Rising to the challenge

Abstract

R. S. Austin, K. Ranshi, E. Jones, R. Watt, P. Briggs discuss training our future dental leaders and managers to make a positive difference against a background of ever-increasing complexity in NHS organisations.

Main

A recent article in the BDJ posed the question 'Do dentists make poor leaders?' and concluded that the 'characteristics of dentists ... are in conflict with the characteristics of a great leader'.¹ However chastening this may be, it's salutary to consider how one's everyday behaviour matches up to modern definitions of exemplary healthcare leadership in today's increasingly complex healthcare organisations (Table 1).²

When one reflects candidly, in light of these behavioural requirements for successful leadership and management, it becomes evident that formal leadership and management training is now an essential requirement, rather than an optional extra. In response to this, Health Education England recently supported a three-day intensive series of workshops conceived and developed by Mrs Elizabeth Jones and Dr Peter Briggs, Postgraduate Dental Dean and Associate Deans for London in collaboration with Professor Richard Watt, Head of UCL's Department of Epidemiology and Public Health. This HealthCare Management and Leadership in Dentistry course was designed to supplement the training programme for senior specialty registrars and specialist trainees, who are shortly to take up leadership positions at consultant level within complex academic and NHS organisations.

Photograph of delegates and organisers

The programme began with Mrs Jones outlining key NHS organisation's roles and interdependence with a strong emphasis on the importance of developing effectiveness in clinical leadership in the current financial climate. Leadership trainer Fiona Stuart-Wilson then provided a clear vision of how inspirational leadership is perceived – to paraphrase the occupational psychologist and management trainer Peter Honey 'you are your behaviour', therefore leadership is defined by the perception that others have about you. This really brought home the importance of healthcare leadership behaviours such as those emphasised by the NHS Leadership Academy (Table 1),² rather than a specific mindset per se.

The focus then shifted to the wider political, socio-economic and demographic context, not just those issues specific to dentistry. This strong public health theme provided a deeper insight into the seismic shifts which are constantly provoking sweeping changes in our healthcare systems, which became all the more relevant as the EU referendum occurred during this time! This unexpected result to vote for Brexit added to the thought provoking discussions led by Drs Len D'Cruz, Jenny Godson and Vanessa Muirhead on how NHS policies and dental commissioning are impacting on the GDS NHS contract as well as specialist and other services. The profound implications of possible retrenchment for dentistry were discussed in detail, as increasingly dental leaders are being asked to justify the need for their services in the light of financial constraints affecting all publicly funded healthcare organisations. There was however a positive note, in the clear strategy and commitment at the highest levels of the NHS and government to ensure that the synergistic linkages between oral and general healthcare are capitalised on and strengthened. This is exemplified by current Chief Dental Officer Dr Sara Hurley's drive to 'put the mouth back in the body' based on clear messages from the recommendations from the Steele Review³ and the more recent 5-Year Forward View.⁴

Table 1 Dimensions of exemplary healthcare leadership behaviour²

On the final day, we were very privileged to be able to catch a glimpse into how a clinical director of a major postgraduate teaching hospital in London is inspiring confidence during probably the most significant change in its entire history. Dr Tim Hodgson described how he was working to communicate a compelling and credible vision of the future move of the UCLH Eastman Dental Institute to its new premises co-localised with the Royal National Ear, Nose and Throat Hospital. He described how he was ensuring the changes feel achievable and exciting to staff and inspiring hope whilst also reassuring patients and the public. He described situations when he was required to explain controversial and complex plans in such a way that different stakeholder groups can hear, understand and buy-in to, whilst also handling robust and public criticism in an honest and ethical manner.

Finally, the registrars themselves were exposed to mock healthcare management scenarios in order to receive constructive and direct feedback from an impressive array of senior consultant colleagues, including both the London Postgraduate Dean and Associate Dean, a clinical director, training programme directors and specialist training committee chairs. These healthcare management scenarios were designed to interrogate our ability to apply a working knowledge of dental public health to common issues affecting dentistry across the UK; our understanding of health service management legislation and practice including NHS and other policy agendas; the impact of commissioning on the GDS and hospital services; and finally the role of a modern NHS consultant including managing difficult colleagues.

Fortunately, despite many difficult and soul searching moments – it all ended in smiles! We left feeling more prepared to face up to the challenges of leading and managing complex healthcare teams in order to make a positive difference, whilst also remaining true to ourselves and emotionally healthy in both our professional and personal lives! Thank you very much to Peter, Liz, Richard and the Team and we strongly recommend this course to the next cohort of senior trainees!