Challenging the narrative

Leadership has always had an odd aura around it- the vision of the hero standing tall, protecting the rest, putting themselves at risk- yet never quite being seen to be fallible. It’s the pictures that are created in our mind which form the narrative- whether it be history, popular culture or indeed the portrait we create in our minds as we read a novel.

Times change yet the NHS has struggled to adapt its narrative of a “hero”- especially when it has come to the issue around leadership. Yet in an NHS when workforce pressures have been a consistent theme as has been burnout -ever more exacerbated by the recent pandemic- this issue does need to be looked at differently. There indeed is a need for leaders who deliberately don’t fit the mould, who are not afraid of showing their weakness and not afraid of reaching out to others too. Vulnerability is the strength, not the weakness.

Below is a view from one of the rising stars in the leadership sphere, Dr. Katrina Sheikh, in the NHS- and it’s worth having a read of her ideas.

It’s not a weakness to be kind

“I work as an acute medical registrar and Chief Registrar at the Royal College of Physicians.

Having experienced undermining and a poor work culture, I pursued a specialist interest in leadership and management.

I want to promote a kind and compassionate leadership where there is a sense of belonging and want to make people feel valued when they come to work. Inclusivity and active listening to vital team members lead to a more collaborative positive workforce which will ultimately result in better patient outcomes, a decrease in staff sickness and increase in job satisfaction (WHO, 2010). Inclusive cultures depend on inclusive leaders. Powerful leadership can be found at all levels, across all roles, and in all teams in the NHS. Bailey and West emphasise that belonging is “fundamental” to human wellbeing. Even outside the NHS, we all want to feel loved and cared for so why not in your work environment?

Team climate is the employee’s shared perception of organisational events, practices, and procedures (Anderson & West, 1998). A healthy climate should be one where team members feel comfortable being themselves, asking questions, sharing ideas and trusting that their co-workers are there for them when needed. A healthy climate is one in which team members feel valued, respected and safe.

Being Chief Registrar for my Trust involves leading quality improvement projects and attending weekly meetings with senior managers and other stakeholders. I work closely with other allied and believe that a healthy team climate is key to job satisfaction. In doing so, I have developed my own emotional intelligence where I maintain an honest and supportive environment. I have learnt that the terms “leadership” and “management” are often used synonymously (Zaleznik, 2004) however they are interrelated, complementary activities, both essential for organisational success. Undertaking my management project, I learnt so much regarding change models as well as dealing with lots of different leadership styles. The project emphasised that leadership and management are synchronous.

In my role as a doctor, I lead ward rounds and at the same time try to inspire juniors to contribute to management plans for the patients. I want to motivate the team so that everyone feels valued. This programme has taught me about followership. “Our understanding of leadership is incomplete without an understanding of followership.” (Uhl-Bien et al, 2014). I have always wanted to be approachable as a registrar and a role model for my juniors as I believe this is how trust is formed.

COVID-19 poses lots of new and ongoing challenges for the healthcare system. Compassionate leadership aims to arrive at a shared, rather than imposed understanding of the challenges that we are facing in this global pandemic. We must empathise with healthcare workers whilst take action to help and support them.

I joined You Okay, Doc? which is a mental health charity for doctors as Ambassador to help promote autonomy, wellbeing and flexibility in the workplace.

How can doctors be expected to look after patients if they don’t look after themselves? 

It is imperative we all look after one another, we must maintain our own physical and mental health so that we can give the best care to our patients. “People don’t buy what you do; they buy why you do it.” says Simon Sinek. I want to become a leader in healthcare because I care for people. I want to continue to better the NHS and enable a caring and compassionate environment where people feel included.

I will not let my poor experience of leaders put me off but turn it into a positive and as Simon Sinek says, “let us all be the leaders we wish we had.”

All heroes…fall

It is imperative that we change our way of thinking- and start dissociating the word “hero” from “leadership”. A leader needs to be inclusive, adept at recognising one’s own need for breaks- as well pointing the necessary need of this approach to others in the team.

The arm around the shoulder isn’t a sign of weakness- it’s more a sign of inclusivity as well as comfort and confidence in one’s own role. A hero only rises to fall- and lest we forget, in the end- every Superman has his kryptonite

References

Anderson, S., (1998) Public, private, neither, both? Publicness theory and the analysis of healthcare organisations. Social Science and Medicine, 74 (3), 313-322. 

Bailey, S. West, M. (2020, March,30). COVID-19: why compassionate leadership matters in a crisis. Retrieved from https://www.kingsfund.org.uk/blog/2020/03/covid-19-crisis-compassionate-leadership.

Kotter, J (1990). A force for change: how leadership differs from management. New York: Free Press

Uhl-Bien, M., Riggio, R.E., Lowe, K.B., Carsten, M.K. (2014). Followership theory: A review and research agenda. The Leadership Quarterly, (25), 83-104.

World Health Organisation (2010) Everybody’s Business: Strengthening Health Systems to Improve Health Outcomes: WHO’s Framework for Action, WHO, Geneva.

Zaleznik, A. (2004) Managers and leaders: are they different? Clinical leadership & management review. Journal of CLMA, 18 (3),171-177.

Dr Katrina Sheikh

Dr Katrina is currently working as a ST6 acute medical registrar and Chief Registrar at the RCP. She studied postgraduate medicine at the University of Warwick, and prior to that did her undergraduate degree at Kings College London in biomedical science. Having experienced undermining and poor leadership during her career, Dr Katrina pursued a specialist interest in leadership and management. She has just completed a PGCert in Leadership for the Health Professions and was awarded a Distinction. Katrina is a big advocate of supporting junior doctors and strives to develop a culture in the NHS where colleagues feel able to raise concerns and are supported when they do so and has recently taken up the role of Speak up Champion for her Trust.

Professor Partha Kar

Professor Partha Kar is a Consultant in Diabetes & Endocrinology, Portsmouth, England and National Specialty Advisor for Diabetes for NHS England. He has led and delivered so far on (April 2016- till date):

• Freestyle Libre being available on NHS -across country
• NHS Right Care Diabetes pathway
• Diabetes “Language Matters” document
• Type 1 diabetes NHS England web-resource – on NHS choices
• Introduction of Frailty into QoF treatment targets for diabetes care in NHS
• Availability of CGM to all T1D pregnant patients
• Diabetes Technology pathway development with multiple stakeholders
• Setting up pilot projects for diabulimia treatment in London & Wessex
• Introduction of Low Carbohydrate App into NHS Apps Library

Other work has involved input in updating of driving guidelines in relation to use of technology in those living with diabetes, helping to develop a virtual reality programme to improve hospital safety and starting work on increased mental health access for diabetes patients across the NHS. He received an OBE in the New Years Honours List, UK in 2021 for “services to diabetes care”.

Declaration of interests

We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.