The Rise of an ACP: Leadership.

Ed – This is the second post on ACP development from Rusty Carroll. You can read the first one here. ACP development is something that we strongly support at St Emlyn’s as part of the development of a multiprofessional emergency care workforce. It is still a relatively new area, and there is huge variety in training and retention programs. This blog focuses on leadership elements of ACP development.

During a conversation with a physician friend – who was about to complete training and take on a role as a consultant – she expressed (with dismay) how ill-prepared she felt for the leadership elements of her imminent role (specifically running MDTs).  Her time as a specialist trainee had prepared her brilliantly for the clinical elements of her role, it was all the other “stuff” that was keeping her up at night.  I reflected upon my own preparation for advanced practice and whether I felt any better prepared for the leadership elements of the role having come through a very different education path.

I am an Advanced Clinical Practitioner (ACP).  In a previous blog, the ACP role was discussed.   Advanced Clinical Practitioners (ACP) are healthcare professionals who have completed a master’s degree in a relevant subject.  They – along with Physician Associates colleagues – are an increasingly common finding in many clinical workforces.

In the previous ACP blog, the four pillars of Advanced Practice were outlined.  As a quick summary, Advanced practice incorporates, clinical practice, research, education and leadership (as defined here in the UK).  The clinical practice pillar usually dominates most ACPs’ work plans.  Quite unexpectedly, I started a role where the leadership pillar dominates in 2020.  Taking on a leadership role during this pandemic has indeed been an interesting journey, with some shareable insights resulting.  This big will explore some of the common leadership lessons that should be reasonably universal – irrespective of your professional background.

All problems are leadership problems

First, let’s put some lines in the sand about leadership.

Leadership is the delivery of change (management better described as being maintenance of the business as usual performance), and solutions require change, therefore all solutions require leadership.

Leadership is a behaviours.  For now, just accept that this is a personal perspective and we’ll come back to a deeper discussion of this on another occasion.  What leadership behaviours are you displaying?

Leadership is more nurture than nature, and whatever leadership talent you might have, it can be improved with education, training, mentoring and practice.

We are all leaders

Leadership does not necessarily require a job title, and sometimes those job titles get in the way of positive leadership behaviours.  Think of those colleagues whose influence spreads much farther than job title/salary/position in the hierarchy would suggest is possible.  This influence can have a positive impact on the organisation, but also negative influence is more than possible.  How many teams have you been in that were dragged down by negativity?

Universality of leadership

In the last year or so, undertaking a leadership role at system level, some patterns have emerged.  Discussing these patterns and their counter-strategies seems pertinent in order to try and help leaders step up and improve their game.

All systems needs great leaders, almost all of them have too few and these systems are not currently designed to be developing their leadership talent effectively enough.  The demand for health care appears to be on a steady skywards trajectory, without a matching capacity or capability.   Leadership is the main and best hope of addressing all those other issues (demand and otherwise) as it has the potential to optimise capacities and capabilities. All issues are leadership issues because all solutions require leadership.

What’s your leadership action plan?

Here are a few observations on some areas for potential improvement.  These work at the individual as well as organisational level. They also translate to the level of systems. These steps will probably assist in individuals, organisations and systems improving their effectiveness.

Firstly is prioritisation – there is always too much work and always more arriving.  Accepting that it is neither possible nor reasonable to try to complete everything is a huge first step.  Once acceptance has been achieved, deciding what can be put to one side comes next.  This is where intuition and logic (decision making) come into play.  Having an over-arching goal will help you test each opportunity for work – does this piece of work help me achieve the greater goal?  Do you know the greater goal?  Does that greater goal match the broader vision and values?  Yes, vision and values have been over-played and are commonly meaningless words, I’m talking about truth not management speak.

Once there has been a process of sifting and the work has some semblance of prioritisation, it is now time to apply the principle of simplicity, or chunking.  Break the big task into smaller pieces of work. This will enable more positive achievements sooner and is underpinned by the “low hanging fruit” management mantra.  Make all your fruit within reach and get some done.  Celebrate the wins.

No person is an island.  In health systems, it is simply not possible to go solo and achieve anything meaningful.  That’s not to say that there is no need to knuckle down and put in the hard (smart) work, but you will need a team to achieve anything significant.  This may be a formal team, but more usually it is the informal teams that come together based on trust and understanding that are the most effective.  In such teams you will need to lead and follow at different times, and judge well when to do which.  Your over-arching goal and the break down of tasks will inform who the team needs to be.  Be open, be dynamic and to quote the late, great John Hinds: “don’t be a dick”.  This team will function best if they know and buy into the “why” rather than just the “what”.  We can call this the intent of the leader and to be optimally successful, the intent must align with the individual’s/organisation’s/system’s core value(s).

Once you have a team all lined up on the task and bought into the intent, time to let go again.  Let go of being in control.  Delegate both tasks and decisions.  To delegate you must trust and be trusted.  You must be trusted to back up your team with a learning approach when the inevitable hiccup-mistakes spectrum kicks in.  Trust your team to learn and let them undertake tasks their way.  Within moral and legal frames of course.

I have found in recent years of personal growth (& ongoing PTSD psychotherapy) that there is one key behaviour/characteristic that will make you a better leader: humility.  The path to being humble is not easy for most of us.

Lead

Follow

Be humble

Let’s get some stuff done.

Rusty

Thanks so much for following. Viva la #FOAMed

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