Some years ago, two outstanding academic leaders, Peter Pronovost and Lord Ara Darzi, wrote an article in which they argued for an end of heroism in medicine.[1] I responded in the pages of our previous CLAHRC WM News Blog along the lines of, be careful what you wish for.[2]

I was reminded of this interchange by the evening celebration of health workers seen across many countries of the world during the COVID-19 pandemic. What were members of the public doing, if not allowing health service to feel just a little heroic? Quite right too, health staff risk their lives on an almost daily basis and have a higher mortality compared to other people of similar ages.

One recent morning I heard a poem about nurses on the radio. The poet was making the point that nursing is not just another profession. I have been a doctor and a patient and I can tell you that from my perspective being a doctor or a nurse is certainly not just another profession. Yes, it is a calling, even if the call comes from inside.

Doctors and nurses put their lives on the line when necessary. They will work all night. They will stay on at the end of the afternoon if they still have patients to see. These are the things we do, we like to do them, and we are admired for doing them. We put ourselves out and we go the extra mile. The patient is not a client, or rather they are privileged clients.

But let us also be aware of the dangers of heroism that might turn self-indulgent and become almost narcissistic. Leadership involves determining a course of action, often an unpopular or dangerous one, and then carrying people with you. Leadership can be demonstrated anywhere within an organisation. My business colleagues talk about dispersed leadership. I have both led people senior to me and I have been led by people junior to me. So there is no room for arrogance in leadership and leaders must listen. They must listen to others and to that quiet, still voice within.

Can leadership be taught? James Stoller has conducted a systematic review of leadership training.[3] On self-reported outcomes, leadership training provides consistent improvement. But objective evidence is hard to find. People who have done leadership training are more likely to go on to senior management roles. But this hardly proves cause and effect. Indeed, trainees who score highly on leadership qualities, such as emotional intelligence at base line, are more likely to gain senior management positions than those with lower scores. So, I would guess leadership training helps a bit, but most of the variance is explained by innate characteristics.

Richard Lilford, ARC WM Director

References:

1. Pronovost PJ, Ravitz AD, Stoll RA, Kennedy SB. Transforming Patient Safety: A Sectorwide Systems Approach. Doha, Qatar: World Innovation Summit for Health. 2015.
2. Lilford RJ. Can We Do Without Heroism in Health Care? NIHR CLAHRC West Midlands News Blog. 20 March 2015.
3. Stoller J. Developing Physician Leaders: Does It Work? BMJ Leader. 2020;4(1): 1-5.