Leadership

So, do you miss clinical work?

This is the common question when I explain that I have relinquished clinical duties to concentrate on my leadership role. The sub-text (at least, to my ears) is ‘Why would you want to stop?’ To be fair, when you have spent a large proportion of your life pursuing a clear goal of being a vet and, in my case, specialising in small animal internal medicine, it does seem like a big shift to leave that behind, and it took me a few months to settle in to the new role.

Redefining my role

To say I am now ‘leading’ is not blowing my own trumpet. It is a change in what I do, not in who I am.

But:

1. I am still a vet.
2. I have always been more than ‘a vet’.
3. My role now is important and is in the service of animals, their owners and my colleagues.
4. Leadership is a valid and valuable activity without which there would be chaos (Figures 1&2).

 

Figure 1. Where is the leadership?

 

 

Figure 2. Here it is!

 

So what do I do now I am not seeing cases?

‘Management is doing things right. Leadership is doing the right things.’ Peter Drucker

My current role is a mixture of management and leadership. For example, I manage the Health and Safety system in the business, and I will manage specific projects (such as the recent installation of new autoclaves) but I also lead the Board of Directors and others in management and leadership positions in the practice.

My leadership role can be broken down into ‘task oriented’, ‘relations oriented’, ‘change oriented’ and ‘external networking’ (Yukl 2013).

Task oriented activity includes clarifying, planning, monitoring operations and problem solving. With the other leaders in the practice I help direct the business strategy, communicate this across the business and I try to ensure understanding is consistent and clear. Often I am able to make sure the right people are talking to each other and have the same understanding and goals i.e. they are heading in the same direction. Of course, no path is perfectly smooth and problem solving is a key skill. That often means I need a broad understanding of the issues in hand and I have to seek the opinions of those who know best. Problems can be practical (the water supply is off), personal (someone has a problem they need help with) and/or political (X does not agree with Y and their motives may be different).

Relations oriented activity includes supporting, developing, recognizing and empowering others. ‘Collective leadership’ is a term used to describe a culture where leadership is shared and the ‘leader’ role assigned according to expertise and the needs of the current situation. This is highly relevant to healthcare, particularly multi-disciplinary care like ours, where for a given circumstance the right call might need to be made by the anaesthetist, the radiographer, the nurse, the surgeon etc, etc. So my job is to ensure that leadership skills and the necessary trust are embedded across the practice. Those familiar with factors influencing patient safety and outcomes will recognize how important this culture is.

So we have worked on leadership and management training beyond the Directors and Shareholders in the practice. We encourage self-development and recognition of achievement of individuals and collective activity. Coaching by myself and others is a focus of activity to encourage and support development. Empowerment means allowing colleagues to try new things and supporting them if they do not get things right and, if necessary, pushing back against criticism. It also means looking to issues such as diversity and inequality.

 

Figure 3 Distributing leadership across the organisation.

 

Change oriented activity includes advocating change, envisioning change, encouraging innovation, facilitating change and collective learning. This is the most difficult part of my role. We are in a volatile and challenging market at the moment and have grown to the point where our very size has meant we have had to change many aspects of how we manage the business, without losing the fundamentals of excellent patient care. Healthcare organisations, and professionals, are often change averse. This is understandable because good healthcare requires robust systems and adherence to detailed and specific ways of doing things. Achieving change in this culture is difficult but I have had to ‘dare greatly’ and hold hard to the long-term vision and shared belief that, in order to continue to successfully deliver outstanding patient care to as many patients as we can, we have to adapt, grow and change so we can remain who we fundamentally are. This is not easy!

External networking means I keep an eye on the world outside. This includes attending conferences, networking, talking to contacts, reading news, following Facebook and Twitter, generally gossiping and sharing titbits. Being involved in other organisations, such as the British College of Veterinary Specialists and Canine Partners, helps this – as does doing bits of work such as assessing applications for the RCVS Advanced Practitioner in Small Animal Medicine.

What have I learnt from clinics that help my current role?

Listening – attending to what is really being said; tone, language, body language. Letting others tell their stories.

Questioning – asking open questions without a ‘Yes’ or ‘No’ answer.

Problem solving – breaking down issues into possible causes, testing and narrowing down.

Planning – how do I get from A to B? Whose help do I need?

Compassion – caring for individuals and their particular challenges and needs.

Complexity and uncertainty – understanding it may not be straightforward and there may be no easy answer.

Trust – to do my job well I need the skill and commitment of others.

Supporting – people face difficult decisions and they need to know you are there for them.

Developing – helping others solve their problems for themselves.

Failing – get used to it! You are not God and you and those around you will fail. Learn from it.

Imagination – sometimes you have to think outside the box.

Daring – know when the right time is to take a risk; it may be the only option.

 

So what are my challenges?

‘The Vet Futures Report identified exceptional leadership and the wellbeing of veterinary surgeons as central to the long-term sustainability of the industry. However, emphasis is placed on the need for visionary, transformational industry leaders rather than the day-to-day challenges of leadership within practice.’ (Pearson and others 2018)

No good job is easy and there are good days and bad. Sometimes the challenges can seem overwhelming and other days all is rosy in the garden.

Some of the my challenges include creating a collective leadership culture where we do not look to ‘the boss’ for answers but to those with the best expertise for the given situation. Trusting and helping others to trust whilst ensuring there is the space to fail and learn. Encouraging forgiveness of failure in myself and others and not allowing failure to stop necessary progress.

It is hard to stay in touch with everyone in the practice as we grow, but it is important to maintain a fair appreciation of different views and challenges across the practice. Leadership can be lonely, so it is also important to maintain friendships and take support where you can. Finding the balance of the two requires subtlety.

Being resilient is a key skill and challenge. It is easy to focus on the negatives and lose sight of all the good things and progress that is made. This can sap your energy, have a direct personal impact on wellbeing and make it more difficult to hold the vision. So I put effort into activities such as mindful meditation, exercise, journaling the good stuff every Friday afternoon, coaching and being coached.

Imposter syndrome is a constant companion. The feeling that I will be found out or that someone could be doing a much better job than me. Support and encouragement from others keeps this at bay (most of the time…).

I am a ‘Thinking’ rather than a ‘Feeling’ type so I tend I have is to constantly remind myself of the emotional response to actions and decisions. I know I do not always get this right (but I try to forgive myself).

So, do I miss clinical work?

I miss the direct contact with clients and the patients, and the warm satisfaction of applying a hard-earned skill like pulling a foreign body out with an endoscope; the regular hit of ‘feel-good’ moments. This loss is counterbalanced by ‘the good stuff’.

I absolutely don’t miss being pulled in two directions; feeling like I am doing two jobs poorly and not being able to concentrate on one or the other, e.g. not having time to read clinical academic papers or attend conferences.

What is the good stuff?

My current role has many rewards. They include:

• The development of others-seeing people grow and take responsibility and become better than I could ever be. Helping people be happy in their roles.
• Seeing plans work out and the vision become reality is as satisfying as clinical work but on a different timescale.
• The support and appreciation of others both inside and outside of the organisation. Seeing in black and white the thanks given to everyone at Davies Veterinary Specialists for the great work we do.

I may not be seeing cases but, ultimately, it is still all about delivering outstanding care. For the chance to lead this fabulous group of people, I am very grateful.

 

References

Pearson, CE., Butler, AJ., Murray, YP. (2018) Understanding veterinary leadership in practice Veterinary Record 182, 460

Yukl, S. (2013). Leadership in Organizations (8th ed.). England: Pearson Education Limited.