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					Masterclass 28th February 2008
‘Culture and Change : developing leadership within a medical

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

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

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

We don’t want health professionals to lose their game, so it is essential we
apply the right learning!

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