The text below is reproduced from Radcliffe e-bulletins “Leadership for Doctors” 16, with permission.
The “Core Competencies” approach
Core competencies are a way of defining what abilities someone needs to fulfil a particular role or group of roles. They are also a way of defining what needs to be learned (and what needs to be taught) to prepare for the role. Of course, the use of the term “role” itself betrays certain cultural assumptions. Different organisational cultures and their different values and ways of dealing with reality will be discussed in detail later in the series. For now, it is sufficient to say that many of the truly great military and political leaders in history, such as Wellington and Churchill, were not comfortable inhabitants of the role culture. They possessed a genius (and faults) that would not have been tolerated in pure role cultures. In Wellington’s case this is beautifully illustrated in a dispatch to Whitehall officials sent at the height of his Iberian campaign to support Spain and Portugal against Napoleon. In it he railed against the attempts of “His Majesty’s Government” to hold him accountable for saddles, bridles, tents, tent poles and jars of raspberry jam! He finished his note with a request for instruction from the government as to whether he was expected “to train an army of uniformed British clerks In Spain for the benefits of the accountants and copy-boys in London” or “to see to it that the forces of Napoleon are driven out of Spain”. In exasperation he wrote that he would pursue either to the best of his ability but could not do both. How this resonates with doctors, nurses and other health care professionals asked to fill in innumerable forms and to provide excellent patient care with only the time and resources to do one or the other!
So, the idea of “core competencies” has limitations! Nevertheless it is a helpful way of thinking about what is required to be a good manager or a good leader. Here we come across another problem good management and good leadership are not really the same thing! The Faculty of Medial Leadership and Management (FMLM) of the Academy of medical Royal Colleges, nevertheless puts them together in its Medical Leadership Competency Framework (http://www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadership-Leadership-Framework-Medical-Leadership-Competency-Framework-3rd-ed.pdf)
This lists FIVE groups of competencies:
- Personal Qualities
- Working with Others
- Managing Services
- Improving Services and
- Setting Direction
Let’s look at this from another angle. Does it help to understand the distinction between administration, management and leadership? We believe it does and we will explore this in the next section.
The distinction between administration, management and leadership
Administration: doing routine tasks well
Management: making things happen effectively and efficiently (often complex things in a complex environment)
Leadership: developing shared vision and direction towards a common goal and purpose and getting the best out of people in serving that purpose.
In these terms administration is a typical role-culture function. It copes well in a steady state where linear models and roles can be applied and is essential to the proper running of any organisation. Good administration is what makes sure all our wages are paid and all our taxes collected. It deals with processes by which people can be held accountable. It is essential to any good organisation even though doctors typically find it boring. At its best it is the unseen foundation that keeps the rest of the organisation running and stable.
Management copes with more complex situations more effectively. It is good management that enables an A & E Department, at its best, to function efficiently and effectively, prioritising the most urgent and needful cases. When administrative targets about maximum wait times are introduced they can (if rigidly adhered to) distort priorities and reduce clinical effectiveness.
Leadership anticipates what will be needed to deal with future contingencies and inspires colleagues to work together towards a shared vision and purpose. To take the A&E example further, it is what anticipates likely demand, involves staff in developing robust contingency plans to deal with predictably unpredictable situations (e.g. “MAJAX” procedures) and what (when the over-controlling central bureaucracy allows) says “hang the four hour wait target just now, we’ve got an unscheduled major accident to deal with.” Such leadership tends to identify with the task in hand and the people doing the work. It is essentially part of a “team” culture. Of course, such leadership will not always be popular with “the accountants and copy-boys in Whitehall.”
Leadership also needs to be distinguished from “drivership” (which sometimes masquerades as leadership. We hear comments about managers “driving” up standards often using metaphorical carrots and sticks. This is how some people treat horses and other animals. Even with horses (and dogs) there are good arguments against this approach (see, e.g. http://www.montyroberts.com/).
Leadership is about understanding what motivates people best for the longer term. Of course fear can be used and is popular in some managerial and political circles (including those who focus on inspection as a way of “driving” standards up, rather than as a way of enabling people to do the best they can). However, in the long term it tends to produce stress and “burnout”. For humans, two things tend to contribute to good leadership. First a mutually positive, respectful relationship between leader and led and second, a shared vision (based on sound evidence) about what is to be done and how it is to be done.
Core competencies again
Good administration is essential but nobody should employ an expensive doctor to do simple straightforward administrative tasks. One of us is old enough to remember the arrival of self-adhesive sticky labels to speed the filling in of investigation request forms and the relief that simple development brought from pressing hard with a ballpoint on “self-copying” forms. We have both come across electronic systems that require doctors to re-enter data that is (or should be) already in the system. Beyond the minimum that is necessary to ensure accurate identification and adequate security, there should be no repetitive data entry and all data that can be entered and checked by administrative staff should be entered and checked by them. Doctors are paid for knowledge and skills that make employing them to enter data unnecessarily, a terrible waste of time. So we will concentrate on the core competencies required for management and leadership. Table 1 lists some competencies of managers and leaders.
Table 1. Some competencies of managers and leaders (abbreviated and modified from Practical management and Leadership for Doctors, 2011)
We have left spaces because no such list can ever be complete for every situation. We would also emphasise that, not only are some competencies important in both roles but also that doctors in management roles are nearly always expected to exercise leadership skills too!
We have kept them separate because (though they often go together) sometimes failing to distinguish between them can cause conflict and confusion.
One of the authors worked as consultant in a “consultant-led” multi-disciplinary community mental health team. Someone higher up the management tree decided that teams needed nurse managers appointed to deal with the administrative tasks of co-ordinating leave between different members of staff, etc. Unfortunately they decided to call them “team leaders” and appointed one between two teams. He was not even a member of the team the author was also asked to lead! Happily, he was a reasonable man and once we had dealt with the confusion caused by mis-labelling we were able to get on with our respective jobs amicably.
There is another example of this kind of potential role confusion in Practical Management and Leadership for Doctors(p4).
Issues caused by confused terminology are important but only if allowed to fester unrecognised and unresolved.
These exercises are designed to help you consolidate learning from this bulletin and to apply it in practice.
Using the FMLM list and/or table 1 as a basis, make a list of the competencies you believe you require for leadership and management in your current role. Rate yourself (and/or ask a trusted colleague to rate you) on a scale of 1 (poor) to 5 (excellent) in each competency. Consider how you can make the most of the areas you are rated highly on and determine how important it is to improve any other areas. If it is important make a plan to do something about these areas.
Review the tasks that form part of your managerial role. List them under headings depending on whether they are primarily administrative, managerial or leadership. So far as possible, make sure that you have support to do the administrative tasks on your behalf. Then prioritise the other tasks in terms of importance as well as perceived urgency and get on with them!
This Radcliffe e-bulletin is reproduced here with permission. You can subscribe to the series at: http://www.radcliffehealth.com/e-bulletins (Leadership for Doctors)
 This is reproduced in full in Practical Management and Leadership for Doctors, J Wattis and S Curran, Radcliffe (2011)