Leadership, management and QIP
Leadership and management
Good medical leadership and management is essential to maintain and improve health and healthcare. Trainees who gain experience in this area before taking on responsibilities as Consultants will be much more effective, able to contribute to a future of personalised, high quality, evidence-based, compassionate respiratory care.
The curriculum defines not only a set of knowledge about the NHS constitution, finances and administration, but a suite of personal skills and behaviours that are essential to develop before CCT. Section C outlines 17 domains which fall under the umbrella of medical leadership; from self awareness and self development, to encouraging innovation and facilitating transformation. Section I is dedicated to Management and NHS Structure and specifies that trainees should demonstrate knowledge of subjects including: clinical coding; the European Working Time Directive; National Service Frameworks; NHS financing and budgeting; and the role of the Independent Sector. The best way to acquire this knowledge is to see it in context by getting involved in a project or joining a committee, as it then becomes meaningful and relevant to patient care.
Trainees should start enhancing their skills from the start of speciality training. This work can be extremely rewarding, and create close working relationships between trainees, allied health professionals and managers. Those in the later stages of training should reflect on how they can demonstrate competency in the areas outlined in the curriculum, and should consider joining local and national committees, and contributing to business plans and guidelines.
Assessing leadership skills
The Medical Leadership Competency Framework, developed by the Academy of Medical Royal Colleges and the NHS Institute for Innovation and Improvement, informed the inclusion of leadership competencies in the Respiratory Medicine curriculum. There was a recommendation for assessment of these competencies, but at present there are no assessment tools which specifically assess leadership and management skills. The Faculty of Medical Leadership and Management (FMLM) launched the Leadership and management standards for medical professionals in February 2015, which set out the behaviours needed for medical leadership and management practice across the UK health sector. They have now developed a 360 degree leadership diagnostic tool for doctors at all stages of training, based on these standards. This could usefully be included as additional information at a trainee’s annual appraisal. The London Leadership Academy also provides a free self-assessment and 360 degree feedback tool for leadership strengths and development.
Taking the role further
The RCP’s Future Hospital Commission recommended that a new, senior leadership role was established, whose focus would be on delivering high quality, safe care. A pilot of the role of Chief Registrar is currently underway to determine the skills, protected time and training needed to support this new leadership position. It is anticipated chief registrars will continue training in leadership and management after CCT. They are expected to hold leadership roles such as clinical director, medical director and chief executive. Some Respiratory trainees may wish to follow this path.
Other ways to access structured training and experience in medical leadership and management include: short courses by the BMA; the RCP’s MSc in Medical Leadership and Management (studied part-time); and the National Medical Director’s Clinical Fellow Scheme (taken as OOPE). One-to-one career coaching is also available from the BMA, the FMLM and the London Deanery.
Audit, QIP and continuous improvement
Clinical governance is a systematic approach to maintaining and improving the quality of patient care within the NHS. All trainees will be familiar with the audit cycle and will hopefully already have some experience of quality improvement. During specialty training, this must be further developed and expanded, to prepare for the role of a Consultant. Some trainees have a negative view of QIP, a legacy of a tickbox approach to audit completion. Now is the time to reignite your interest in innovation, collaboration, and quality; and to find bold, inventive ways to improve the health of individuals and populations!
The Respiratory Medicine SAC strongly recommends that all trainees should undertake at least two audits in the specialty (Respiratory Medicine) during training. At least one of these should demonstrate effectiveness, ie have led to change in practice that has been re-audited. In addition at least one audit or quality improvement project should be in general internal medicine. Contributing to a national audit (eg the BTS audit programme) and then identifying and implementing changes at a local level before re-auditing is achievable in a 6 month rotation.
The key to QIP is to make it meaningful. Trainees should choose an area of practice they are interested in and to which they can commit energy and enthusiasm. Support to ensure this energy is channelled effectively is available from trusts and Lead Providers. Trainees should gain experience in evidence-based practice, using tools such as the PDSA (Plan, Do, Study, Act) cycle and run charts. The science of improvement is fascinating, spanning clinical science, human psychology, organisational culture, statistics, and science communication. Any opportunity to improve quality, safety, and value in health care should be grasped. If not by you, then who?
Dr Alex Wilkinson, BTS STAG Chair and winner of the RCP Patient Award 2016 advises: “Trying to complete an effective QI project during a 12-month placement is a real challenge. Try to develop a special interest, and when you identify a problem you can hopefully bring a solution as well. You cannot audit your way to excellence, but audit can prove there is a problem, be a driver for change, and show evidence of improvement. Don’t let audit dominate your QI project though.”
See the forum for resources which will help you navigate the changing NHS landscape, find accredited training in medical leadership, and complete an interesting and effective quality improvement project.