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Role of Medical Director

Role of Medical Director

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Published by Kurt Sinclair
What does it take to become a medical director? What does the job involve? What career path should you expect?
What does it take to become a medical director? What does the job involve? What career path should you expect?

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Published by: Kurt Sinclair on Jul 28, 2013
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09/10/2013

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Developing NHS leadership: therole of the trust medical director
Background
Over the last few years there hasbeen a great deal of interest indeveloping clinical leadership.A substantial number of seniormanagers have a clinical background,but doctors are under represented. There is a need to bridge the gapbetween NHS managers anddoctors. Strong evidence existsthat organisations with engagedclinicians deliver higher quality careand are able to respond to changemore effectively. The NHS Next Stage Reviewcontinued this theme by stressingthe leadership role of clinicians,particularly doctors. The NHS Institutefor Innovation and Improvement haspublished research on engagingdoctors in leadership and workedwith the Academy of Medical RoyalColleges on a significant programmeto define leadership competenciesand to integrate leadership intomedical education. And the chief executive of the NHS in England,David Nicholson, has said that hewould like to see a doctor on eachchief executive shortlist. This reflectsa concern that a large and able partof the workforce should be betterrepresented among its leaders.Key to this ambition is the role of themedical director and how doctorsemerge and move on to chief executive and other key leadershiproles. Although the role of medicaldirector predates the 1983 Griffithsreport on NHS management, andhas been growing in significanceover the last 25 years, a numberof questions remain about it,specifically:What do medical directorsactually do?How can the key elements be mademore effective?
APRIL 2009PAPER 2
Future of leadership
www.nhsconfed.org/leadership
 The
Future of leadership
series of papers and events is designed to stimulate new thinking about NHS leadership andyou can be part of the discussion. Have your say now at
www.nhsconfed.org/leadership
 The NHS Confederation annual conference and exhibition,
Local leadership: a national service
, in Liverpool from 10 to 12 June 2009, willoffer the opportunity to progress the discussion further. Visit
www.nhsconfed.org/2009
for more information about the conference.
Key points
The medical director role haschanged considerably and currentexpectations of the role need tobe clearer. New skills are neededto meet current challenges.A clearer career path in and out of the role is required, includingshadowing and secondments inother organisations.Pay, job insecurity, loss of link toprofession and pressures of the job can make chief executive rolesseem unattractive to medical staff.If doctors are to be attracted tosenior management roles, moreeffort should be made tocommunicate the positive aspectsof the medical director role to junior doctors.Views vary on whether it isimportant for medical directors toretain some clinical work or ‘dothe job’ full time.
 
always very clear. This may meanthat chief executives and otherboard members are not certainabout what they can expect fromthe medical director.Our seminar participants thoughtthere were a number of functionsthat should be contained inthe role, regardless of how it isdesigned, including:leading the formation andimplementation of clinical strategytaking a lead on clinical standardsproviding clinical advice tothe boardproviding professional leadershipand being a bridge betweenmedical staff and the boardproviding translation, assessingthe mood and, crucially, creatingalignment between theorganisation and doctors (this canbe a particularly delicate task,especially where it is necessary tochallenge medical colleagues)outward-facing work with the PCT,strategic health authority (SHA)and other external organisations.A number of other important rolesare sometimes delegated, but oftenseen as the medical director’sresponsibility:clinical governanceacting as the Responsible Officerfor revalidationquality and safetyeducationmedical staffing planningdisciplinary issues concerningdoctors.
Future of leadership:
Developing NHS leadership: the role of the trust medical director
02
“Being a medical directorhas become a full-time job. The role has changeddramatically in the last tenyears and the work increasedexponentially”
What preparation is needed forthe role?What should the career path loolike and what is the route for exitor progression?How can more people beencouraged to take up thechallenge? To look in more depth at thesequestions, with NHS medical director,Sir Bruce Keogh, we ran two seminarsand conducted in-depth interviewswith current medical directors,deputy directors and clinical divisionmedical directors. We were joined byprimary care trust (PCT) medicaldirectors, who brought someimportant insights, but it becameclear that there is considerablediversity in the roles of PCT medicaldirectors and that their differentresponsibilities and challenges makegeneralisation difficult. Some of theideas in this paper are relevant toPCTs, but further work is needed tounderstand the specific challengesthey face.
Clarity about the medicaldirector role
It is hard to sell a role to potentialapplicants or get the best from it if there is insufficient clarity aboutwhat it entails. The role of medicaldirector can be designed in differentways and its exact nature is notWe also heard that some medicaldirectors get involved in Caldicottguardian roles, infection control andresearch and development.One common feature was theinvolvement of the medical directorin the immediate problems andcrises connected to the day-to-dayrunning of the organisation. Whilethis is unavoidable, there may be toomuch of a tendency for staff to‘delegate upwards’, making the rolemore stressful than necessary anddetracting the medical directorfrom more strategic issues. The medical directors we spoke tothought that the role had changedconsiderably in a short space of time,reflecting the merger of trusts,increasing managerialism and there-introduction of the internalmarket. They told us new skills arerequired to meet these challenges.
Structure and support
 The size of the medical director roleis significant and potentially too largefor one individual, particularly inlarger and multi-site trusts. The levelof support provided is thereforecrucial in determining effectiveness– everything from high-levelmanagerial support from managersand associate medical directors tomore basic back office andadministrative support.We heard of a range of models forthe level below medical director,including associates and deputies.Examples of medical directors withboth wide and narrow spans of control include:direct lines to divisional medicaldirectors
 
Future of leadership:
Developing NHS leadership: the role of the trust medical director
03
dotted lines, with divisionalmedical directors reporting tothe director of operations ordivisional general managerslarger number of clinical directorsreporting to the medical director orassociate/deputy medical directors.All of these models have advantagesand disadvantages and there is nodirect evidence about which worksbest. However, there seemed to beconsensus against having a largenumber of clinical directors reportingdirectly to the medical director.Our seminar participants concludedthat culture and behaviour isprobably more important thanstructure, and that the trend fororganisations to cycle throughdifferent models suggests thatdecisions are based on people inroles, history and other local factors.Administrative support and back upis a key issue for a number of themedical directors we spoke to. The number of meetings and areasin which they are involved oftenmeans it is difficult to followup or implement decisions if they do not have administrativeand managerial support. A numberof them feel strongly that this aspectof their supporting infrastructureneeds improvement.
Becoming amedical director
 The route into the medical directorrole is generally through being aclinical director of a department ordirectorate. The motivation to do itoften comes from a wish to make asignificant difference to theorganisation, particularly the qualityof patient care. Importantly, thepeople we talked to believe thatcare for patients can be improvedthrough changing the way thatsystems are designed, staff work andthe organisation functions, as wellas through excellent clinical work.Others were also interested in theopportunity to shape the strategicdirection of their organisations.However, preparing for the role issomewhat haphazard and should bemore systematic. There is no definitecareer path. As one acute trustmedical director put it: “You reallyhave to create these things foryourself, talk to people and manageyour career for yourself”. There is some value in formal coursesto learn some of the basics of howthe organisation works and coremanagement skills. However,beyond this there is more value fromcourses which deal with real issuesdealt with on the job rather thanmanagement theory.Practical opportunities to learn areparticularly valuable and a number of measures could be put in place thatwould help more doctors make thestep up, such as:more mentorship, coachingand supportproject management roles,improvement roles and otherspecific tasks which provide a goodintroduction to some of the key skills
Being a medical director in the independent sector
A number of the themes outlined in this paper are similar for medicaldirectors in independent sector organisations, for example the importanceof putting in place systems to ensure that there is consistent and reliabledelivery of standards. This needs to be supported with arrangements forclinical governance, training and education. Also, good understanding of the techniques of quality and efficiency improvement is required. As withthe NHS role, dealing with issues of standards and behaviour is animportant skill. The medical directors we spoke to stressed the importance of their corporaterole, namely their shared responsibility for strategy, finance and marketingand for bringing a clinical perspective to key decisions from procurementto strategy.Learning the language of management and finance is a key challenge, butthis is only the beginning of learning the role.Independent sector medical directors see themselves as having opportunitiesto branch out into wider leadership roles.
“At some point, I think, thesize of the agenda for manymedical directors will meanyou have to think longand hard about whetheryou can continue”

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