This is our third blog, and it finds us further ahead in our ongoing journey to understand why managers and medics struggle to lead collectively and with trust and transparency in the NHS today. In our earlier blogs we explored how well understood healthcare managers are[1] and how partnership working in practice can be hampered by learnt mindsets reinforcing professional differences [2]The huge response to these blogs indicates the topic has relevance to many in UK health services today.

Earlier this Spring, to explore this further, we hosted a Tweet chat with BMJ Leader, Proud2bOps and the Faculty of Medical Leadership and Management (FMLM).  Our aim was to hear more voices on these topics, focusing on good collaboration and collective leadership between managers and medics. We considered what it looks and feels like when we take responsibility jointly and equally, and what stops it happening more often, or more widely encouraged to build greater strength, rather than feeling like a compromise. Reflections included frequent lack of time, a tolerance of ignorance, and gaps in understanding of each other’s roles.

One of the medically trained participants in the Tweet chat noted there can be a presumption amongst clinicians that they have a monopoly on patient-focused care and patient safety, when in their own experience, the most patient-focused people they had met were managers. Indeed, much good management training (such as that provided by the NHS Leadership Academy[3]), is focused on understanding the experience and delivery of services for users, and safety-critical principles and systems thinking. Clinicians may fail to realise this; assuming incorrectly that managers have all been schooled with a corporate MBA or have predominantly financial skills.

We heard that the curriculum at medical school and role models early in a medic’s career didn’t always see managers as on the same team. It isn’t just in our early training – colleagues noted, and we would agree, that it is still true that managers and clinicians often face different pressures and have varying views of what “good” means – aligned to divergent measures in how performance is assessed and valued. Managers need to lead here too – it’s too easy to hide behind the furniture of structures and processes than to engage on a human level and understand one another. These themes led to some suggestions for novel personal and professional learning, for blended education. As leaders we needed to be more intentional in recognising our own gaps in knowledge, and the risk of such cultural divides leading to a lack of respect, but formal tools can help.

Our work on this theme has revealed that current educational and organisational development systems are not well set up for managers and medics to understand one another. Conferences and training programmes tend to specialise or be accredited within professional boundaries, or structured to accommodate particular working patterns, which limit wider participation. The Messenger Review[4] has highlighted the poor structure and consistency in leadership development and a need for more focus on collaboration, as well as greater recognition of the skills and professionalism of NHS management.

Let us step back and consider the development of operational managers in UK Health services.  Proud2bOps is a national network established to energise, connect, and develop operational managers and leaders.  As a network, Proud2bOps recognises that the greatest learning and development takes place in the spaces where people feel safe, foster curiosity, and regularly connect with multiple professionals to access operational knowledge and practical excellence.  Despite these spaces being well evidenced to be hugely beneficial, reality remains that those that need it most, often fail to access these impactful opportunities because of professional boundaries we have ourselves put in place, and which structures within the NHS and professional regulators can reinforce.

If we need better collective leadership and collaboration, in this time-poor world how do we teach this, and find ways to learn this together, across professional boundaries – what if we approached this differently? As leaders we all also know that our competence is our responsibility. If you are reading this, you probably also believe in keeping your knowledge up to date with new ideas and research. We see opportunities to harness our leadership and curiosity to improve the status quo.

FMLM and Proud2bOps would rather start with collaboration, avoiding isolated leadership development, and so working together they propose a novel upstreaming and real-time collaborative approach to learning and development, and are keen to hear from colleagues and systems who feel the same.

Upstreaming means providing learning development opportunities that involve both medical and management professions and insist on collective responsibility and presence.  Rather than separate routes for clinical and non-clinical professions, and then perhaps at a more senior level learning paths may join – if you are fortunate to have the opportunity. Deliberately development offers would prepare and solidify understanding, shared experiences, and improve visibility of collective leadership and responsibility between managers and medics.  Building on this principle, we would take forward implementation of the Messenger Review recommendations and co-design leadership and management standards and related programmes to be multi-professional and reliant on collaborative learning, mutual respect, and responsibility.

Real-time development means moving away from “parachute” interventions – coming in when either there is a problem, or we want a special programme to help a specific cohort of individuals to emerge with skills and abilities that will save the day. Instead, we propose a supportive, collaborative programme, where problems and issues are recognised immediately and ongoing as they arise, as shared and professionals are connected. Such real-time development would focus on knowing each other and appreciating difference through appreciation of values and motivations on all sides.

Formal development will help of course, but as leaders what stops us from sitting down with colleagues across the professional spectrum and taking time to check in and make sure all points of view are understood; that we really do have shared goals, and shared expectations of what these really mean. Start with your own education – start today. Spend a day with a manager or medic you don’t know (or one you do or think you do). Ask what is available in your organisation as formal training and development for medics/managers and join. As a participant in our Tweet chat summarised perfectly: actively seek opportunities to learn. Really go after what you don’t know. Be vulnerable in that space. Listen a lot. Invite people into a conversation. If you can, help. Really help. In times like these we cannot afford not to.

Join the conversation: There is more to come from us on this topic in the future and we want to hear from you. Join us and BMJ Leader in further conversations – let us know what you try, and have tried, and what works.

References

[1] “Managers value you; do you know enough to value them?” by Emma Challans-Rasool and Charlotte Williams – The official blog of BMJ Leader

[2] https://blogs.bmj.com/bmjleader/2023/01/25/why-are-managers-so-often-seen-to-be-on-the-dark-side-and-who-puts-them-there-by-emma-challans-rasool-and-charlotte-williams/

[3] https://www.leadershipacademy.nhs.uk/programmes/

[4] Health and social care review: leadership for a collaborative and inclusive future – GOV.UK (www.gov.uk)