Leadership Development for Psychiatrists in the NHS RCPsych London Division Winter Academic Meeting 1 December 2010 Dr

1. Leadership Development for Psychiatrists in the NHSRCPsych London Division Winter Academic Meeting1 December 2010Dr Justin Earl Firstly Dr Raji – thank you for inviting me to speak today on this topic. Often hear call to leadership from senior leaders so I hope a perspective from the other end of the spectrum will be interesting. You may also have realised that I have changed the title of the presentation. When talk about training, tend to think about obtaining skills and knowledge – and then being able to do something: RiO Training for example or CPR training – what you need can be learned from a course. In addition to skills and knowledge, leadership also requires certain attitudes and behaviours and these develop over time through experience and nurturing. Firstly Dr Raji – thank you for inviting me to speak today on this topic. Often hear call to leadership from senior leaders so I hope a perspective from the other end of the spectrum will be interesting. You may also have realised that I have changed the title of the presentation. When talk about training, tend to think about obtaining skills and knowledge – and then being able to do something: RiO Training for example or CPR training – what you need can be learned from a course. In addition to skills and knowledge, leadership also requires certain attitudes and behaviours and these develop over time through experience and nurturing.

2. By way of brief overview of what I hope to speak about today. Why me? Not the OMG why me – with wailing an gnashing of teeth – but a little background as to why I am standing here this morning. Why leadership and why now? What is it about what is happening now that everyone is calling for leadership. What? What do we mean by leadership – and what skills involved How? How can we look at developing these skills?By way of brief overview of what I hope to speak about today. Why me? Not the OMG why me – with wailing an gnashing of teeth – but a little background as to why I am standing here this morning. Why leadership and why now? What is it about what is happening now that everyone is calling for leadership. What? What do we mean by leadership – and what skills involved How? How can we look at developing these skills?

3. Guess the key reason I am giving this presentation is because I was fortunate to be selected for the first cohort of the Darzi Fellowship program that ran from March last year to April this year. The name of the Fellowship obviously is due to Lord Darzi who undertook a review of the NHS for the government: High Quality Care for All – NHS Next Stage Review. As you may recall he resigned from government in the summer last year and that left us with an identity issue as Darzi Fellows Poor Fellows Darzi widows another The overall design ? pg 11 The idea was really the brain child of Dr Fiona Moss ? pg 10 quote. Good at training doctors to look after individual patients. We fail miserably to train doctors to look after the system of care. Guess the key reason I am giving this presentation is because I was fortunate to be selected for the first cohort of the Darzi Fellowship program that ran from March last year to April this year. The name of the Fellowship obviously is due to Lord Darzi who undertook a review of the NHS for the government: High Quality Care for All – NHS Next Stage Review. As you may recall he resigned from government in the summer last year and that left us with an identity issue as Darzi Fellows Poor Fellows Darzi widows another The overall design ? pg 11 The idea was really the brain child of Dr Fiona Moss ? pg 10 quote. Good at training doctors to look after individual patients. We fail miserably to train doctors to look after the system of care.

4. Organisational responsibility: doctors and other professionals Other professionals grow and gain organisational skills and responsibility as they progress in their careers. For doctors though this is quite different – the jump from SpR/HST6 is remarkable. And all new consultants will say that the clinical work is easy – its all the other stuff that is challenging and keeps you awake at night. Other professionals grow and gain organisational skills and responsibility as they progress in their careers. For doctors though this is quite different – the jump from SpR/HST6 is remarkable. And all new consultants will say that the clinical work is easy – its all the other stuff that is challenging and keeps you awake at night.

5. Programme aims to help clinicians: Engage in change efforts in their local context. Develop their ability to read “political” environments. Understand how modern service organisations work. Uncover their assumptions and explore other perspectives about organisational change; and the roles of clinical and managerial professionals. Learn how to support systems to act intelligently. Build a network of colleagues facing similar challenges. Gain real experience in working differently in teams and systems.

6. Intended outcomes To manage people and relationships to support organisational goals, specifically the Framework for Action; To support sound management and service innovation within the organisation; For Fellows to develop reflective practices to analyse their own impact on situations and to devise strategies for being more effective with others.

7. Of the 39 Darzi Fellows in the first cohort, 9 were psychiatrists – representing 9 out of the 10 MH Trusts in London Here we all are. Many will be/are looking for consultant jobs so please remember our names…Of the 39 Darzi Fellows in the first cohort, 9 were psychiatrists – representing 9 out of the 10 MH Trusts in London Here we all are. Many will be/are looking for consultant jobs so please remember our names…

8. May be useful to mention how my training path led to becoming a Darzi Fellow. In many ways my training up to that point had been unremarkable. By that I mean I was not in any significant leadership positions; probably only had a very general idea of the NHS structure; certainly had no real idea what a PCT was or an SHA. We had all not long been through the MMC debacle and I was quite keen to just settle into a job for a year and establish some degree of stablility. That was not to be however – I was working in a Trust outside of London in an addiction service that was going through the process of being tendered out. The NHS lost the service to a Third Sector provider and I noticed the stress the uncertainty caused among the staff. I felt quite helpless through it all and couldn’t help thinking – surely this could have been managed better. I was essentially out of a job too and it was at this time the advert for the fellowship position came out – thought why not! May be useful to mention how my training path led to becoming a Darzi Fellow. In many ways my training up to that point had been unremarkable. By that I mean I was not in any significant leadership positions; probably only had a very general idea of the NHS structure; certainly had no real idea what a PCT was or an SHA. We had all not long been through the MMC debacle and I was quite keen to just settle into a job for a year and establish some degree of stablility. That was not to be however – I was working in a Trust outside of London in an addiction service that was going through the process of being tendered out. The NHS lost the service to a Third Sector provider and I noticed the stress the uncertainty caused among the staff. I felt quite helpless through it all and couldn’t help thinking – surely this could have been managed better. I was essentially out of a job too and it was at this time the advert for the fellowship position came out – thought why not!

9. So Leadership. Why all this interest and call for leadership in the NHS?So Leadership. Why all this interest and call for leadership in the NHS?

10. Two reasons for showing these: Call for leadership is nothing new Change is definitely something new in the NHS – and each time it is viewed as more radical and complex.Two reasons for showing these: Call for leadership is nothing new Change is definitely something new in the NHS – and each time it is viewed as more radical and complex.

12. Current challenge for the NHS – hearing more about this today.Current challenge for the NHS – hearing more about this today.

13. But still not really help us with why there is the call for leadership. READ slide This article outlines how in Canada, they made the shift in defining the leadership that would be required to face the challenges they were facing in their health care system. Needed new models of leading change that emphasised momentum, execution, perseverance and collaborative engagement. Describes the LEADS framework they developed - which defines exceptional health leadership in terms of 5 capabilities: Leads self Engages others Achieves results Develops coalitions Transforms systems Similarity to the MLCF But still not really help us with why there is the call for leadership. READ slide This article outlines how in Canada, they made the shift in defining the leadership that would be required to face the challenges they were facing in their health care system. Needed new models of leading change that emphasised momentum, execution, perseverance and collaborative engagement. Describes the LEADS framework they developed - which defines exceptional health leadership in terms of 5 capabilities: Leads self Engages others Achieves results Develops coalitions Transforms systems Similarity to the MLCF

14. Another factor is that the health system in which we work is dynamic and increasingly complex. And that the issues and problems and challenges are no straight forward – but are “wicked”. For example – commissioning ? really difficult. Its not going to be sorted just by moving it to someone else and say you give it a go. Another factor is that the health system in which we work is dynamic and increasingly complex. And that the issues and problems and challenges are no straight forward – but are “wicked”. For example – commissioning ? really difficult. Its not going to be sorted just by moving it to someone else and say you give it a go.

15. This concept of Wicked Problems is something we were introduced to very early on in our Darzi Fellowship. Initially as a bright eager Darzi Fellow – off on your journey (Echos of another Fellowship….) ? this is not the most heartening news to be confronted with. So you are giving me a project that is about a problem that may not be the actual problem; there is no right answer and there is unlikely to be an end ? GREAT! Actually it was the most useful information because it meant that you did not have to go into the situation like some kind of Messiah and save the day. Instead you had to develop relational skills: Getting the right people together to discuss and decide on a way forward Create space for that to happen Believe that the system is able to find the answer.This concept of Wicked Problems is something we were introduced to very early on in our Darzi Fellowship. Initially as a bright eager Darzi Fellow – off on your journey (Echos of another Fellowship….) ? this is not the most heartening news to be confronted with. So you are giving me a project that is about a problem that may not be the actual problem; there is no right answer and there is unlikely to be an end ? GREAT! Actually it was the most useful information because it meant that you did not have to go into the situation like some kind of Messiah and save the day. Instead you had to develop relational skills: Getting the right people together to discuss and decide on a way forward Create space for that to happen Believe that the system is able to find the answer.

16. So we have seen that the call for leadership is not new; And this may be because: change is inevitable in the NHS The problems we face are wicked But we still have not really defined what the leadership that is being called for is or looks like. Start with a definition.So we have seen that the call for leadership is not new; And this may be because: change is inevitable in the NHS The problems we face are wicked But we still have not really defined what the leadership that is being called for is or looks like. Start with a definition.

18. Transformational leadership skills are the ones seen as necessary to drive the change required in the NHS Can we somehow bring all these theories and ideas together so they make sense.Transformational leadership skills are the ones seen as necessary to drive the change required in the NHS Can we somehow bring all these theories and ideas together so they make sense.

19. This framework also highlights the concept of emergent leadership in complex system and shared leadership. This framework also highlights the concept of emergent leadership in complex system and shared leadership.

20. The issue of how to behave in different situations/contexts is important and Daniel Goleman – he of Emotional Intelligence fame – offers some ideas in this regard When a leader is faced with a problem or challenge, she can adopt a particular style to tackle the issue. The best leaders are skilled at several styles and have flexibility to switch between them as the situations or circumstances dictate. Each of the styles make use of key components of Emotional Intelligence. The issue of how to behave in different situations/contexts is important and Daniel Goleman – he of Emotional Intelligence fame – offers some ideas in this regard When a leader is faced with a problem or challenge, she can adopt a particular style to tackle the issue. The best leaders are skilled at several styles and have flexibility to switch between them as the situations or circumstances dictate. Each of the styles make use of key components of Emotional Intelligence.

21. Starting to get a picture of the skills required. Many require unpacking – communication; building bonds Note that there are “SELF” skills: Self-awareness; Self-management BUT also “SELF-IN-RELATION” skills – Social Awareness and Social Skill This is important as we move to consider the model of SHARED LEADERSHIPStarting to get a picture of the skills required. Many require unpacking – communication; building bonds Note that there are “SELF” skills: Self-awareness; Self-management BUT also “SELF-IN-RELATION” skills – Social Awareness and Social Skill This is important as we move to consider the model of SHARED LEADERSHIP

22. The key difference in this model is that influence is no longer in one direction – from leader to follower. In this model leadership is fluid – moves between individuals in the group who are leaders and followers.The key difference in this model is that influence is no longer in one direction – from leader to follower. In this model leadership is fluid – moves between individuals in the group who are leaders and followers.

23. Also called “post-heroic” leadership model. Shifting from developing individuals to become leaders – focus on self and independence But developing people so that they move from independence to interdepenence.Also called “post-heroic” leadership model. Shifting from developing individuals to become leaders – focus on self and independence But developing people so that they move from independence to interdepenence.

24. Using this as an illustration of shared leadership model. Unique in that it is an orchestra that performs without a conductor (chamber music model for large ensemble) Each musician is as responsible as the conductor for having an interpretation and knowing the score and being able to discuss this with fellow musicians.Using this as an illustration of shared leadership model. Unique in that it is an orchestra that performs without a conductor (chamber music model for large ensemble) Each musician is as responsible as the conductor for having an interpretation and knowing the score and being able to discuss this with fellow musicians.

26. Spent some time looking at different leadership models and the skills highlighted by some of these. We know that it is an essential and now recognised element of our training. Now we can consider what skills need to be developed. To decide this we need to consider the context we will be working in. Spent some time looking at different leadership models and the skills highlighted by some of these. We know that it is an essential and now recognised element of our training. Now we can consider what skills need to be developed. To decide this we need to consider the context we will be working in.

27. New landscape New relationshipsNew landscape New relationships

28. This was quoted by a commentator in the Health Services Journal when describing the challenge of the NHS White Paper. Think it is useful as it highlights that achieving the taks is not down to one person or leader: Engineers; pilots; designers; technicians; etc And that it is not just about being an expert ? but being able to bring those expertise and work collaboratively.This was quoted by a commentator in the Health Services Journal when describing the challenge of the NHS White Paper. Think it is useful as it highlights that achieving the taks is not down to one person or leader: Engineers; pilots; designers; technicians; etc And that it is not just about being an expert ? but being able to bring those expertise and work collaboratively.

30. Now there is guidance on which skills we should be developing. College CurriculumNow there is guidance on which skills we should be developing. College Curriculum

31. Think the MLCF is probably familiar to most people I think it is a very useful tool to guide leadership development. There is always a danger that it becomes a “tick-box” exercise that people feel they have to demonstrate and that would be unfortunate. There is an accompanying Medical Leadership Curriculum which expands on the knowledge, skills, attitudes and behaviours for each competency. Its also useful as it suggests ways in which these competencies can be developed in a persons everyday work. Think the MLCF is probably familiar to most people I think it is a very useful tool to guide leadership development. There is always a danger that it becomes a “tick-box” exercise that people feel they have to demonstrate and that would be unfortunate. There is an accompanying Medical Leadership Curriculum which expands on the knowledge, skills, attitudes and behaviours for each competency. Its also useful as it suggests ways in which these competencies can be developed in a persons everyday work.

32. Based on the Leadership Wheel There are 5 domains Each domain has 4 subsections Each subsection has 4 competencies. The model of leadership underpinning the framework is that of SHARED LEADERSHIPBased on the Leadership Wheel There are 5 domains Each domain has 4 subsections Each subsection has 4 competencies. The model of leadership underpinning the framework is that of SHARED LEADERSHIP

33. Could also see the framework as building through different levels of self, team and organisation.Could also see the framework as building through different levels of self, team and organisation.

34. Just to bring the other key framework we discussed earlier – Emotional Intelligence – to a greater degree this is incorporated into the MLCFJust to bring the other key framework we discussed earlier – Emotional Intelligence – to a greater degree this is incorporated into the MLCF

35. Add this in as it illustrates that if your model of leadership is based on leader development - individual-level skill then you focus on self-awareness; self-regulation and self-motivation. If leadership is seen as a social process (shared) – then other skills become the focus. However, both are necessary.Add this in as it illustrates that if your model of leadership is based on leader development - individual-level skill then you focus on self-awareness; self-regulation and self-motivation. If leadership is seen as a social process (shared) – then other skills become the focus. However, both are necessary.

37. This is from a systematic literature review that was carried out for the NHS Leadership Centre. From the studies reviewed: 360 degree; Mentoring and Action Learning most successful development methods. 360 degree feedback Useful to identify leadership development needs, it can provide leadership development in itself ? must be handled properly Increase transformational leadership behaviours Increase self-awareness through understanding the perception of others. Mentoring Opportunity to learn about leadership challenges. Action Learning Focus on problem-solving real issues with reflection on what happened and why. This is from a systematic literature review that was carried out for the NHS Leadership Centre. From the studies reviewed: 360 degree; Mentoring and Action Learning most successful development methods. 360 degree feedback Useful to identify leadership development needs, it can provide leadership development in itself ? must be handled properly Increase transformational leadership behaviours Increase self-awareness through understanding the perception of others. Mentoring Opportunity to learn about leadership challenges. Action Learning Focus on problem-solving real issues with reflection on what happened and why.

38. Look at the components of the Darzi Fellowship programme Hosted by a trust – worked on specific projects – learning on the job (job challenge) From the evaluation, the elements that were felt to be most beneficial were: Network Structured teaching programme Mentoring ( access to significant health leaders) Look at the components of the Darzi Fellowship programme Hosted by a trust – worked on specific projects – learning on the job (job challenge) From the evaluation, the elements that were felt to be most beneficial were: Network Structured teaching programme Mentoring ( access to significant health leaders)

40. Camden & Islington’s  CLP Structure Higher trainees work on projects which are core to the Trust’s objectives for one year. Group supervision on 6-8 weekly basis - chaired by MD or other director. Additional support from trust directors, clinical governance team and other managers. Accredited course at Middlesex University. Completion of 4 modules and assignments awards 30 credits towards a post-graduate certificate in management.

41. London Leadership Programmes 25 London NHS trusts are developing or running training programmes with funding from London Deanery 25 London NHS trusts are developing or running training programmes with funding from London Deanery

42. Look what is available – see what other services/trusts are doing and adapt the idea for your service/Trust. Utilise what you have already – using supervision sessions to explore some of the competencies outlined in the MLCF and Medical Leadership Curriculum. Look what is available – see what other services/trusts are doing and adapt the idea for your service/Trust. Utilise what you have already – using supervision sessions to explore some of the competencies outlined in the MLCF and Medical Leadership Curriculum.

43. What I have hopefully highlighted today is that leadership is necessary and important particularly as we face the challenges and opportunities of the new NHS structure – its going to be a long journey In terms of skills – at times it will be necessary to lead the way – show direction. Often it will be important to follow – and that is a skill too. Most importantly I think we need to build the relational skills so that we use our expertise to bring the right people together and encourage dialogue and effective contribution from everyone. What I have hopefully highlighted today is that leadership is necessary and important particularly as we face the challenges and opportunities of the new NHS structure – its going to be a long journey In terms of skills – at times it will be necessary to lead the way – show direction. Often it will be important to follow – and that is a skill too. Most importantly I think we need to build the relational skills so that we use our expertise to bring the right people together and encourage dialogue and effective contribution from everyone.

44. It is always helpful to end with a quote – seems like the right thing to do. And this is from Dame Mary Marsh – Director of the Clore Social Leadership Programme who was a speaker on the college prestigious lecture series on leadership earlier this year which some may have attended. The title of her lecture was -Preparation and support for leadership journeys. And this piece of sage advice is where I will end. Thank you It is always helpful to end with a quote – seems like the right thing to do. And this is from Dame Mary Marsh – Director of the Clore Social Leadership Programme who was a speaker on the college prestigious lecture series on leadership earlier this year which some may have attended. The title of her lecture was -Preparation and support for leadership journeys. And this piece of sage advice is where I will end. Thank you