Healthcare leaders need support to ensure good patient care report says

Senior healthcare leaders need support to help them overcome challenges that can impact on patient care, according to research commissioned by the General Medical Council (GMC) and published today (Wednesday 14 August).

Suzanne Shale, a medical ethics consultant, found that positively-engaged leaders, from diverse backgrounds, are key to transforming organisational cultures. However, they are often unprepared and unsupported for the challenges of leadership during the early stages of their management careers.

Particular challenges highlighted in the research, How doctors in senior leadership roles establish and maintain a positive patient-centred culture, included balancing competing priorities and demands, focusing on people and culture rather than tasks, and recognising and tackling problematic subcultures.

Five ‘notable clinical subcultures’, that could be harmful if allowed to develop, were identified as part of the research:

• Diva subcultures – powerful and successful professionals are not held to account for inappropriate behaviour. Left unchecked, divas become viewed as untouchable, and colleagues accommodate them and work around them.
• Factional subcultures – arise when disagreement becomes endemic, and the team starts to organise itself around continuing conflict. Those in dispute look for support and loyalty from colleagues, and staff may seek to avoid working with those on the ‘other side’.
• Patronage subcultures – arise around influential leaders who have social capital in the form of specialist knowledge, professional connections, high status, respect and access to resources.
• Embattled subcultures – where resource has been inadequate, and unequal to demand, practitioners eventually become overwhelmed. They feel besieged by the unmet need they see in patients, and may show signs of chronic stress such as short temper, anxiety and burnout.
• Insular subcultures – some units become isolated from the cultural mainstream of a larger organisation, resulting in professional practice or standards of care that deviate from what is expected. The isolation can be geographical or psychological.

The report highlighted how damaging subcultures were a challenge to an organisation’s senior leaders, and once they became established significant time and resources were required to turn them around.

The research was conducted by in-depth interviews with participants in senior leadership positions, and focused on how medical leaders conceptualise and promote a positive culture, how they identify its presence or absence, and how they approach the task of building or sustaining a positive culture in their workplaces.

Participants revealed that the most demanding, but often unsupported, step into senior leadership was the first one beyond the level of consultant. They said leaders drew on their own knowledge and experience to shape interactions with colleagues, and developing leadership skills was often a matter of trial and error.

‘We cannot just assume that doctors in senior leadership roles will automatically be good leaders. Leading in healthcare isn’t easy. Leaders are developed, not born, and doctors who choose to take on these roles deserve to have all the necessary support and resources to help them succeed.

‘This research is a really valuable contribution to an important issue, and should be required reading for people right across healthcare in the UK. There are many of us with roles to play assisting those in leadership positions, and I would encourage people to read and digest this report. This is the start, and there are more conversations to be had about the lessons we can all take from this work.’

Suzanne Shale said:

‘The evidence we already have suggests there is a clear association between constructive working cultures and measurably better outcomes for patients. Senior leaders are vital in developing those cultures, and many fulfil that role to a very high standard despite the pressures they face.

‘But until now there has been limited research into how senior medical leaders view the culture they work in and meet the day to day challenge of building positive working environments. This study set out to capture their perspectives, and to convey their lived experience of attempting to nurture positive cultures in a wide range of healthcare structures and organisations.’

A copy of the full report, How doctors in leadership roles establish and maintain a positive patient-centred culture, is available on the GMC’s website.