Presentation on theme: "A Mandatory Management/Leadership Development Framework for Doctors"— Presentation transcript:
1A Mandatory Management/Leadership Development Framework for Doctors Professor Peter Spurgeon Director of Institute of Clinical Leadership University of WarwickA Mandatory Management/Leadership Development Framework for Doctors
2Enhancing Engagement in Medical Leadership Joint Project undertaken by National Institute for Innovation and Improvement, and Academy of Medical Royal CollegesOverall goal ‘create a culture of greater medical engagement in management and leadership with all doctors at every level’Two key productsMedical Leadership Competency FrameworkMedical Engagement Scale
3Project BenefitsBenefits to the NHS and medical professionals include:Greater commitment and capability to effect service change and improvementSupport the drive towards the new medical professionalismGreater awareness by medical professionals of the contribution of effective management and leadership in both operational and strategic activitiesIncrease and strengthen the pool of medical managers and leaders available to take on senior roles within the service
4Project Products and Research International study on preparation of doctors for leadership rolesResearch into the link between medical engagement and organisational performance includingLiterature reviewInterviews with Chief Executives and Medical DirectorsDevelopment of a medical engagement scaleEngaging doctors publicationMedical Leadership Competency Framework
5Medical Leadership Competency Framework Describes the leadership competences doctors need to become more actively involved in the planning, delivery and transformation of health services.The MLCF is being used to:Inform the design of training curricula and development programmes at undergraduate and postgraduate stages of a doctors trainingHighlight individual strengths and development areas through self assessment and structured feedback from colleaguesAssist with personal development planning and career progression through to revalidationThe MLCF applies to all medical students and doctors
6Medical Leadership Competency Framework Tested in 5 sites across the country Sept – Dec 07included medical schools, postgraduate deaneries, acute and primary care trustsFurther amendments made and endorsed by the Steering Group and Academy of Medical Royal Colleges in March 08Delivering services to patients and others who use healthcare services is at the heart of the Competency Framework. The five domains (Personal Qualities etc) highlight the general areas in which doctors need to be competent.Each domain is subdivided into four elements, each element is further divided into four competency outcomes.
7Medical Leadership Competency Framework Development of the Medical Leadership Competency Framework (MLCF) was informed by:A review of literature and key publicationsComparative analysis of leadership competency frameworksAnalysis of medical curriculaConsultation with members of the medical and wider NHS community includingGeneral Medical Council (GMC)Postgraduate Medical Education Training Board (PMETB)NHS ConfederationNHS EmployersConference of Postgraduate Medical Education Deans (COPMeD)Medical Schools Council (MSC)British Medical Association (BMA)Input from the project steering group, reference and focus groups, test sites and AoMRC patient/lay group.
8Medical Leadership Competency Framework Application of the MLCF will differ according to the career stage of the doctor and the type of role they fulfill. The following graphics demonstrate the emphasis that is likely to be given to the domains at each stage:UndergraduatePostgraduateContinuing Practice
9Demonstrating Personal Qualities Doctors showing effective leadership need to draw upon their values, strengths and abilities to deliver high standards of care.Developing self awareness: being aware of their own values, principles and assumptions and by being able to learn from experiencesManaging yourself: organising and managing themselves while taking account of the needs and priorities of othersContinuing personal development: learning through participating in continuing professional development and from experience and feedbackActing with integrity: behaving in an open, honest and ethical manner.
10Working with OthersDoctors show leadership by working with others in teams and networks to deliver and improve services.Developing networks: working in partnership with patients, carers, service users and their representatives, and colleagues within and across systems to deliver and improve servicesBuilding and maintaining relationships: listening, supporting others, gaining trust and showing understandingEncouraging contribution: creating an environment where others have the opportunity to contributeWorking within teams: to deliver and improve services.
11Managing ServicesDoctors showing effective leadership are focused on the success of the organisation(s) in which they work.Planning: actively contributing to plans to achieve service goalsManaging resources: knowing what resources are available and using their influence to ensure that resources are used efficiently and safely, and reflect the diversity of needsManaging people: providing direction, reviewing performance, motivating others and promoting equality and diversityManaging performance: holding themselves and others accountable for service outcomes
12Improving ServicesDoctors showing effective leadership make a real difference to people’s health by delivering high quality services and by developing improvements to service.Ensuring patient safety: assessing and managing the risk to patients associated with service developments, balancing economic considerations with the need for patient safetyCritically evaluating: being able to think analytically, conceptually and to identify where services can be improved, working individually or as part of a teamEncouraging improvement and innovation: creating a climate of continuous service improvementFacilitating transformation: actively contributing to change processes that lead to improving healthcare
13Setting DirectionDoctors showing effective leadership contribute to the strategy and aspirations of the organisation and act in a manner consistent with its values.Identifying the contexts for change: being aware of the range of factors to be taken into accountApplying knowledge and evidence: gathering information to produce an evidence-based challenge to systems and processes in order to identify opportunities for service improvementsMaking decisions: using their values, and the evidence, to make good decisionsEvaluating Impact: measuring and evaluating outcomes, taking corrective action where necessary and by being held to account for their decisions
14UndergraduateThe revised Tomorrow’s Doctors released Sep 2009 includes MLCFProject support will includeUpdate to Medical Schools Council and offer support to Medical Schools to implement MLCFMeet with Medical School Deans to assess progress and offer advice regarding implementationDevelopment of a resource and learning pack with a consortium of medical schoolsIdentify minimum levels of attainment across the domains to assist in development of appropriate assessmentContribute to Medical Professionalism Roadshows across the UK (with Royal College of Physicians, King’s Fund and GMC)
15PostgraduateAll Medical Royal Colleges and Faculties are undergoing a review of their curricula, PMETB has advised that the MLC is to be included in this revision.Project support includes:Medical Leadership Curriculum has been developed, based on the MLCF and provided to all colleges and facultiesMeeting with each college to discuss approach to implementation, and how we can support this processProviding assistance to colleges and faculties regarding assessmentDevelopment of e-Learning for Healthcare (DH) material that will be available to all doctors in training, regardless of specialty, in early 2010Supporting the delivery of the new curricula with tools and support for training clinical tutors
16Continuing PracticeRevalidation will be introduced from 2011 and the project team are working with the relevant regulatory bodies to ensure the MLCF is included in the guidelinesProject support includes:Meeting with SHA Medical Directors and Home Country Chief Medical Officers to raise awareness and advise on implementation including deliveryContribute to review of Good Medical PracticeWork with DH, NHS, GMC and AoMRC on revalidation, providing input on MLCF
17Engagement is Critical to Organisational Performance Since 1997, Gallup’s extensive Q12 survey has assessed more than 4 million individuals – results revealed that of less than a third of employees (29%) are actively engaged in contributing to their employing organisations successIn 2003 “The Quest for Quality in the NHS” (Leatherman and Sunderland) described UK clinicians as being attentive but not fully engaged in the NHS quality improvement agendaSuccessful medical engagement is crucial to future improvements in the NHS and is a policy priority with high performing NHS Trusts consistently identifying high levels of medical engagement as the key factor in achieving service improvements (Emphasised in Lord Darzi’s High Quality Care for All: NHS Next Stage Review Final Report – 2008)NHS organisations not only need reliable and valid tools to measure how well they engage doctors, they also need to promote and embrace a cultural change where managers and medical staff actively want to build better, more co-operative and productive relationships that drive service improvements
18The Three Aims of the Research To develop a reliable and valid measure of medical engagement in leadership which will be quick and relatively unobtrusive to completeTo differentiate within the scale a measure of personal engagement at an individual level (the motivation of the individual to perform in appropriate managerial and leadership roles) from the organisational context (which may foster or constrain engagement)To develop a systematic framework for recommending organisational strategies capable of enhancing medical engagement and performance at work
19Key Assumptions of Current Approach Improvement in healthcare needs the positive involvement and engagement of doctors who are highly influential in planning and delivering service changeCompetence can be thought of as what someone “can do” but engagement requires a “will do” attitudeReliable and valid measurement and monitoring of medical engagement is critical since this will inform and shape the effective management of changeMany definitions of engagement focus solely on individual aspect of engagement whereas the current approach also incorporates organisational conditionsOur definition of Medical Engagement is:-‘The active and positive contribution of doctors within their normal working roles to maintaining and enhancing the performance of the organisation which itself recognises this commitment in supporting and encouraging high quality care.’ [Spurgeon, Barwell & Mazelan, 2008]
20Origins of the Medical Engagement Scale (MES) Applied Research Ltd. – Established large database re: attitudinal, individual & cultural aspects of NHSExisting measure of work satisfaction and personal commitment based on 23,782 NHS staff and 20+ health organisationsBest items from previously established scales selected as relevant to medical engagement and re-analysed using Factor AnalysisScales adapted to focus on engagement - reliable, valid & relatively easy to administer & complete
21Pilot Phase FocusPiloting took place in 4 NHS Trusts measures distributed, 118 medical staff returns & 19 senior managers (above 50% response rate)The pilot was aimed at developing a reliable and valid measure of medical engagement in leadership which will be quick and relatively unobtrusive to completeThe measure comprised a set of items representing various scales and a behavioural checklist, enabling an assessment of the alignment between the medical and managerial perspectivesTo explore within the scale a measure of personal engagement at an individual level (the motivation of the individual to contribute to appropriate managerial and leadership roles) from the organisational context (which may foster or constrain engagement)
23MES Reliability & Validity Overall items reduced to 18 [or 30 for full sub-scale version] with reliability scores (Cronbach’s alpha) ranging from 0.70 to 0.93Inter-scale correlations with key core concepts of engagement suggest -engagement is a conceptually distinct constructthe sub-scales are important as engagement is multidimensionalScores from the pilot trust sites were statistically significant & in the predicted order i.e. top two are rated excellent & have taken steps to promote medical engagement, the last is in the poorest performing category & opportunistic site in the middle
24MES Medical Engagement Model The MES model emphasises the interaction between the individual doctor and the organisation.The MES model emphasises the interaction between the individual doctor and the organisation.
29Engagement Intervention Strategies The IHI Framework for Engaging Physicians in Quality and Safety – Reinertsen et al (2007) - comprises six areas which can be used as a checklist for engaging physicians in quality and safety. In a similar way the hierarchical structure of the MES has also been linked to suggested potential intervention strategies and these are outlined in the hierarchical figure shown.
30Levels of Medical Engagement Summary for Trust 1
31Levels of Medical Engagement Summary for Trust 28
32Levels of Medical Engagement for All Trusts in Current Sample