Masterclass 28th February 2008 ‘Culture and Change : developing leadership within a medical culture’ Clinical Leadership – Perspectives from Dr Wendy Thomson Is leadership in healthcare possible? Dr Thomson maintains that not only is leadership in healthcare possible, it is essential; to imagine a world where we can advance without clinical leadership is not conceivable. Thomson formulates her argument around three key factors: The global health imperative What is leadership? How do people develop leadership? The Global Health Imperative Dr Thomson argues that it is impossible to ignore inequalities in healthcare even if clinicians do not believe this to be part of their remit. It is imperative in this global world that we start to look at local health challenges in a global context. This means becoming familiar with the differences between life expectancy and mortality rates, globally as well as within countries. The pandemic threat is a global phenomenon that will be experienced locally as well as globally. At present, the global population lives in small microclimates, each with separate thinking about what healthcare is - Thomson argues that this mentality is not going to lead us to a sustainable health care system. The challenges within our healthcare systems are not going to be resolved solely by technical solutions - global health challenges need new ways of thinking. This thinking needs to happen within our own disciplines; at present, this is not happening, so we need to recognise the challenge. We need to start testing each other’s assumptions and thinking outside the box to gain the knowledge base we need. What is leadership? Thomson uses a standard definition of leadership: Thomson considers the global healthcare challenge is about identifying the changes that leaders need to face - these changes can be separated into two streams: Technical Change - based on challenges that have been experienced before and solutions that been used to resolve problems in the past. The other stream of change is Adaptive Change - challenges that we haven’t yet encountered and therefore do not know how to solve. We set off on these challenges not knowing the right direction, creating new ways of working and new solutions. Thomson deems the most common source of leadership failure is treating adaptive problems as technical ones - in fact, this, she suggests, often causes bigger problems than those you started with. Thomson maintains that the healthcare world is facing adaptive challenges that are global in nature and are not going to be solved simply by injecting more money into the system. The change is more fundamental in nature and it will take a different set of relationships to address these adaptive challenges. The people who deal with these challenges should be those with the problems – they have insight into these problems and this knowledge makes them very credible contenders for tackling these challenges. According to Thomson, the global healthcare system needs to hold back until these adaptive challenges have been addressed - ‘we need to think about the solution and consider whether we really know the best way to move forward’. Thomson believes clinical leadership is possible and furthermore, essential, as it is clinicians who have the credibility and knowledge to deal with the adaptive challenges facing healthcare. They are the people who face the problems on the front line, everyday. How do physicians become leaders? Thomson suggests that behavioural economics show that clinicians need to be empowered to: Feel compelled to act (motivation) Feel capable of action (agency) Not by being told what to ‘do’ Nor how to ‘be’ By thinking this way, health professionals will ‘do’ leadership and, in fact, Thomson points out that clinicians are already ‘doing’ leadership. She proposes that the real question should not be about ‘can clinicians be leaders’, rather it should focus on finding the right leadership style to fit with, and complement, individual strengths. She uses the example of an ‘inner game’ to explain this statement and relates it to learning the art of tennis. ‘If you played tennis as well as the lessons you have taken, it would suggest that everyone who has taken tennis lessons would be very good – however, this is not the case!’ This implies that simply learning leadership may not lead to better leadership. This idea is developed further by consideration of different types of learning. For example: ‘type one’ learning refers to learning that is internalised, being actions and decisions we can make without thinking, as opposed to ‘type two’ learning which encompasses the learning that we feel we need and which has probably been taught by others. There is a danger that we put too much emphasis and time into ‘type two’ learning - evidence has shown that we get caught up in thinking about too many elements we have learnt, at the expense of the motivational and emotional factors that may naturally drive leadership and which, ultimately, are more likely to facilitate effective leadership. We don’t want health professionals to lose their game, so it is essential we apply the right learning!