS leaders to lead<\/em>, which came out the same day.<\/span>\u00a0<\/span>This report found that bullying and discrimination are “prevalent and accepted\u201d in the NHS and that some leaders \u201cdo not feel confident that speaking out would make a difference.\u201d <\/span><\/p>\n

Depressingly to those who work in the NHS, these are not surprising findings. We have all seen at least one boss, one manager, and one colleague who encapsulates these failings. While it is not everyone, it is ubiquitous. <\/span><\/p>\n

How did we get to this situation? How is it that one of the world\u2019s largest employers, which deals in compassion and care for its patients, has created such a toxic work environment for its employees? Suzie Bailey, director of leadership and organisational development at the Kings Fund, writes that<\/a> \u201cNHS leaders face a near toxic mix of pressure with widespread staffing vacancies, significant financial and performance challenges and a common culture of blaming individuals for failures beyond their control.\u201d\u00a0<\/span>The average tenure of an NHS CEO is three years<\/a><\/span>, which creates a change in captains more often than governments. This does not breed stability or the ability to learn from mistakes<\/span>\u2014<\/span>something else Hancock called for. <\/span><\/p>\n

In a post Francis report world<\/a>, it is well established that a lack of or poor leadership leads to poor clinical outcomes.<\/span>\u00a0The Kerr report<\/a> points to how this is exemplified in CQC ratings<\/a>. Of those trusts with outstanding ratings, only 3.3% per cent had vacant executive posts. Those with inadequate ratings? It climbed to 14.3%. There are currently 20 unfilled CEO positions<\/a> within the NHS<\/span>. That\u2019s 20 NHS trusts without a rudder to steer them. No wonder there is immense pressure on those left <\/span>standing<\/span>.<\/span><\/p>\n

When clinicians are engaged in leadership, trusts have higher quality outcomes<\/a> for patients<\/span>. But at present leadership and management skills do not come as standard in either pre<\/a> or postgrad<\/a> medical curriculums. Of 25 medical school institutes asked, only 12 had formal evaluations for leadership training<\/a>. A survey of 400 junior doctors found that 97% thought leadership and management training was important<\/a>, but fewer than 50% felt they had their seniors\u2019 support in trying to implement change<\/span>. Leadership, while identified as a must for clinicians, is still neglected. <\/span><\/p>\n

With his call for action on leadership training, Hancock is not trying to discover a brave new world. This call has been echoed for at least 10 years<\/a> under consecutive governments<\/span>. And in that time, numerous leadership initiatives have been introduced, including the London Leadership Academy<\/a><\/span>, clinical schemes at the Faculty of Medical Leadership and Management<\/a><\/span>, the <\/span>Clinical Executive Fast Track Scheme<\/a>, the Developing People – Improving Care<\/a> framework<\/span>,<\/span> and GMC guidance<\/a> on leadership and management skills<\/span>, <\/span>as well as NHS leadership competency frameworks<\/a><\/span>, <\/span>to name but a few. <\/span><\/p>\n

Yet despite all this, in last year\u2019s NHS staff survey almost a quarter of staff reported being bullied, harassed, or abused<\/a> over the previous 12 months<\/span>. And how many of the top positions were occupied by doctors?\u00a0A survey\u00a0carried out by NHS Providers in late 2017 found that of the 129 chief executives they had data on, only 9% were medically qualified<\/a>.<\/span><\/p>\n

Perhaps we are at that moment of slight disconnect that comes with sea changes. The change is coming but it\u2019s still being trained. Maybe the NHS is having its #MeToo realisation: we\u2019re starting to recognise that bullying and discrimination are not the marks of good leaders and that if we stand together, preferably with a hashtag (#hammeritout<\/a>), we can change the culture of leadership in the NHS. But it will take everyone, from CEO to janitor to nurse to student, to make it happen. If we keep allowing toxic leaders to steer the ship, we will never make land.<\/span><\/p>\n

Greta McLachlan<\/strong> is a general surgical trainee currently working at <\/em>The BMJ as the editorial registrar. Twitter\u00a0@geemclachlan<\/a><\/em><\/p>\n

Competing interests:\u00a0<\/strong>I have read and understood BMJ policy on declaration of interests and declare the following interests:\u00a0I am on the National Medical Director’s Clinical Fellow scheme, which is mentioned in this article<\/span>.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

Leadership skills are still neglected among clinicians, says Greta McLachlan, and the NHS is the worse for it […]<\/p>\n

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