4 Development of a medical leadership programme: uncovering needs using a qualitative approach

Introduction Leadership is key to the delivery of excellent, person-centred care by engaged, empowered teams. Ensuring essential leadership behaviours and skills are promoted and developed is fundamental in shaping organisational culture In 2018, NHS Tayside instituted a clinically led model of management. Whilst traditional medical training focusses on the development of clinical skills to treat individual patients, the delivery of high-quality care for populations requires a knowledge of systems thinking, change management and team management skills. The acquisition of these skills is often 'on the job' whilst in a leadership role. Our goal as a health board is to assist medical staff in the development of leadership qualities and management skills throughout the medical career; from undergraduate through to consultant and career grade staff with bespoke formal training available. In doing so we hope to demonstrate that medical leadership roles are viewed as both valued and attractive posts within the Board. Aims and objectives of the research project or activity To identify and understand the development needs of both current and aspiring medical leaders of NHS Tayside to establish recommendations for the development of a tailored programme that addresses these needs. We identified the following required actions: Consultation with existing leaders Examine existing training in other Health Boards Review existing frameworks for practice Our key questions to leaders were: What knowledge, skills and attitudes do doctors within NHS Tayside need to excel in Medical Management positions? What experience and support is required by doctors to develop the skills needed to lead teams in a complex system and support the delivery of high-quality patient care? Method or approach Semi-Structured interviews were performed, exploring our key questions with a purposeful sample of current, recent and aspiring leaders within NHS Tayside. Participants were provided with information regarding scope of the project and data consent, they were then invited to book an interview. Participants were identified from medical, nursing and senior management teams across different leadership levels. Interviews were carried out on 'Teams' by three interviewers using open ended questions developed as prompts. Transcripts were recorded and two of the interviewers analysed them, using Atlas.ti, an AI-driven coding system to identify emerging themes through qualitative analysis. In combination a search was undertaken of existing National resources relating to medical leadership development and practice. Finally, communication via the network of Scottish Clinical Leadership Fellows explored formal training opportunities that existed within other Scottish Health Boards. Findings 1. Results of Consultation with Leaders We had engagement from across the medical, nursing and professional manager lines at numerous career levels in total 30 respondents were interviewed. Emerging qualitative codes included: Communication and relationships Dealing with uncertainty Generic challenges of leadership Professional development Strategy and decision making Self-awareness Supportiveness The common themes which were identified in interviews could broadly be grouped into; preparation for the role, facilitators to who assist leaders, skills needed for the role and barriers to achieving objectives. 2. Existing Frameworks for Practice There are numerous frameworks which provide a structure for thinking about leadership practice in healthcare. These models come from professional bodies such as the GMC, Faculty for Medical Leadership and Management and the Royal Colleges and cover broadly similar themes. 3. Existing Training in Other Health Boards Communication via the SCLF network suggested that only a few formal structured medical leadership programmes at a Health Board level are currently being delivered. One example which had recently been implemented offered a structured educational programme to support the learning needs of medical consultants within the first 5 years of their career. Key messages Reflecting on the qualitative analysis and learning from existing resources, there would appear to be five areas that should be the focus for improvement. 1. Role clarity Ensure existence of job description for all medical leadership roles with clear objectives Structured handover from previous incumbents 2. Individual Support Develop mechanisms to encourage access to: Coaching Mentoring Peer support Return to face-to-face meetings Maximising appraisal process Self-assessment 3. Leadership Skills Managing diverse teams Conflict resolution Development of a just culture Communication in difficult circumstances 4. Change Management Skills Service Design Developing change ideas Human Factors and Ergonomics Improvement science 5. Management Procedures Formal training in management procedures, for example: HR policies Finance Many elements of this programme already exist and require improved signposting. Differentiating between essential and desirable elements will help to provide a programme that is valuable and can be delivered in a realistic timeframe for the individual.