Everyone seeks it, we all need it, it's free to give to others and when you go out of your way to be a giver, you will feel great too. This short is quite wonderful, enjoy :)
Seek an opportunity to validate someone each and every day, and watch those around you grow.
At the weekend I read an insightful publication from The King's Fund, a UK organisation that reviews and makes recommendations about health policy. It's about 50 pages long, but for me the take away messages are summarised below. The original publication is here.
The way we work needs to change in 3 ways, and all have the potential for big reward for both professionals and patients of the future. And if you're a junior doctor or medical student - don't switch off, this is especially important for you!
1. Focus on engagement
The principle values that underpin engagement in our workplace are those of:
There is clear evidence in healthcare that having an engaged workforce results in reduced stress, reduced absenteeism, increased motivation, fewer errors, lower hospital infection rates and even reduced mortality. Happy staff = happy patients.
We build an engaged workforce by focusing on both individuals and teams within the hospital. All staff need:
2. Leaders at all levels
There is a growing recognition that to be a good doctor of the future, it's no longer enough to be head-down in clinical work. Intense sub-specialisation and the devolution of many aspects of care to the wider MDT, means that we all need the skills to help build and be part of an effective team. We all need leadership skills - and from day one of the job.
There is a need for medical leadership to be taught in medical schools, for every doctor to recognise that their role as a professional is not limited to clinics, ward work or the operating theatre. These are the baseline expects. All doctors need to understand the dynamics of the teams they work in, appreciate the values they personally bring to, and adopt within, the service. We need to invest energy in the relationships and behaviours that will make our whole team a success.
Leadership isn’t about being an extraordinary person, it’s about being open and accessible, with an emphasis on team work, collaboration and removing barriers to communication. It reflects a desire to see the world through the eyes of others, taking on their perspectives and working with their ideas. Often, it’s about challenging the status quo.
So how do you start being a leader? You start now, right where you are, with the people and teams that you interact with on a daily basis. Think about how you can bring a focus of engagement to those around you. Find others to share the enthusiasm and help them too. And look out for opportunities to engage with managers who are open to a new approach in how they work as well.
3. Management: devolved authority
For too long the pervasive style of senior hospital management has been ‘top down’, a command and control culture, with a demanding focus on targets (e.g. Emergency Department access times, surgical waiting lists, etc). Recognition and reward is closely linked, ensuring the medical and nursing teams are constantly paying attention to these priorities - not that they aren't worthy, but often it's to the exclusion of clinical and team goals of an equal or greater importance.
Unfortunately, in many hospitals, a target-focus has been linked with a reluctance to delegate control to middle managers and senior clinicians. Staff become robbed of the authority to make decisions, there is a reluctance to collaborate with teams about changes that directly affect them, leading to demoralisation and ultimately poor patient care.
We need a new management style to breathe life into our hospitals. We need hospital managers to recognise the importance of engaging both patients and staff, with a rethink of the way power and responsibility is distributed within organisations. If there are problems on the floor, senior medical and nursing staff should be consulted about the issues and engaged to find solutions. They are usually in the best position to understand the dynamics of what will and what won’t work.
Managers need to bring clinicians into leadership roles, ensure that leadership and decision-making is distributed throughout the organisation. Control over how clinicians do their job is the biggest predictor of an engaged, happy and functional workforce - 'no decision about me, without me'.
If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.
Gordon Tredgold outlines here the 5 daily habits that leaders need to do to increase engagement with those around them.
Whether you're the medical student taking your first patient history (yes, they look up to you too!) or the Director of Medical Services setting the standard for the hospital, leadership engagement is key for all of us.
To summarise:
Sounds easy, but the wonderful thing, is that it actually is easy. And those around you will both grow and thank you.
If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.
'I know what I need to do. I just don’t know how to do it'
We know that we want to bring strong leadership to our workplace. We have put thought into the strategies that we think will succeed. But how do we move forward? What principles do we need to put in place to ensure success?
I recently came across a discussion about a book called ‘The 4 Disciplines of Execution’. A book that builds on extensive case studies to describe 4 disciplines (abbreviated 4DX) that help organisations implement high level strategies. I believe there might be something in this for medical leaders who want to bring positivity, strength, purpose and direction to their own leadership.
So what is the 4DX framework, and how can we adapt it to our goals?
Discipline #1: Focus on the Wildly Important
The more you try to do, the less you actually accomplish. Execution should be aimed at a small number of ‘wildly important’ goals. This simplicity will help focus energy (yours and your departments) to bring real results. As David Brooks wrote in ‘The Art of Focus’: ‘If you want to win the war for attention, don’t try to say ‘no’ to the trivial distractions you find on the information smorgasbord; try to say ‘yes’ to the subject that arouses a terrifying longing, and let the terrifying longing crowd out everything else’.
Pick a few challenges or new approaches that - when successful - will really turn around the way your team work together and provide care. Don’t be afraid to be ambitious, make them ideas that will produce profound, tangible rewards for your team.
Discipline #2: Act on the lead measures
Once you’ve chosen your wildly important goal, you need to measure your success. There are 2 types of metrics for this: lag measures and lead measures. Lag measures describe the thing you’re ultimately trying to improve. For example, you might choose to do some work on supporting your staff. You know that staff who are better supported will be both happier in the workplace and contribute to better patient care, for a whole range of reasons. The relevant lag measure for supported staff is improved feedback at their 6/12 monthly review; or improved patient outcomes if you look even further afar.
As the 4DX authors explain, the problem with lag measures is that they come too late to change your behaviour. Lead measures, however ‘watch the new behaviours that will drive success on the lag measures’. In the case of supporting our staff better, you might choose lead measures such as:
Of course there are many more activities that are involved in creating an engaged workforce, and these are just a few examples. As you improve the numerical quantity of your lead measures, your lag measures will improve as well. In other words, lead measures turn your attention to improving the behaviours you directly control in the near future, which in turn will ensure the success of your long-term goals.
Discipline #3: Keep a compelling scoreboard
The 4DX authors explain: ‘People play differently when they’re keeping score’. This means that it’s important to have a public scoreboard to drive your team’s engagement toward your wildly important goal. This not only creates a sense of competition, but once the team notices their success in the lead measure, they become invested in perpetuating the performance.
Turning to our example, you might keep a physical document that tabulates all the registrars and RMOs by month and the number of meetings that have taken place. Other lead measures are more personal, so the Director might alone keep a calendar on the wall and check off when she or he carries out a weekly communication with the team in some form or other. Finally, individuals may keep a note on their daily journal or have a recurring ‘To do’ item on their phone that reminds them to seek out individuals within their team to reward with some specific positive feedback.
For other wildly important goals, you might create a public scoreboard for the whole team: e.g. if you decide to do a piece of work focusing on reducing complication rates of some description, it’s important that you have a running score somewhere, so the team knows how it’s going.
Discipline #4: Create a cadence of accountability
To maintain focus on lead measures, this is the final step to put in place. ‘A rhythm of regular an frequent meetings of any team that owns a wildly important goal’. During these meetings, the contributors confront their scoreboard, commit to actions to further the cause and reflect on what happened to the numbers since the last meeting, reviewing their previous actions.
For individuals assessing their own scoreboard, this means a ‘weekly review and reflection’. Where the goals are owned by larger teams, it should include all who are committed to the cause, and be systematic in it’s approach. This might take place at a weekly or monthly team meeting, depending on which lead measures need review.
The 4DX framework is based on the fact that execution is fundamentally more difficult than strategising. For all of us. After reviewing hundreds of case studies, the inventors nailed it down to a few simple disciplines that can help. For most medical leaders, the idea of keeping and reviewing a scoreboard isn’t intuitive. And even if our goals aren’t wide ranging or desperately complex, the 4DX disciplines can help achieve success by aligning our practice with a method that is known to work.
If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.
Simon Sinek here highlights the medical profession as an example of poor leadership, and the consequences of this.
Hospitals are run like businesses, and the problem isn't the people giving the care - those people are highly trained. The problem is the way those people are cared for.
We all have to own this, by looking after our teams, and guiding them in doing the same for each other.
The video starts right at the relevant segment and lasts 2 minutes. The ongoing conversation about the human factors involved and how all organisations can create a workplace that inspires our teams is very important too.
Last week I came across some interesting research carried out by Google, looking at why some of their teams are highly productive and others, not so much. The results got me reflecting on our own teams and how relevant this research might be for healthcare professionals.
Thinking more widely, it brought me to the question: does undergraduate and postgraduate training prepare doctors for the leadership challenges they face for the rest of their working lives?
Most postgraduate programs have extensive curricula, challenging examination hurdles, and are many years duration. When I think about advanced specialty trainees as they approach the end of their training, almost unanimously their anxieties are about their level of practical skills or clinical knowledge. Are they going to be able to cut it as a boss, to be the all-knowing leader of a clinical team? They angst about whether they can do the procedures, if they have enough operations under their belt to be the slick consultant they want to be. A leader who is good enough, in turn, to mentor his or her own registrars.
Becoming the boss
But what does it actually take to be a leader? What skills are necessary to lead a successful team? What do clinical Directors look for when interviewing for a new consultant? Registrars are often surprised when I tell them that clinical or surgical expertise is rarely one of the differentiating values between candidates. It's actually taken as read that you can do the job if you fulfill the criteria to be shortlisted. You've done your time, you've got your Fellowship. I don't care if you've done 50 or 500 hysterectomies - the clinical expertise will come with time and support. What is most important is can I work with this person every day of my life? Are they going to bring value to the team? Are they emotionally intelligent? Or are they going to cause chaos and disharmony in the workplace that requires constant fire-fighting. When you bring a colleague into your team, you are selecting a new family member. So it needs to be a good one.
Evidence-based leadership qualities
As I mentioned, Google found that some teams within their company were excelling, whilst others were poorly functioning, even though they all seemed to have members with similar technical abilities. So they looked to determine the characteristics of the leaders of the best functioning teams within their organisation. Google's Project Oxygen worked through exit interviews, team reviews and 360 degree ratings, amounting to over 10,000 observations of leaders' behaviours. There were 8 characteristics identified in leaders of high quality teams - and technical expertise was at the bottom of the list.
Think about what you look for in your leaders as you train, is it not all of the above? Teams want a leader who helps them to puzzle out problems themselves. Always giving the answers implies superiority and shuts down the conversation. Asking questions implies confidence in your team and sustains communication. People need constructive feedback, within a caring and supportive environment. Your team needs to know that you believe in them and to provide them with adequate mentorship for their growth. One of the most valuable things you can give your team is one-on-one time. We cannot lead from a distance.
Improved patient care
The most important consequence of this, is that it doesn't just produce happy workers, it builds teams that are highly functional. Leaders who focus on these characteristics will have teams that embody respect for each other and support one other in their day to day work. This means better patient care and fewer adverse events. Highly functional teams will go above and beyond the call of duty to get the job done.
But how to start? When to start?
You might not have explicitly thought about it, but all through postgraduate training (and often before, as a student), we are put in situations where we are expected to lead. These include:
Notice that I'm not talking about only medical teams. If you're the registrar on duty, you are a member of more than one clinical team, and many of these are multidisciplinary: your ward team including the RMO and nurses responsible for your patients, the MET call team, the surgical team in theatre, the birth suite team, including the shift co-ordinator and all the midwives. Our responsibilities don't only lie with other medical staff. It's as much our role to provide all the 8 leadership qualities to the nurses, midwives and other health care workers within our wider MDTs.
So, when & where to start? Right here, right now. Think about how you can map the leadership qualities above to your own daily experience and responsibilities as a doctor.
If you think this is important, join the positive leadership movement and talk about these issues. Share/like on social media, so others know you believe in it and the word spreads. Be the change you want to see in our health care systems.
You’re an RMO. You’re a registrar. Or a consultant. You come to work each day, to a job you enjoy. It has its ups and downs like all jobs - you’re resilient, you get the work done. Go home, relax, eat, sleep, repeat.
But there are two types of work that we all do: proactive work and reactive work - you might think of proactive work as your work. As you become more senior, the more you recognise the importance of your work in reaching your own goals - and the goals of your organisation. Where you are going and what you are building for those around you, medicine as a whole and the world. Longer term, bigger picture stuff.
Let’s face it, our jobs are busy and we’re never short of things to do. It doesn’t only expand to fill the time, it expands way beyond the time we have. And this is why you have to:
As a junior doctor, your work includes everything you’re doing to build a career, improve the care your teams deliver and to move you closer to your personal goals. Your work is proactive, not reactive and includes:
For all of us, this includes taking time out for just thinking, for reflecting on things, bringing all your experiences together and working out how to move forward in the areas that are challenging you.
Even if we define our priorities for our day, often other people’s ‘urgent’ needs come along and derail our plans. Unless you intentionally block off time in your day or your week for longer-term, meaningful work, it will always get crowded out by the small stuff.
Of course for us, the small stuff isn’t usually small, and all the other things we do are absolutely important too. We can, however, be intentional in how we plan each day. So that when the end of the month comes around, we’ve all edged that bit closer to our important goals.
“You are the steward of your own potential. The resources within you—and around you—are only tapped when you recognise their value and develop ways to use them... The greatest leaders will be those most capable of tuning into themselves and harnessing the full power of their own minds.”
It’s very easy to be constantly sucked into a day and a week of busyness, bouncing from one urgent thing to the next. The best creative minds agree that giving ourselves time to think and focus on our own priorities - as well as the needs of others - is the key to long term productivity and success.
As Henry David Thoreau said, “It is not enough to be busy. So are the ants. The question is: What are we busy about?”
“Mutual accountability: the holy grail of teams. Where I feel that I can succeed, among people I know, trust and care for, why would I let them down?”
But what does this look like in practice? How can I have it in my workplace. What can I do?
If you’re the RMO, build trust and strong relationships by looking after your colleagues; ask what you can do to make their day easier if you’re having a quiet one. Get to know others on a personal level and ask them about the important things in their life. Relationships are about the small stuff. Take your medical students under your wing, acknowledge the stress of short attachments, constant change & disorientation (you know about that too). Enthuse them with your excitement for being a doctor - you’re their inspiration. Let them do things, give them responsibility, and show you trust them to complete it. Touch base with everyone, often.
If you’re the registrar, remember what it was like being an RMO, they will appreciate your empathy. Relationships and communications are key to happy teams, and your role as a middle grade doctor is central. You carry much more power in team dynamics than you realise - especially in wider MDT relationships. Keep your ears to the ground for the general mood of your team - if there are frictions, consider why and what you can do to help solve them. Ask for help if you’re not sure. Team trust is built through reciprocity - share knowledge, ideas and concerns, contribute to each others problems, acknowledge and talk about your shared goals of excellent patient care. Teach your RMOs and medical students about the importance of efforts devoted to creating a strong workplace culture. When your RMOs or registrar colleagues are busy, offer a hand to help. They will never forget the feeling of being well supported and will return the favour. Ironically, when we help others, we have more to gain, because it makes us feel great too.
Consultants understand that the key to a strong, happy team is a combination of trust, social connectedness and empathy. They support members who are in difficulty, but most importantly, are constantly looking for opportunities to reward positive behaviours in others. Make it a rule to acknowledge at least one person in your team for something good they did, every single day. Heartfelt, specific and in public if appropriate. The more senior you are, the more important it is to listen properly. People look to you for sage advice, but you will never learn anything new unless you are listening. Demonstrate humility, acknowledge your own imperfections, model the behaviours you want to see in others and you will lift your team higher than you could imagine. And earn the respect of those around you.