A new study involving 22 trust chief executives with medical backgrounds provides important insight into medical leadership within the NHS.
Medical chief executives in the NHS calls for a more structured and systematic approach to medical leadership and suggests that the days of the ‘keen amateur’ are numbered.
It was commissioned by the NHS Institute for Innovation and Improvement and the Academy of Medical Royal Colleges from the Universities of Birmingham and Warwick with the aim of learning about the career paths taken by medical chief executives.
The study was undertaken in response to Darzi’s High Quality Care for All: NHS Next Stage Review Final Report, which emphasised the need for NHS reform to be locally led with the full engagement of clinicians, including doctors.
The study shows that the career paths of medical chief executives are highly variable with some becoming chief executives relatively early in their careers and others being appointed much later.
There has been little if any structured support for doctors who wish to take on leadership roles within the NHS. Some of those interviewed reported that, in the absence of structured support, they had benefited from advice and guidance from senior colleagues.
The training received by medical chief executives is highly variable and often involves learning on the job rather than more formal development.
Most of the medical chief executives (17 of the 22) gave up clinical commitments on becoming chief executives, either out of choice or because it was impossible to continue.
The study shows that an important motivation for becoming a chief executive is the opportunity to make a bigger difference than is possible in clinical work.
The chief executives reported that their experience was generally positive, although thre were greater insecurities than being clinically focused. The short tenure of many chief executives in the NHS was felt to be a major deterrent to more medical leaders putting themselves forward.
Pay differentials between chief executives and senior doctors were also considered to be relevant to the number of doctors wishing to become chief executives, as was lack of recognition of leadership roles in clinical excellence awards.
The study suggests a number of changes need to happen to support doctors to become chief executives in future:
• strengthen career planning, training and development, including the use of coaches and learning sets;
• develop clearer career paths that enable doctors to see how they can gain experience in different roles on the way to becoming chief executives;
• use existing medical and non-medical chief executives as role models, mentors and advisers;
• review pay differentials and use clinical excellence awards to recognise the contribution of medical leadership where appropriate;
• consider the establishment of a faculty of medical or clinical leadership to address the question of professional identity and to promote high standards of practice;
• develop a framework for continuing education and professional development that defines the competences and skills needed by medical leaders; and
• enable medical chief executives to undertake clinical retraining as happens in Denmark, should they wish to return to clinical work.
The clear message from this study is that the time has come to adopt a more structured and systematic approach to developing medical leadership in the NHS.
The NHS will only be able to rise to the challenges that lie ahead by ensuring that the work being developed by the National Leadership Council is translated into a practical programme of support for the future.
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Tags: Management
