HISTORIA DEL SUBLEVEL CAVING - MARCO CONCEPTUAL TEORICO

MARCO CONCEPTUAL TEORICO

3.1 HISTORIA DEL SUBLEVEL CAVING

As part of the process of moving from “amateur” status of doctors in leadership roles, all of the sites had recently gone through a process whereby if they did not have a formalised process for the appointment of medical leaders previously they had implemented one. These more formalised processes typically involved an advert going out to all doctors along with a job description and interested doctors are then invited to apply for these roles. Those considered suitable are interviewed by members of the executive team and in one case a service user (Site I) before selecting the individual who will take on this role.

Site D reported having assessment centres for medical leadership roles based on the Medical Leadership Competency Framework. This process is suggested to stand in contrast to previous approaches whereby medical leaders would “emerge” from the consultant body as the “natural” people to take on this role. This was seen as problematic as it did not engender competition for medical leadership roles and therefore either these might go to the same ‘usual suspects’ or emerge through an opaque process. The sorts of names that might emerge through this process could come with varying levels of personal enthusiasm and competence.

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Formalisation of the appointment process in most of the trusts had not in practice generated huge competition for medical leadership roles. As one Director described, doctors are not necessarily “queuing up for these roles”. For the most part trusts were trying hard to make sure that they did

manage to generate more competition in future and they were being

“ruthless in getting the right people” (Director, Site D). However, some of

the directors at site A, for example, were less concerned about a fiercely competitive process and suggested that their lack of contest could be due to the fact that their talent management processes are so effective rather than doctors not being interested in these roles.

At site C similarly medical leadership positions are often uncontested at the clinical director level. The consultants in directorates often came together and decided which of their colleagues they would like to be put forward for these roles and then once agreed this individual would apply for the role. This meant that although a formalised structure was in place in theory, in practice the consultants in that service area appointed the individual. The doctors concerned were reported to be happy about this as they believed it was a helpful way of determining the most appropriate person for the job. A counter view was that this kind of informality could be perceived as an “old boys” network that sought to exclude the views of the rest of the team.

In some trusts where there was either little contest for posts or no willing applicant for them, doctors from different specialty areas were appointed to these roles. This typically only happened at associate medical director or clinical director level (i.e. one management level below the medical

director) and those in the lower levels of medical leadership roles were seen to require the specialist knowledge of that clinical area. This was seen as unproblematic because at this level what was being sought in these

individuals was their leadership and management skills, rather than necessarily their specialist knowledge of this particular clinical area. Arrangements of this kind were reported to be a helpful way to allow medical leaders to be more objective in their leadership as they would not be swayed by their interest in that specialty. They were also seen as a way of allowing medical leaders to challenge behaviours without worrying that they would damage relations with their colleagues and this is particularly helpful in those areas that are more challenged.

Alongside these formalised processes there are various informal processes of talent spotting whereby individuals who are seen to be suitable for

medical leadership roles are noted and are allocated project based activities so that they can try out these kinds of roles. Site C in particular reported doing a lot of work with newly appointed consultants who meet on an individual basis with the chair, chief executive and the medical director. As the medical director described to us:

“Getting to younger consultants is really important, they’ve got another 25-30 years here so we need to get them engaged now”.

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In terms of what trusts are looking for in terms of medical leaders, rather unsurprisingly clinical credibility was seen as an important factor. Typically this might mean that candidates for medical leadership roles would need 5- 10 years experience in a consultant role before they were seen as having sufficient “clout” with their colleagues so that they could be successful in these roles. For those applying for clinical director or associate medical director type roles there was normally an expectation that an individual had undertaken some sort of clinical lead work or other project-based work in the trust before which would have given them experience of management and leadership.

Aside from clinical credibility another major factor across all of the trusts is an ability to think and act in a “corporate manner”, beyond the doctor’s immediate specialty area. As one director explained:

“The doctor traditionally represented the consultants at management and that has changed now. It is now representing a clinical position in the tough choices that need to be made. And then if tough decisions need to be made then explaining that to your colleagues. It’s not a trade union representative on the board and most people get that” (site A).

This was echoed by a Director at site H who commented that:

“We don’t want people whose primary aim is to be the doctors’ advocate. We want people whose primary aim is to improve the quality of the service and understand that that might mean they have to say or do things their colleagues might not like”.

Beyond these factors, interviewees found it difficult to identify what it was precisely that they looked for in medical leaders. For many they “knew it

when they saw it” but couldn’t quite articulate what the important factors

are. Many suggested that they are quite similar to those sorts of

characteristics that make good leaders in a more general sense, so things like the ability to communicate well at a number of levels, being engaging, having the ability to think strategically and being able to make decisions. These leadership qualities are quite different from management

competencies though, as an interviewee at site B noted:

“They [chiefs of service and clinical director] are not managers. They are clinical leaders. I don’t expect them to go to a 50 page budget report and show the overspending on sutures. I expect them to be conceptually thinking about the future and making sure the present is appropriately managed with a team. I am expecting leadership skills, not management skills”.

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In document Aplicación de la teoría de confiabilidad en la planificación de minas : caso mina Iscaycruz (página 35-40)