Senior healthcare leaders need support to help them overcome challenges that can impact on patient care, according to research commissioned by the General Medical Council and published Wednesday 14 August.
Suzanne Shale, a medical ethics consultant, found that positively-engaged leaders, from diverse backgrounds, are key to transforming organisational cultures. However, they are often unprepared and unsupported for the challenges of leadership during the early stages of their management careers.
Particular challenges highlighted in the research, How doctors in senior leadership roles establish and maintain a positive patient-centred culture, included balancing competing priorities and demands, focusing on people and culture rather than tasks, and recognising and tackling problematic subcultures.
Five ‘notable clinical subcultures’, that could be harmful if allowed to develop, were identified as part of the research:
- Diva subcultures – powerful and successful professionals are not held to account for inappropriate behaviour. Left unchecked, divas become viewed as untouchable, and colleagues accommodate them and work around them.
- Factional subcultures – arise when disagreement becomes endemic, and the team starts to organise itself around continuing conflict. Those in dispute look for support and loyalty from colleagues, and staff may seek to avoid working with those on the ‘other side’.
- Patronage subcultures – arise around influential leaders who have social capital in the form of specialist knowledge, professional connections, high status, respect and access to resources.
- Embattled subcultures – where resource has been inadequate, and unequal to demand, practitioners eventually become overwhelmed. They feel besieged by the unmet need they see in patients, and may show signs of chronic stress such as short temper, anxiety and burnout.
- Insular subcultures – some units become isolated from the cultural mainstream of a larger organisation, resulting in professional practice or standards of care that deviate from what is expected. The isolation can be geographical or psychological.
The report highlighted how damaging subcultures were a challenge to an organisation’s senior leaders, and once they became established significant time and resources were required to turn them around.
Source: General Medical Council 15th August 2019