Dame Clare Marx ASiT speech – ‘Emerging from Covid: why leadership matters’

Introduction

I want to start by thanking you for your extraordinary efforts over the past year. Without your flexibility and professionalism, the health service could simply not have achieved such an amazing response.

The success of the vaccine roll-out now gives us hope that the worst of the pandemic is behind us.

But this is not the end of the story.

As surgeons, we’re acutely aware of the backlog of work that has been accumulating. Treating the millions of patients who’ve been waiting for surgery will be a Herculean task. And it will challenge your skill, ingenuity and professionalism. Surgical teams will need to pull together like never before.

So today I want to share some thoughts on choices, the choices each of us makes about how to behave. It doesn’t cost anything and there is no exam. But the evidence is there for all to see. 

Teamwork, tolerance and kindness are not optional extras. They are integral to our duty as doctors. In the heat of a difficult surgery, it is often these skills that make the difference. They are the glue that holds teams together and enables them to perform at their best.

These are the qualities that must define the next stages of our response to the pandemic. Making that commitment is critical – not just for our colleagues, but also our patients.

Why compassionate culture matters

In the 43 years since I qualified, surgery has changed dramatically. 

Just look at my specialty – in the early knee replacements, patients spent 3 weeks in hospital, not allowed to bend their knee for over a week (and we wondered why they were stiff). Now they’re in and out in a matter of days.

The response of the profession to the pandemic has shown that our capacity to innovate is infinite.

But when it comes to professional behaviours, progress has been much slower.

I still remember feeling undermined in my early years, when my gender seemed more important than my surgical ability. Decades later, many of those old attitudes still remain.

Medicine is a tough job, but it’s made far tougher by the way we treat each other. We’ve all seen incivility and intolerance run roughshod over communication and teamwork.

Ultimately, such behaviour is self-defeating. Its impact is felt in the environment in which we work and in the care we provide. 

Looking back, I reflect that sometimes, as surgeons, our most beneficial interventions are the least glamorous ones. A hip replacement might seem run of the mill now, but for the patient it is life changing. 

And often it’s like that with leadership. Kindness and humanity are not flashy, but they are transformational.

Without them, relations between colleagues break down. Patient experience and satisfaction with their care is compromised. And team morale is eroded. 

 

"We rise or fall on the strength of our team. The success of an operation can turn on our ability to communicate well and share information."

Dame Clare Marx

Chair of the General Medical Council

Learning to lead

We rise or fall on the strength of our team. The success of an operation can turn on our ability to communicate well and share information. 

That’s why these skills need to be prioritised from the earliest moments of a doctor’s career.

No one is born a good leader. The building blocks are acquired, just as clinical knowledge and skills are acquired throughout our careers.

It's never too early to start. Don’t wait until you reach consultant level. The emphasis has to be there right from the beginning. Leadership skills define everything that comes later.

Leaders who show respect, who are open and courteous, are immensely powerful in the environments they create – environments where colleagues and patients alike are listened to and respected. But when these values are absent, cultures become closed and toxic. And those dynamics play out negatively in the care our patients receive. 

That’s why developing your ability to lead is as crucial as your surgical skill or your command of your specialty. 

We know leadership skills are often undervalued. A study by Newcastle University found that new consultants are under-prepared for the non-clinical leadership elements of their work, and that leadership is under-represented in training programmes.*

Research by Suzanne Shale tells a similar story. She highlights doctors’ realisation that “success rested as much on their ability to engage and motivate colleagues as it did on the technical or clinical expertise that they had acquired in their decades of training.”**

So without the opportunity to develop your leadership skills, you may be ill-prepared for your consultant post and lack the tools you need to prosper in the job.

There’s now a growing recognition that doctors need these skills to thrive. It’s a major focus for the GMC this year as we look to embed that emphasis across all stages of a doctor’s career. We really believe it can make a difference to your lives and to patient care. 

Professional behaviours’ impact on patient care

As doctors, we go into medicine because we want to help people. Being let into patients’ lives is the joy and privilege of our profession, but it comes with responsibility.

To make a difference we need skills and expertise and of course we also need compassion. Having the former doesn’t override the need for the latter. Ability without empathy does not equal great care.

Recent history tells us what happens when patients’ needs are not given precedence.

This last year, we’ve heard from three inquiries where patients have been harmed – Cumberlege, Patterson and Ockenden. Right at the centre of these reviews were patients who said they were not listened to.

That should pull us all up short.

We’ve seen in the pandemic that when difficult decisions are being made under pressure, listening, communication and kindness become more important than ever.

There’s really no good way of dressing up bad news. But we can make sure that it’s delivered kindly and clearly, so that patients can make informed decisions about their care and families understand the issues.

Inclusive environments 

The way we treat our patients is a reflection of how we treat each other as colleagues.

The strength of our profession lies in our diversity, with doctors of all different specialties, ages and backgrounds. Working well together is not optional – it is our professional and moral duty. 

Sadly most of us will have experienced dysfunctional departments. It’s always poor professional behaviours that underlie that dysfunction. To reach their full potential, a doctor needs to be listened to, supported, and made welcome. I don’t know many who work at their best in closed, toxic environments. And not working at our best means not delivering the best care possible to patients. 

To make matters worse, we know that some doctors feel less included than others. Discrimination still exists in medicine, as it still exists in all walks of life and surgery is not immune.

Our own research shows the systematic issues faced by BME doctors, including an attainment gap.

A recent survey by the Royal College of Physicians found consistent evidence of BME trainees being less successful at consultant interview than white trainees .***

The reasons for this are multifaceted. But one thing is clear – relationships with peers and seniors are crucial as a doctor progresses. And BME doctors report receiving less support and feedback during training. They are often not part of the ‘in crowd’.

We cannot accept this harmful status quo. We must actively challenge it. The tribalism and thoughtless exclusion of other groups I encountered when I joined the profession 43 years ago sadly persist. Part of this is structural, but a large part is behavioural. 

It’s people that make environments inclusive, or not. If we want the next 43 years to be different, the onus is on us to make a conscious effort to enable change.

Conclusion

In the past year, the willingness to work together has seen the NHS take on the biggest challenge in its history.

As elective services restart and work to clear the backlog ramps up, doctors will once again need to draw on the strength of their colleagues. Leadership, inclusivity, teamwork, communication and compassion will be needed more than ever. 

The evidence shows that it’s not just delivering care that matters, it’s how we go about it. The pandemic has given us a playbook for behaving differently. We can choose. So let’s take this reset moment and use it – for the good of our colleagues and our patients. 

Thank you. 

References

* p2 of Everyday Leadership  

** p9 of How doctors in senior leadership roles establish and maintain a positive patient-centred culture

*** See Royal College of Physicians: RCP survey uncovers years of discrimination against black, Asian and minority ethnic doctors