- Email: [email protected]
How to be an effective clinical director
ARTICLE IN PRESS Current Paediatrics (2005) 15, 504–508
www.elsevier.com/locate/cupe
How to be an effective clinical director David B. Shortlanda,, John Gatrellb a
Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK Kings House, 17, West Borough, Wimborne Minster, Dorset BH21 1LT, UK
b
KEYWORDS Clinical director; Effective training and support
Summary Medicine is one of the oldest professions with its origins dating back to ancient times. Current management strategies are a relatively new feature of the National Health Service, and have evolved and increased in importance quite dramatically over the last 30 years. Although doctors previously had a role in management, the creation of the Clinical Director post has formalised these arrangements. A Google search for ‘clinical director’ comes up with 16,900,000 entries (taking just 0.31 s to come up with this fact!) but despite the enormous amount that has been written about this role many doctors taking on these duties believe they are poorly prepared, and the medical organisations, including the Royal Colleges, have been unable to develop training programmes for prospective or newly appointed clinical directors. Clinical directors’ duties differ between organisations of different size and with different management structures, but there are issues, such as key competences, training and support, which are relevant to all posts. & 2005 Elsevier Ltd. All rights reserved.
Many consultants reach a stage in their career when it may seem attractive to take on new professional challenges. The British Association of Medical Managers suggests six options that are open to consultants.1 These include taking up roles in education; academic research; non-medical work such as law or pharmaceuticals; National Health Service (NHS) management (for example, within their strategic health authority or the Department of Health); a change of clinical emphasis or direction; and finally, medical management. It Corresponding author. Tel.: +44 1202 442039; fax: +44 1202 442822. E-mail address: [email protected] (D.B. Shortland).
could be argued that the last of these is potentially the most difficult because it is so far removed from the role for which they have been trained. Although few take on a full management role by seeking a chief executive post, many may find themselves being invited to take on the lead role for their directorate. This article seeks to provide help for those who decide to accept that invitation. It explores the origins and nature of the role of clinical director and gives advice aimed at those who would like to make a difference during their period of office. The role of clinical director in England may be traced back to 1984 when clinicians and managers at Guy’s Hospital responded to a failed cost-saving attempt (the temporary closure of 100 beds) by
0957-5839/$ - see front matter & 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.cupe.2005.07.009
ARTICLE IN PRESS How to be an effective clinical director experimenting with a new system of speciality level operational management. This was based on the ‘John Hopkins’ model of medical management.2 The term ‘clinical director’ has developed differently in different places. Nevertheless, clinical directorates, in which a consultant takes on shared responsibility for leadership, management and budgetary matters, have become standard in virtually all NHS hospitals. Current management strategies have evolved and increased in importance over the last 30 years. Sir Roy Griffiths, in response to the NHS management enquiry, stated that ‘the nearer that the management process gets to the patient, the more important it becomes for doctors to be looked upon as ‘natural managers’.3 His comments were an important catalyst for the subsequent development of clinical director roles. Although doctors previously had a role in management, the development of the post has formalised these arrangements. Despite the enormous amount that has been written about the role, many doctors who take on clinical director duties feel poorly prepared. Although there are many and diverse training programmes for prospective or newly appointed clinical directors, it can be difficult for most newly appointed clinical directors to find a training programme that will reliably meet their needs. This is due in part to the lack of formality in the appointment process, poor definition of the role in many trusts, and the assumption by some doctors that the required skills are simply an extension of their existing skill-mix.4 Hospital Trusts vary in the different roles and responsibilities expected from their clinical directors. In the early 1990s the British Medical Association, The Institute of Health Services Management, The Royal College of Nursing together with the recently formed British Association of Medical Managers produced a joint report that helped to define the evolving role and function of clinical management.5 The report identified clinical directors as being responsible for co-ordinating and developing patient services. They should have managerial control over nurses and paramedic staff. They should be supported by a nurse manager and business manager and have administrative support. In practice, the role of clinical director is subject to a number of influences such as the:
size of the directorate; degree of control over the budget; configuration of services (e.g., paediatrics with obstetrics and gynaecology); time allocation for duties; level of responsibility for targets and performance measures.
505 One survey found that most clinical directors’ managerial workload took up more than the contracted time available6; they were likely to be managing a budget of £2–3 million; and around two-thirds were able to use cost savings for the benefit of their directorate, meaning that the rest were not. Unsurprisingly, doctors are often ambivalent about taking on the role. Some will take it on because they feel it is their turn. Others may have an ambition to be involved in management because they wish to develop particular aspects of the service. A few may have an ambition to play a key role in the strategic direction of their Trust, for instance by eventually becoming chief executive. In the early 1990s it was not uncommon for those who were appointed as clinical directors to see their role as defender of their directorate, largely achieved by blocking management-led change. This latter view has largely disappeared, although questioning the need for some changes is still perceived as an important role for doctors who are members of Trust senior management teams. The opportunity to perform this latter role is a factor in most clinical directors’ minds. Relatively few doctors decide during their early training that they would like to take on a medical management role. There is currently no formal training pathway for future clinical directors. Why should doctors become involved in management? Many regard the management duties as being either boring, someone else’s problem or believe their time could be better spent providing direct patient care. Although these views are understandable, the NHS is currently going through great change and this offers opportunities and threats. A clinical director has the opportunity to achieve far greater benefits for the service by working with others rather than alone and by being pro-active rather than reactive to NHS reform. The term ‘medical autonomy’ has been used to explain the difference between professional and managerial judgement.7 Clinical judgement, however, takes place in the real world of finite resources. The clinical director is in a position to build a bridge between these two positions. A consultant who, for example, has trained in cardiology will have undertaken a clearly defined training programme, and when taking up a consultant post, will generally feel confident to deal with problems related to their speciality. Consultants are used to having their opinions respected by patients and other health professionals. The situation is different for clinical directors, particularly when new to the post, as they will be working with managers, commissioning organisations and inspection bodies (amongst others). They may feel
ARTICLE IN PRESS 506 somewhat ‘out of their depth’ and poorly prepared for the duties they are being asked to undertake. They will have a role in financial planning, budget setting, strategy and facilitating, and managing change; and are unlikely to have received formal training in any of these areas.8 There is no nationally-recognised qualification for clinical directors, and despite a growing medical interest in studying for masters degrees in business administration (MBAs), few doctors have formal business management qualifications. When they were preregistration house officers most consultants will have experienced the feeling of being overwhelmed by what is going on around them and will not want to repeat this experience as managers! Too often there is little succession planning for clinical directors, and it may take 1 to 2 years before they feel able to contribute fully to the management of a directorate. A clinical director is usually a consultant and will normally return to that role after completing the requisite time (usually 3 years) in the post. Consultants generally are committed to the NHS and have strong opinions as to how their patients should be cared for. Therefore they are not an easy group to manage. Although health professionals within a directorate may see the clinical director as ‘head of department’, this is not necessarily the view of the other consultants. They are more likely to regard the senior medical hierarchy as flat, perhaps regarding their clinical director colleague as ‘first among equals’. To be clinically effective, a consultant must be able to work satisfactorily with colleagues, and this may lead a recently appointed clinical director to try to avoid confrontation. Under the new consultant contract clinical directors are involved with determining colleagues’ working practices, undertaking appraisals, and dealing with colleagues’ salary progression through the pay thresholds. Is there an equivalent role in industry where a manager determines an employee’s salary one year and then the roles are reversed the following year? There have been a number of attempts to define the key competencies required of a clinical director.6,9,10 Some common features include:
Strategic planning. Preparing and managing a business plan. Implementing change. Acting as a figurehead for the directorate. Negotiating. Chairing meetings. Appraising colleagues. Delegating tasks. Managing self.
D.B. Shortland, J. Gatrell There is general agreement that doctors should be involved in Trust management, and there are many positive contributions that doctors can make. Consultants are senior figures within an organisation and generally have a good understanding of how the various systems function. They are used to dealing with people and generally have fairly good communication skills. They are seen as figures of authority, they have a strong intellectual base and an understanding of effective interventions for their patients. There are also potential conflicts when doctors are involved in management. Doctors generally rely on research to determine which types of intervention are likely to be effective; they favour evidence-based decision-making processes; and prefer to make sense of information that is detailed and structured.11 Conversely, managers are frequently obliged to make decisions based on less precise evidence. Indeed, most doctors regard management practice as having an inadequate research base and frequently use this to challenge managers. Doctors generally act in a tactical rather than strategic manner.8 Young4 caricatures the differences between doctors and managers. He describes doctors as moral absolutists, managers as moral relativists; doctors as autonomous decision takers, managers as group decision takers; doctors as suspicious of change, managers as thriving on change. These perceived differences help to explain the challenge for a doctor who takes on a managerial role. A newly appointed clinical director will generally want to receive appropriate training and the natural tendency is to focus on areas in which they believe they are deficient such as financial planning. Although these skills are highly relevant to successful budgetary and departmental management, a business manager is likely to have these skills, and therefore, it is not crucial to have training in these areas, at least not to start with. The role is more likely to involve emphasis on management of medical staff, providing a lead in service development and ‘troubleshooting’ when clinical problems arise within the directorate. It might be helpful to explore the difference between management and leadership as a way of developing understanding of the clinical director’s key role. Management is generally held to be about planning, co-ordinating, organising resources, controlling staff and problem solving. Conversely, leadership is about building and communicating a vision for the future, developing and implementing strategies for change, helping people to understand and share commitment to service development, motivating and inspiring colleagues. Leadership is more about accommodating uncertainty than removing it.
ARTICLE IN PRESS How to be an effective clinical director Some self-awareness is helpful as a lead-in to taking on the role of clinical director. Many people in leadership positions in the NHS have taken advantage of the Leadership Qualities Framework, developed by the NHS Leadership Centre and launched in 2002. This scheme provides an opportunity for individuals to receive feedback from work colleagues at all levels and can be a powerful development tool. It can be accessed at http:// www.nhsleadershipqualities.nhs.uk. The 3601feedback process is usually part of a wider programme of development and many leadership courses now use it to help newly-appointed leaders to create a personal development plan. Newly appointed clinical directors may find it helpful to concentrate his/her activities in the following main areas:
To understand the ‘patient journey’ and to develop an understanding of directorate processes and procedures that contribute to this journey. To explore and gain insight into areas where the directorate functions well and to confront those where there are problems. To understand the coding and audit processes involved in collecting activity data and to gain an understanding of quality issues. To understand the junior doctors rotas and training opportunities as the European Working Time Directive and ‘New Deal’ compliance have created great tensions between working practices, training and patient care. To look at the communication structure within the directorate in order to create a management system that can effect change and allow the management group to be fully informed of any problems within the directorate. To become familiar with national documents and agendas that can influence the local delivery of services. The National Service Framework for children, young people and maternity services, ‘Every Child Matters’ and choosing health recommendations that have a wide ranging impact on the local departments. Clinical directors should have a good understanding of the key recommendations in order to work pro-actively with local hospital and management teams to improve services. These documents may be sent to individual clinical directors or accessed via websites such as the Department of Health or the website run by the Clinical Directors’ Specialist Interest Group.
It helps for clinical directors to make an honest assessment of their personal strengths and weaknesses, to build on their strengths and to work on
507 areas that can be developed with appropriate training. This will determine how effective they will be at managing change, managing conflict and developing the service. A clinical director may have undergone regular in-training assessment or 3601 appraisals which can inform him/her accordingly. Although it is not possible or desirable to change your personality to mirror the demands of the job, there are courses available that give clinical directors an insight into how to use their strengths and minimise their weaknesses when dealing with difficult colleagues, managing conflict or implementing change. Clinical directors who require training in this area can obtain help at local level from training and human resources managers or the medical director and at national level from organisations such as the British Association of Medical Managers, The British Medical Association, The Institute of Health Services Management or Clinical Directors Special Interest Group (RCPCH, London). Managing your own learning is also an important aspect of developing the skills required in the new role. A period of a few months spent shadowing the present clinical director before taking over can be very beneficial. The NHS Leadership Qualities Framework identifies 15 qualities or strengths that come together in the most successful leaders. We have selected a few that may help you to meet the challenge of clinical leadership. (a) Self-awareness is about knowing our own strengths and limitations and working to build on the strengths, develop or accommodate limitations. Completing the 3601 feedback based on the Framework can be helpful. Many doctors have found the Myers–Briggs personality-type inventory gives an insight that is helpful in understanding the impact they have on others and how relationships are affected by personal preferences.11 (b) Self-management is mostly about organising time and personal resources to best effect. It is possible to become overwhelmed by the demands of a new role if you make no attempt to pace yourself. Simple routines such as dealing with e-mails later in each day, rather than first thing, can help you to keep control of your workload by stopping you from dealing with low-priority items first. Time spent in planning and prioritising either at the end or beginning of each day is often very useful. Remember that important but non-urgent activities such as long-term planning, networking, re-structuring workloads and relationship building are key
ARTICLE IN PRESS 508 elements in the process of avoiding difficulties and even crises in the future. There are many books on the topic of time management—a library or web search will help you to find one that suits your personal style. (c) Broad scanning—keeping abreast of what is going on in the wider world of health care, at Trust, SHA or national level helps decisionmaking and can increase your credibility with colleagues. Members of the senior management team will normally be pleased to share their knowledge. (d) Empowering others means giving individual team members a greater sense of ownership of the processes and decisions that contribute to directorate achievements. This can have an impact on the team effectiveness and on individual motivation. It requires trust and confidence, and sometimes taking risks to do this well, but benefits are seen in the long run. Being a clinical director can be challenging, frustrating and sometimes even exciting. It is seldom dull. For those who want to have a greater impact on their service and to be able to stand back and see a difference, it can be rewarding. It helps to be well prepared for the role before you take it on. This involves developing self-awareness, recognising your strengths, confronting your weaknesses and working on the latter. Training courses do exist, although it probably helps if you can evaluate them before committing yourself to attending one. Ask
D.B. Shortland, J. Gatrell for the names of previous participants and talk to them about the benefits of attending.
References 1. Anon. Consultant careers—times of change. Stockport: British Association of Medical Managers; 2001. 2. Chantler C. Historical background: where have clinical directorates come from and what is their purpose? In: Hopkins A, editor. The role of hospital consultants in clinical directorates. The Syncromesh report. London: Royal College of Physicians; 1993. 3. NHS Management Enquiry Report. The Griffiths report. London: DHSS; 1984. 4. Young A. The medical manager—a practical guide for clinicians. BMJ Books: London; 1999. 5. Boufford JI, Harwood A. Managing clinical services, a consensus statement of principles for effective clinical management. London: Institute of Health Services Management; 1993. 6. Simpson J, Scott T. Leading clinical services. Stockport: British Association of Medical Managers; 1997. 7. Marnoch G. Doctors and management in the National Health Service. Buckingham: Open University Press; 1996. 8. Riordan JF, Simpson J. Getting started as a medical manager. In: Simpson J, Smith R, editors. Management for doctors. BMJ 1994;309:1563–5. 9. Stuart J, Hicks J. Organisation of clinical directorate: AngloAmerican experience from laboratory medicine. Clin Manage 1993;1(1):3–5. 10. Gatrell J, White A. Medical student to medical director— a development strategy. Bristol: NHS Training Division; 1995. 11. Houghton A. Understanding personality type. BMJ Career Focus 2004;329:177–8.
www.elsevier.com/locate/cupe
How to be an effective clinical director David B. Shortlanda,, John Gatrellb a
Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK Kings House, 17, West Borough, Wimborne Minster, Dorset BH21 1LT, UK
b
KEYWORDS Clinical director; Effective training and support
Summary Medicine is one of the oldest professions with its origins dating back to ancient times. Current management strategies are a relatively new feature of the National Health Service, and have evolved and increased in importance quite dramatically over the last 30 years. Although doctors previously had a role in management, the creation of the Clinical Director post has formalised these arrangements. A Google search for ‘clinical director’ comes up with 16,900,000 entries (taking just 0.31 s to come up with this fact!) but despite the enormous amount that has been written about this role many doctors taking on these duties believe they are poorly prepared, and the medical organisations, including the Royal Colleges, have been unable to develop training programmes for prospective or newly appointed clinical directors. Clinical directors’ duties differ between organisations of different size and with different management structures, but there are issues, such as key competences, training and support, which are relevant to all posts. & 2005 Elsevier Ltd. All rights reserved.
Many consultants reach a stage in their career when it may seem attractive to take on new professional challenges. The British Association of Medical Managers suggests six options that are open to consultants.1 These include taking up roles in education; academic research; non-medical work such as law or pharmaceuticals; National Health Service (NHS) management (for example, within their strategic health authority or the Department of Health); a change of clinical emphasis or direction; and finally, medical management. It Corresponding author. Tel.: +44 1202 442039; fax: +44 1202 442822. E-mail address: [email protected] (D.B. Shortland).
could be argued that the last of these is potentially the most difficult because it is so far removed from the role for which they have been trained. Although few take on a full management role by seeking a chief executive post, many may find themselves being invited to take on the lead role for their directorate. This article seeks to provide help for those who decide to accept that invitation. It explores the origins and nature of the role of clinical director and gives advice aimed at those who would like to make a difference during their period of office. The role of clinical director in England may be traced back to 1984 when clinicians and managers at Guy’s Hospital responded to a failed cost-saving attempt (the temporary closure of 100 beds) by
0957-5839/$ - see front matter & 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.cupe.2005.07.009
ARTICLE IN PRESS How to be an effective clinical director experimenting with a new system of speciality level operational management. This was based on the ‘John Hopkins’ model of medical management.2 The term ‘clinical director’ has developed differently in different places. Nevertheless, clinical directorates, in which a consultant takes on shared responsibility for leadership, management and budgetary matters, have become standard in virtually all NHS hospitals. Current management strategies have evolved and increased in importance over the last 30 years. Sir Roy Griffiths, in response to the NHS management enquiry, stated that ‘the nearer that the management process gets to the patient, the more important it becomes for doctors to be looked upon as ‘natural managers’.3 His comments were an important catalyst for the subsequent development of clinical director roles. Although doctors previously had a role in management, the development of the post has formalised these arrangements. Despite the enormous amount that has been written about the role, many doctors who take on clinical director duties feel poorly prepared. Although there are many and diverse training programmes for prospective or newly appointed clinical directors, it can be difficult for most newly appointed clinical directors to find a training programme that will reliably meet their needs. This is due in part to the lack of formality in the appointment process, poor definition of the role in many trusts, and the assumption by some doctors that the required skills are simply an extension of their existing skill-mix.4 Hospital Trusts vary in the different roles and responsibilities expected from their clinical directors. In the early 1990s the British Medical Association, The Institute of Health Services Management, The Royal College of Nursing together with the recently formed British Association of Medical Managers produced a joint report that helped to define the evolving role and function of clinical management.5 The report identified clinical directors as being responsible for co-ordinating and developing patient services. They should have managerial control over nurses and paramedic staff. They should be supported by a nurse manager and business manager and have administrative support. In practice, the role of clinical director is subject to a number of influences such as the:
size of the directorate; degree of control over the budget; configuration of services (e.g., paediatrics with obstetrics and gynaecology); time allocation for duties; level of responsibility for targets and performance measures.
505 One survey found that most clinical directors’ managerial workload took up more than the contracted time available6; they were likely to be managing a budget of £2–3 million; and around two-thirds were able to use cost savings for the benefit of their directorate, meaning that the rest were not. Unsurprisingly, doctors are often ambivalent about taking on the role. Some will take it on because they feel it is their turn. Others may have an ambition to be involved in management because they wish to develop particular aspects of the service. A few may have an ambition to play a key role in the strategic direction of their Trust, for instance by eventually becoming chief executive. In the early 1990s it was not uncommon for those who were appointed as clinical directors to see their role as defender of their directorate, largely achieved by blocking management-led change. This latter view has largely disappeared, although questioning the need for some changes is still perceived as an important role for doctors who are members of Trust senior management teams. The opportunity to perform this latter role is a factor in most clinical directors’ minds. Relatively few doctors decide during their early training that they would like to take on a medical management role. There is currently no formal training pathway for future clinical directors. Why should doctors become involved in management? Many regard the management duties as being either boring, someone else’s problem or believe their time could be better spent providing direct patient care. Although these views are understandable, the NHS is currently going through great change and this offers opportunities and threats. A clinical director has the opportunity to achieve far greater benefits for the service by working with others rather than alone and by being pro-active rather than reactive to NHS reform. The term ‘medical autonomy’ has been used to explain the difference between professional and managerial judgement.7 Clinical judgement, however, takes place in the real world of finite resources. The clinical director is in a position to build a bridge between these two positions. A consultant who, for example, has trained in cardiology will have undertaken a clearly defined training programme, and when taking up a consultant post, will generally feel confident to deal with problems related to their speciality. Consultants are used to having their opinions respected by patients and other health professionals. The situation is different for clinical directors, particularly when new to the post, as they will be working with managers, commissioning organisations and inspection bodies (amongst others). They may feel
ARTICLE IN PRESS 506 somewhat ‘out of their depth’ and poorly prepared for the duties they are being asked to undertake. They will have a role in financial planning, budget setting, strategy and facilitating, and managing change; and are unlikely to have received formal training in any of these areas.8 There is no nationally-recognised qualification for clinical directors, and despite a growing medical interest in studying for masters degrees in business administration (MBAs), few doctors have formal business management qualifications. When they were preregistration house officers most consultants will have experienced the feeling of being overwhelmed by what is going on around them and will not want to repeat this experience as managers! Too often there is little succession planning for clinical directors, and it may take 1 to 2 years before they feel able to contribute fully to the management of a directorate. A clinical director is usually a consultant and will normally return to that role after completing the requisite time (usually 3 years) in the post. Consultants generally are committed to the NHS and have strong opinions as to how their patients should be cared for. Therefore they are not an easy group to manage. Although health professionals within a directorate may see the clinical director as ‘head of department’, this is not necessarily the view of the other consultants. They are more likely to regard the senior medical hierarchy as flat, perhaps regarding their clinical director colleague as ‘first among equals’. To be clinically effective, a consultant must be able to work satisfactorily with colleagues, and this may lead a recently appointed clinical director to try to avoid confrontation. Under the new consultant contract clinical directors are involved with determining colleagues’ working practices, undertaking appraisals, and dealing with colleagues’ salary progression through the pay thresholds. Is there an equivalent role in industry where a manager determines an employee’s salary one year and then the roles are reversed the following year? There have been a number of attempts to define the key competencies required of a clinical director.6,9,10 Some common features include:
Strategic planning. Preparing and managing a business plan. Implementing change. Acting as a figurehead for the directorate. Negotiating. Chairing meetings. Appraising colleagues. Delegating tasks. Managing self.
D.B. Shortland, J. Gatrell There is general agreement that doctors should be involved in Trust management, and there are many positive contributions that doctors can make. Consultants are senior figures within an organisation and generally have a good understanding of how the various systems function. They are used to dealing with people and generally have fairly good communication skills. They are seen as figures of authority, they have a strong intellectual base and an understanding of effective interventions for their patients. There are also potential conflicts when doctors are involved in management. Doctors generally rely on research to determine which types of intervention are likely to be effective; they favour evidence-based decision-making processes; and prefer to make sense of information that is detailed and structured.11 Conversely, managers are frequently obliged to make decisions based on less precise evidence. Indeed, most doctors regard management practice as having an inadequate research base and frequently use this to challenge managers. Doctors generally act in a tactical rather than strategic manner.8 Young4 caricatures the differences between doctors and managers. He describes doctors as moral absolutists, managers as moral relativists; doctors as autonomous decision takers, managers as group decision takers; doctors as suspicious of change, managers as thriving on change. These perceived differences help to explain the challenge for a doctor who takes on a managerial role. A newly appointed clinical director will generally want to receive appropriate training and the natural tendency is to focus on areas in which they believe they are deficient such as financial planning. Although these skills are highly relevant to successful budgetary and departmental management, a business manager is likely to have these skills, and therefore, it is not crucial to have training in these areas, at least not to start with. The role is more likely to involve emphasis on management of medical staff, providing a lead in service development and ‘troubleshooting’ when clinical problems arise within the directorate. It might be helpful to explore the difference between management and leadership as a way of developing understanding of the clinical director’s key role. Management is generally held to be about planning, co-ordinating, organising resources, controlling staff and problem solving. Conversely, leadership is about building and communicating a vision for the future, developing and implementing strategies for change, helping people to understand and share commitment to service development, motivating and inspiring colleagues. Leadership is more about accommodating uncertainty than removing it.
ARTICLE IN PRESS How to be an effective clinical director Some self-awareness is helpful as a lead-in to taking on the role of clinical director. Many people in leadership positions in the NHS have taken advantage of the Leadership Qualities Framework, developed by the NHS Leadership Centre and launched in 2002. This scheme provides an opportunity for individuals to receive feedback from work colleagues at all levels and can be a powerful development tool. It can be accessed at http:// www.nhsleadershipqualities.nhs.uk. The 3601feedback process is usually part of a wider programme of development and many leadership courses now use it to help newly-appointed leaders to create a personal development plan. Newly appointed clinical directors may find it helpful to concentrate his/her activities in the following main areas:
To understand the ‘patient journey’ and to develop an understanding of directorate processes and procedures that contribute to this journey. To explore and gain insight into areas where the directorate functions well and to confront those where there are problems. To understand the coding and audit processes involved in collecting activity data and to gain an understanding of quality issues. To understand the junior doctors rotas and training opportunities as the European Working Time Directive and ‘New Deal’ compliance have created great tensions between working practices, training and patient care. To look at the communication structure within the directorate in order to create a management system that can effect change and allow the management group to be fully informed of any problems within the directorate. To become familiar with national documents and agendas that can influence the local delivery of services. The National Service Framework for children, young people and maternity services, ‘Every Child Matters’ and choosing health recommendations that have a wide ranging impact on the local departments. Clinical directors should have a good understanding of the key recommendations in order to work pro-actively with local hospital and management teams to improve services. These documents may be sent to individual clinical directors or accessed via websites such as the Department of Health or the website run by the Clinical Directors’ Specialist Interest Group.
It helps for clinical directors to make an honest assessment of their personal strengths and weaknesses, to build on their strengths and to work on
507 areas that can be developed with appropriate training. This will determine how effective they will be at managing change, managing conflict and developing the service. A clinical director may have undergone regular in-training assessment or 3601 appraisals which can inform him/her accordingly. Although it is not possible or desirable to change your personality to mirror the demands of the job, there are courses available that give clinical directors an insight into how to use their strengths and minimise their weaknesses when dealing with difficult colleagues, managing conflict or implementing change. Clinical directors who require training in this area can obtain help at local level from training and human resources managers or the medical director and at national level from organisations such as the British Association of Medical Managers, The British Medical Association, The Institute of Health Services Management or Clinical Directors Special Interest Group (RCPCH, London). Managing your own learning is also an important aspect of developing the skills required in the new role. A period of a few months spent shadowing the present clinical director before taking over can be very beneficial. The NHS Leadership Qualities Framework identifies 15 qualities or strengths that come together in the most successful leaders. We have selected a few that may help you to meet the challenge of clinical leadership. (a) Self-awareness is about knowing our own strengths and limitations and working to build on the strengths, develop or accommodate limitations. Completing the 3601 feedback based on the Framework can be helpful. Many doctors have found the Myers–Briggs personality-type inventory gives an insight that is helpful in understanding the impact they have on others and how relationships are affected by personal preferences.11 (b) Self-management is mostly about organising time and personal resources to best effect. It is possible to become overwhelmed by the demands of a new role if you make no attempt to pace yourself. Simple routines such as dealing with e-mails later in each day, rather than first thing, can help you to keep control of your workload by stopping you from dealing with low-priority items first. Time spent in planning and prioritising either at the end or beginning of each day is often very useful. Remember that important but non-urgent activities such as long-term planning, networking, re-structuring workloads and relationship building are key
ARTICLE IN PRESS 508 elements in the process of avoiding difficulties and even crises in the future. There are many books on the topic of time management—a library or web search will help you to find one that suits your personal style. (c) Broad scanning—keeping abreast of what is going on in the wider world of health care, at Trust, SHA or national level helps decisionmaking and can increase your credibility with colleagues. Members of the senior management team will normally be pleased to share their knowledge. (d) Empowering others means giving individual team members a greater sense of ownership of the processes and decisions that contribute to directorate achievements. This can have an impact on the team effectiveness and on individual motivation. It requires trust and confidence, and sometimes taking risks to do this well, but benefits are seen in the long run. Being a clinical director can be challenging, frustrating and sometimes even exciting. It is seldom dull. For those who want to have a greater impact on their service and to be able to stand back and see a difference, it can be rewarding. It helps to be well prepared for the role before you take it on. This involves developing self-awareness, recognising your strengths, confronting your weaknesses and working on the latter. Training courses do exist, although it probably helps if you can evaluate them before committing yourself to attending one. Ask
D.B. Shortland, J. Gatrell for the names of previous participants and talk to them about the benefits of attending.
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