1. business and industrial

Developing psychiatrists
as clinical leaders
Dr Lenny Cornwall
Deputy Medical Director, TEWV NHSFT
Summary
 What is a clinical leader?
 My personal development
 Leadership programme for SRs in TEWV
 Leadership competencies for consultants
 Leading the clinical team
What is a clinical leader?
What does the GMC say?
Leadership (all doctors)
 Most doctors work in multidisciplinary teams. The work of these teams is
primarily focused on the needs and safety of patients. The formal leader
of the team is accountable for the performance of the team, but the
responsibility for identifying problems, solving them and taking the
appropriate action is shared by the team as a whole.
 You must be willing to work with other people and teams to maintain and
improve performance and change systems where this is necessary for the
benefit of patients.
 You should respect the leadership and management roles of other team
members, including non-medical colleagues.
What is a clinical leader?
What does the RCPsych say?
OP74 The role of the consultant psychiatrist (2010)
 a consultant psychiatrist can, and indeed is uniquely positioned to, lead a
team in such a way that practice and outcomes for patients are good and
are continuously improving
 the seniority of the consultant within the multi-disciplinary team can confer
accountability for clinical leadership, but it is not automatic
Why is this so difficult?
The meaning behind medical language
Making doctors
Simon Sinclair (1951-2014)
“The psychiatrist is thus the lowest
form of medical life, but is joined in
the first circle of medical student hell
by psychologists, sociologists, and
general practitioners. In Sinclair’s
jargon, they lack proper Knowledge
(“hard facts”), do not give proper
Experience (finding physical signs or
learning practical procedures), and
do not have proper Responsibility
(going on as they do about
multidisciplinary teams).”
Book review by Simon Wessely
(1998)
What is valued in medical culture?
 High value
 Low value
 Knowing stuff
 Finding things out
 Certainty
 Uncertainty
 Clinical experience
 Academic practice
 Individual responsibility
 Team working
 Competition
 Co-operation
 Practice
 Theory
Think like a patient,
act like a tax payer
My personal history
 Higher training
 chair of RCPsych PTC during Calmanisation
 Early years as consultant
 Leading a adult psychiatry sector team
 different Trust, different culture
 DME
 leadership training for SRs
 DMD
 competency framework for consultant recruitment
Medical leadership competency framework
Healthcare leadership model
Effective leadership of clinical teams
 Leading to quality report (Yorkshire MH trusts, 2013)
 Characteristics of leaders of effective teams
 Passionate about providing quality service
 Democratic but decisive leadership
 Focused on team as a unit and individuals within it
 Willing to manage performance
 Able to balance needs of team and of the organisation
 Vary approaches to manage change
Alimo-Metcalfe et al (Bradford University, 2013)
Healthcare leadership model
 Inspiring a shared purpose
 Leading with care
 Evaluating information
 Connecting our service
 Sharing the vision
 Engaging the team
 Holding to account
 Developing capability
 Influencing for results
What should happen?
 What the MLCF says
 Undergraduate
 Demonstrating personal qualities, Working with others
 Postgraduate
 Managing services, Improving services
 Continuing practice
 Setting direction
What can happen?
 A realistic approach to training: registrars
 Demonstrating personal qualities
 Self awareness & reflection
 Plan own workload
 Audit own practice
 Working with others
 Being part of the team (for 6 months)
 Valuing the contribution of other professionals
 Giving feedback to others
What can happen?
 A realistic approach to training: senior registrars
 Managing services
 Attend service management meetings
 Manage resources you control
 Highlight waste
 Supervise more junior staff
 Improving services
 Participate in clinical governance process
 Undertake complex audits
 Lead a change project
 OP80 (RCPsych, 2012)
 Translating the MLCF
competency framework to
the psychiatry curriculum
 Organising clinics
 Carrying out supervision
 Prioritising work
 Dealing with concerns
 Delegating to the team
 Leading change
Leadership training for SRs
 TEWV leadership training programme
 6 x full day workshops over 12 months
 Doctors as leaders
 The NHS
 Managing change and service improvement
 NHS financing and commissioning
 Personal effectiveness
 Emotional intelligence and team working
 Leading a change project with a “leadership champion” (voluntary
component)
Leadership competency for consultants
 TEWV recruitment model
 4 competency domains
 Clinical knowledge, skills and experience
 Academic skills & life long learning
 Personal & professional qualities
 Leadership
 Leadership
 Self awareness & openness to change
 Influencing & persuading
 Commitment to quality
 Organisational commitment
Job descriptions & job planning
 Clinical duties of post
 Educational & academic duties
 General professional duties
 Leadership duties
 Provide leadership to MDT alongside team manager
 Contribute to service development
 Contribute to clinical governance & responsibility for setting and
maintaining standards
 Show commitment to quality improvement
Leading a clinical team
 Psychiatrists as leaders of the clinical team
 Self awareness
 Seek & act on feedback
 Influencing & persuading
 Use power & influence appropriately
 Work within organisational constraints
 Commitment to quality
 Learn from mistakes
 Work with team manager to develop service
 Organisational commitment
 Understand & accept Trust priorities
A new example to consider
 Bridging the clinical leadership gap
 AoMRC guide to effective
use of resources in
everyday clinical practice
 Written by 2 SRs
 Published this week
Promoting value
 How reducing waste leads to higher value care
 20% of clinical practice brings no benefit to the patient
(Berwick, JAMA, 2012)
 A cultural shift is required which calls upon doctors and other
clinicians to ask, not if a treatment or procedure is possible,
but whether it provides real value to the patient and genuinely
improves the quality of their life
 3 key areas
 Overuse of medication
 Overuse of diagnostic or monitoring tests
 Unplanned admissions
Conclusions
 Psychiatrists should be and must be clinical leaders
 Medical training means leadership development does
NOT happen automatically
 Competency based curriculum may have made the
situation worse rather than better (discuss!)
 Disconnect between clinical and leadership curricula
 Leadership skills are the key to consultant appointment
(in TEWV at least)