1. Developing psychiatrists as clinical leaders
Dr Lenny Cornwall
Deputy Medical Director, TEWV NHSFT

2. Summary What is a clinical leader? My personal development
Leadership programme for SRs in TEWV
Leadership competencies for consultants
Leading the clinical team

3. What is a clinical leader?
What does the GMC say?
Leadership (all doctors)
Most doctors work in multidisciplinary teams. The work of these teams is primarily focused on the needs and safety of patients. The formal leader of the team is accountable for the performance of the team, but the responsibility for identifying problems, solving them and taking the appropriate action is shared by the team as a whole.
You must be willing to work with other people and teams to maintain and improve performance and change systems where this is necessary for the benefit of patients.
You should respect the leadership and management roles of other team members, including non-medical colleagues.

4. What is a clinical leader?
What does the RCPsych say?
OP74 The role of the consultant psychiatrist (2010)
a consultant psychiatrist can, and indeed is uniquely positioned to, lead a team in such a way that practice and outcomes for patients are good and are continuously improving
the seniority of the consultant within the multi-disciplinary team can confer accountability for clinical leadership, but it is not automatic

5. Why is this so difficult?

6. The meaning behind medical language

7. Making doctors Simon Sinclair (1951-2014)
“The psychiatrist is thus the lowest form of medical life, but is joined in the first circle of medical student hell by psychologists, sociologists, and general practitioners. In Sinclair’s jargon, they lack proper Knowledge (“hard facts”), do not give proper Experience (finding physical signs or learning practical procedures), and do not have proper Responsibility (going on as they do about multidisciplinary teams).” Book review by Simon Wessely (1998)

8. What is valued in medical culture?
High value
Knowing stuff
Certainty
Clinical experience
Individual responsibility
Competition
Practice
Low value
Finding things out
Uncertainty
Academic practice
Team working
Co-operation
Theory

9. Think like a patient, act like a tax payer

10. My personal history Higher training Early years as consultant
chair of RCPsych PTC during Calmanisation
Early years as consultant
Leading a adult psychiatry sector team
different Trust, different culture
DME
leadership training for SRs
DMD
competency framework for consultant recruitment

11. Medical leadership competency framework

12. Healthcare leadership model

13. Effective leadership of clinical teams
Leading to quality report (Yorkshire MH trusts, 2013)
Characteristics of leaders of effective teams
Passionate about providing quality service
Democratic but decisive leadership
Focused on team as a unit and individuals within it
Willing to manage performance
Able to balance needs of team and of the organisation
Vary approaches to manage change
Alimo-Metcalfe et al (Bradford University, 2013)

14. Healthcare leadership model
Inspiring a shared purpose
Leading with care
Evaluating information
Connecting our service
Sharing the vision
Engaging the team
Holding to account
Developing capability
Influencing for results

15. What should happen? What the MLCF says Undergraduate Postgraduate
Demonstrating personal qualities, Working with others
Postgraduate
Managing services, Improving services
Continuing practice
Setting direction

16. What can happen? A realistic approach to training: registrars
Demonstrating personal qualities
Self awareness & reflection
Plan own workload
Audit own practice
Working with others
Being part of the team (for 6 months)
Valuing the contribution of other professionals
Giving feedback to others

17. What can happen? A realistic approach to training: senior registrars
Managing services
Attend service management meetings
Manage resources you control
Highlight waste
Supervise more junior staff
Improving services
Participate in clinical governance process
Undertake complex audits
Lead a change project

18. Translating the MLCF competency framework to the psychiatry curriculum
OP80 (RCPsych, 2012)
Translating the MLCF competency framework to the psychiatry curriculum
Organising clinics
Carrying out supervision
Prioritising work
Dealing with concerns
Delegating to the team
Leading change

19. Leadership training for SRs
TEWV leadership training programme
6 x full day workshops over 12 months
Doctors as leaders
The NHS
Managing change and service improvement
NHS financing and commissioning
Personal effectiveness
Emotional intelligence and team working
Leading a change project with a “leadership champion” (voluntary component)

20. Leadership competency for consultants
TEWV recruitment model
4 competency domains
Clinical knowledge, skills and experience
Academic skills & life long learning
Personal & professional qualities
Leadership
Self awareness & openness to change
Influencing & persuading
Commitment to quality
Organisational commitment

21. Job descriptions & job planning
Clinical duties of post
Educational & academic duties
General professional duties
Leadership duties
Provide leadership to MDT alongside team manager
Contribute to service development
Contribute to clinical governance & responsibility for setting and maintaining standards
Show commitment to quality improvement

22. Leading a clinical team
Psychiatrists as leaders of the clinical team
Self awareness
Seek & act on feedback
Influencing & persuading
Use power & influence appropriately
Work within organisational constraints
Commitment to quality
Learn from mistakes
Work with team manager to develop service
Organisational commitment
Understand & accept Trust priorities

23. A new example to consider
Bridging the clinical - leadership gap
AoMRC guide to effective use of resources in everyday clinical practice
Written by 2 SRs
Published this week

24. Promoting value How reducing waste leads to higher value care
20% of clinical practice brings no benefit to the patient (Berwick, JAMA, 2012)
A cultural shift is required which calls upon doctors and other clinicians to ask, not if a treatment or procedure is possible, but whether it provides real value to the patient and genuinely improves the quality of their life
3 key areas
Overuse of medication
Overuse of diagnostic or monitoring tests
Unplanned admissions

25. Conclusions Psychiatrists should be and must be clinical leaders
Medical training means leadership development does NOT happen automatically
Competency based curriculum may have made the situation worse rather than better (discuss!)
Disconnect between clinical and leadership curricula
Leadership skills are the key to consultant appointment (in TEWV at least)