8 minute read
Future Leaders Programme – Why leadership matters
Hiro Tanaka and Lisa Hadfield-Law
Hiro Tanaka is a Consultant Foot and Ankle Surgeon at Aneurin Bevan University Health Board. He is a council member of the BOA and Editor for the JTO. He led the development of the Future Leaders Programme as Chair of the BOA Education Committee and currently runs the programme in partnership with Lisa Hadfield-Law.
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Lisa Hadfield-Law has spent 20 years in clinical practice and surgical education. She has managed an orthopaedic/trauma service of a teaching hospital and has insight into the circumstances and challenges facing surgical teams. She is Education Advisor to the British Orthopaedic Association & AOUKI, and contributes to the T&O SAC, FST Advisory Board and ISCP Management group.
– Jack Welch - Why leadership matters
Over the last decade, the role of clinicians in the NHS as leaders of healthcare has been viewed as critically important in the delivery of patient safety and improving outcomes. The shift away from increasing managerialism to engaging clinicians was encapsulated in a wave of policies published by the Department of Health in 2009: High Quality Care for All. Lord Ara Darzi had been appointed as health minister in 2007 and his vision was to put quality at the heart of the NHS.
The need for clinicians as leaders has become even more pressing in the face of a global economic downturn and pandemic crisis because improving care within an environment of shrinking resources becomes a major challenge.
The transition from an individual clinician to a healthcare leader is a significant step, one which requires a change in selfimage, values, behaviours, knowledge and skills. People understand the term leadership in different ways. Perhaps the most stereotypical view is that of the individual, powerful, charismatic leader who authoritatively manages a team or organisation. Whilst many surgeons are appointed to management positions, this view of clinical leadership is somewhat outdated, and the modern conceptualisation puts more emphasis on the process of leadership as opposed to the individual.
In a complex system such as healthcare, leadership is distributed and the responsibility of the clinician is to contribute to this process by nurturing and empowering the leadership capacity of others. This principle lies at the heart of the BOA Future Leaders Programme (FLP) and this article sets out its key learning outcomes. These outcomes are reflected in the 2021 T&O curriculum and the Medical Leadership Competency Framework [Figure 1) from the Academy of Medical Royal Colleges.
Figure 1 – Medical Leadership Competency Framework.
Where are we now?
FLP is a natural evolution of the BOA Clinical Leaders Programme which ran successfully for five years. The change in learning outcomes to the skills required to excel as an orthopaedic surgeon and to deliver quality improvement was necessary to reflect their needs in the early years of independent practice.
The third cohort of fellows will be starting the programme in 2021 which comprises four two-day modules over 12 months. Each module is designed to be delivered in a face-to-face format although it has been adapted to a virtual format when necessary.
The selection of fellows has become increasingly competitive with demand for places exceeding capacity this year. Fellows are awarded places either through trust funded positions or through specialist societies (BOFAS, BOA, BLRS, BASS, BHS, BOOS, BOTA/Postgraduate Orthopaedics, BSS, BSSH, WOC and Orthohub). Individual applications are welcome from senior trainees, fellows, SAS doctors and newly appointed consultants.
Diversity is a core value of FLP and of the 31 fellows on the 2021 programme 30% are female. One third of fellows was in consultant posts at the start of the programme.
What are the key principles?
1. Each fellow has a unique journey
FLP is best viewed as a learning journey where the programme facilitates the development of the fellow into the role of a clinical leader through reflection and experimentation. The concept that emerging leaders can be identified by their personality traits and that leadership can be taught in the traditional sense have not been realised despite vast amounts of literature. It is essential that fellows have the freedom to develop their own vision for their role as leaders in T&O regardless of whether they take on academic, educational, clinical, managerial or national roles.
2. Action learning
Action learning therefore forms an integral part of the programme with fellows allocated to networking groups.
The Action Learning Sets meet between sessions to share, reflect and challenge each other to improve their leadership skills.
3. Application to practice
The fellows apply their knowledge and skills to their Ambition in Practice (AiP) which is the framework for a Quality Improvement Project (QIP). There is no expectation of the fellow to complete the project within the 12-month programme and it is important that their learning is focussed upon why and how to design an effective QIP. Afterall, QIPs which make the greatest and sustained changes to patient care often take years to come to fruition.
4. Reference to theory
The curriculum of the programme is grounded in established leadership theory and as students of leadership, fellows are encouraged to use the lexicon, continue selfdirected learning of Quality Improvement methodology and to use the skills in everyday practice.
5. Alumni of BOA Future Leaders
As the fellow completes the programme, they join a family of like-minded colleagues and can draw on the support and experience of a network of leaders. With every annual cohort, the cadre of FLP fellows becomes larger and there is a celebration and networking event at each BOA Annual Congress.
What is the programme framework?
The four-stage format of the programme is designed to start with the individual fellow so that they develop an awareness of their own values, beliefs and behaviours. Once the foundation of leadership has been established, only then will they be able to effectively apply the technical and relational elements of leadership. The final session explores the context in which they lead whether it be at a local or national level.
This model is reproducible at deanery level and with the introduction of the new curriculum, trainees can be trained in these areas to meet the requirements of Generic Professional Capabilities.
Aims and learning outcomes of the programme
Session 1 – Personal leadership.
Leadership theory
• Define the evolution of theories of leadership (Great Man, Trait, Servant)
• Development of emotional intelligence (Goleman)
• Critically analyse what type of leadership is required within the NHS
Personality in leadership
• Analyse aspects of personality which will help or hinder their role as a leader
• Consider the impact of Kahlers Drivers and their personality traits on their leadership role
Leadership style theory
• Define leadership styles (Goleman)
• Plan how to use styles flexibly in practice
• Identify options for practice in their workplace
Resilient leadership
• Explain the impact upon stress on behaviour and consequence upon others
• Use tools for becoming a more resilient leader (Duckworth, Peters, Seligman)
Conflict
• Differentiate between conflict resolution styles (Robin)
• Assess their own conflict resolution style
• Apply strategies for maximising benefits and minimising damage resulting from conflict
Feedback, coaching and reflection
• Define the role of reflection, feedback and coaching for leaders
• Explain the: Advocacy enquiry model for debriefing; GROW model for coaching
• Adapt to different contexts
Session 2 - Technical leadership.
What is quality?
• Establish a foundation of the principles of quality within healthcare
• Explain what improving quality means
• Describe how QI has evolved, relating to future strategy setting
Quality Improvement science
• Run Chart
• Statistical Control Chart
• Lean • Process Mapping
• Flow/Lean Six Sigma
• Model for Improvement (Deming PDSA)
• Root Cause Analysis
• Care Bundles/Checklists
Experienced based codesign & qualitative data
• Define the role of data
• Critique faculty experience of: Shadowing; Integrating experience into process mapping; Qualitative data analysis; Schwartz rounds
Stakeholder mapping
• Identify key stakeholders with whom they need to engage on their project
• Explain why and how they might do this
• Identify how they link with each other
• Integrate their knowledge of individual personalities and drivers
Session 3 - Relational leadership.
Social awareness
• Relate principles of transactional analysis to improve communication and recognise dysfunctional relationships (Berne)
• Articulate their values, beliefs and identity using the principles of Life Scripts and Drivers
• Manage cognitive bias and apply Unconditional Positive Regard (Kahneman, Rogers)
• Use and read body language and micro-expressions to improve communication
High impact presentation
• Apply Monroe’s Motivated Sequence
• Use appropriate body language and eye contact
• Handle questions
• Manage nerves
Reframing conflict
• Select the most useful framework for reflection for them
• Review their own conflict scenarios with feedback from others
• Identify potential spark points in their QI plans
Social management
• Apply principles of negotiation to achieve win/win scenarios
• Communicate with assertiveness
• Communicate with positivity and be aware of the culture of critique
• Develop skills to manage difficult people
• Demonstrate influence in leadership style
Session 4 - Contextual leadership.
Organisational culture
• Apply principles of organisational culture to read their immediate context (Schein)
• Use appreciative inquiry to lead change in culture
• Adapt leadership style with respect to authority position
Effective chairing
• Preparation to be able to facilitate the most productive meetings
• Utilise social awareness and management skills to maximise engagement and inclusivity
• Ensure that innovation turns into action
Power and networking
• Apply power effectively in leading change
• Establish networks to enhance leadership at a wider level
Scaling up a QIP
Shifting culture
Leading at a national level
• Technical and experiential tips from guest speakers
Conclusion
There can be no doubt that recent events will result in a fundamental shift in the way in which the NHS delivers services. The impact upon the day-to-day functions of a T&O consultant, the expectations of their performance and the long-term effects upon their career must not be underestimated. As a professional body (BOA), we should do whatever we can to ensure that high quality patient care is protected and future colleagues are trained to flourish in an ever changing environment. Our future leaders will need a constant reminder of the words of Reinhold Niebuhr: “Grant me the serenity to accept the things I cannot change, the courage to change the things that I can and the wisdom to know the difference.”
