First and last, think about humanity Everything else is an irrelevance Bertrand Russell

The triple challenge

During this talk the national debt will rise by >£20m

Lansley – hero or villain? Patient choice through information revolution GP commissioning Outcomes not process targets New public health Reform of social care …and how will history judge him?

Robert Francis 6Feb Fundamental standards and measures of compliance 2.Statutory requirement for openness, transparency and candour 3.Compassionate, caring, committed nursing 4.Stronger healthcare leadership 5.….and 286 other things!!!

The Future of Clinical Leadership

What is Clinical Leadership Leading clinicians? Leading doctors? Clinicians leading? Doctors leading? Leading clinical services?

Do We Value Medical Leaders & Leadership? As a system? As a profession? Do we value our roles? Take it seriously? Time and resources? Accountability? Do you know your value? Is medical leadership a profession? Does it matter?

The link between the Management of People & Patient Mortality in Acute Hospitals West M et al. Int J HR Mgt :

Robert Francis 6Feb 2013 The recognition that healthcare management and leadership is, or should be treated as a profession, is important. The concept carries with it a need for members of that profession to commit to a professional code of ethics, conduct and standards relevant to their work, separate from any such commitment they have by reason of other professions. It puts all professionals in the health service on an equal footing………….

Robert Francis 6Feb 2013 Much effort is being put into increasing the availability of management and leadership training at all levels, and this is clearly a positive development to be encouraged. The medical profession is making its contribution with the establishment of the Faculty of Medical Leadership, which is seeking to integrate the development of managerial and leadership skills into the work of its members, and to enhance the professional status of healthcare management.

Robert Francis 6Feb 2013 The development of this concept is likely to contribute to the willingness of suitable candidates to come forward, will encourage the integration of a common culture, and offers the possibility of providing assurance to the public about the competence and suitability of those appointed as senior managers and leaders.

Faculty of Medical Leadership and Management

NHS Leadership - progress NHS Leadership Academy SC Leadership Development Partner (~10,000) Inter-collegiate Faculty of Medical Leadership and Management Clinicians now lead the system! More senior clinical leaders than ever

….and Clinical Engagement ?

Discretionary Effort = Personal Capability – Minimum Requirement ‘there is an increment of human effort which individuals can apply exclusively at their discretion’

A cow with a name produces more milk than one without Douglas & Rowlinson, Newcastle University …and treating her as an individual …increases milk yield by 500 pints /yr

Some farmers: have waterbeds for cows to rest on play classical music hire animal chiropractors to give older cows a tune-up ……all to ensure maximum milk output.

…a lot of managers … trying to solve problems miss the forest for the trees by forgetting to look at their people…...I think they need to look a little more closely at what it’s like for their people to come to work there every day.

Quality healthcare for patients is only achievable if all parts of the system work together – our starting point is to get our senior management team to strengthen relationships with doctors.

From Competence to Engagement Competence may be thought of as “can do” but engagement requires “will do”- the motivational aspect Engaged employees characterised by - belief and pride in their organisation - commitment to improve the outcome/ product - understanding of the wider organisational context beyond their own job role - respect for colleagues - “willingness to go the extra mile”

Scales and Definitions

Levels of Medical Engagement Embedded Expanded Energised Expectant Excluded Doctors are fully involved at all levels in leading the design and delivery of service innovations Doctors traditional roles have become expanded to embrace some aspects of managing healthcare Doctors are keen to become more involved in the planning, design and delivery of services Doctors understand the importance of becoming involved in the management agenda Doctors are not part of the management process and confine their activities to their traditional role

How to achieve staff engagement Michael West Central: a culture of trust - in leaders, managers and system Importance of perceptions of fairness distributive justice, procedural justice, interactional justice What leaders pay attention to, monitor and measure and on what basis they allocate resources The behaviours they [leaders] model Criteria for recruitment, selection, promotion & disciplinary action Flat hierarchies, rituals and rites promote involvement, celebrations of accomplishment, encouragement of innovation. No good deed goes unrecognised Focus of the organisation’s systems and procedures is on the outcomes they value e.g., quality of health care (not cost cutting above all else!)

The Future of Clinical Leadership

In a time of drastic change, it is the learners who inherit the future. The learned find themselves equipped to live in a world that no longer exists. Eric Hoffer

Perceptions of junior doctors in the NHS about their training Gilbert A, Hockey P, Vaithianathan R, Curzen N, Lees P. BMJ Quality & Safety Online: Jan 12 Leadership Development yes no How valued do you feel by: Consultants? <0.001 Non-consultant colleagues? <0.001 Managers? <0.001 Chief executive? <0.001 Your organisation?

FMLM has 1,000 Junior Doctor and Medical Student Members The Future of Clinical Leadership

The Future is Bright The Future will be as bright as we make it In 5 years all UK doctors will have demonstrated their fitness to practice to high standards. Within 3 years we will have implemented three accredited levels of NHS leadership. In 5 years 800 trainees who joined FMLM in 2011 will be 7 years further on in their portfolio careers In 5 years the recession will be over? The NHS will be the most transparent healthcare system in the world. The NHS will be the best healthcare system in the world.

The need for collective engagement Furthermore, the solutions to the current dilemmas lie not in a few clever people incarcerated in head offices but by the collective effort of one of the largest workforces on the planet with the largest condensation of intellect in the land. Is it too far-fetched to assume that that combined brainpower should be able, not only to overcome the current crisis but also to deliver a better future characterised by innovation, quality, efficiency, positivity and an outstanding ‘place’ to work and be treated?

When the elephants fight it is the grass which suffers African proverb