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The bigger picture

What makes a good leader and how do you become one? Lisa Oxlade canvasses opinion from four physio leaders in strategic and managerial settings

Management and leadership have always been part of the career plan for some physios. Jenny Brown, general manager for the therapies clinical directorate at St George's healthcare trust, London is in this category.

As she explains: 'I think I had always been interested in management. I was working in Canada when I first took on management tasks when I designed and opened a new physiotherapy department in an outlying hospital... I loved treating patients, but the

management role gradually became more interesting and challenging. Management/ leadership allows you to see a much wider picture than clinical work and allows you to influence change.'

However, for others the move out of the more traditional physiotherapy role in a clinical setting was more a question of taking advantage of opportunities as they came along. Jane Nicklin is allied health professions lead for Essex workforce development confederation. She says her move into management 'was really a matter of luck and seizing the opportunity when it arose. An advertisement for a project manager looking at neurorehabilitation services in Essex came up at a time when I was considering a move out of the highly specialist world that I worked in [see cvs box on page 10].

'I soon realised that leadership was such an important ingredient in developing excellent services that really centred on what service users wanted, with clinicians supported and stimulated by opportunities for continuing professional development. I knew that I would have to find a position where I could influence in a strategic way to get things to happen.'

For Karen Middleton, professional advisor at the Department of Health, her move into management was 'not planned, but I did take opportunities as they came my way. The secondment [see cvs box] was the biggest step, but easier because it was a secondment. It taught me I could do something which I had little knowledge of - project management, user consultation, the clinical area of physical disabilities... What I learnt was that many of my physiotherapy skills were transferable.'

Suited to lead

Possessing transferable skills is key to moving into leadership roles and in this physios are well placed. Today's managers agree physios already have many skills that will stand them in good stead as they move into more senior positions. These abilities, says Ms Middleton, include clinical decision-making skills that allow physios to think through any problem analytically, whether clinical or not.

They also include the ability to motivate people, the capacity to work with all sorts of different people, and to look at a problem and to come up with solutions. 'You must never forget that as a clinician you never lose those clinical decision-making skills, and judgment about clinical situations, but it is important to know what you don't know.'

Janet Edwards, assistant director, adult services, at Bolton primary care trust (PCT), agrees physios are well placed in terms of transferable skills. She adds that physios' communication and interpersonal skills, their flexible approach, their ability to work under pressure and the fact that many physios are approachable, supportive, confident and decisive means they are also well suited to become leaders. 'And finally,' says Ms Nicklin, 'a bit of a stereotype but - they are generally big characters.'

So what makes a good leader? Ms Nicklin comments that for her the essence is 'often something indefinable'. However, she adds 'for me to respect another leader, it's their integrity that counts for a lot. A willingness to make difficult decisions and be able to explain why they are taking perhaps an unpopular decision.

'I think in many instances the good leaders that I see among AHPs [allied health professionals] usually have an understanding of the political environment in which they are working, and which they have to influence to make others understand what AHPs can contribute. They can see the bigger picture and can communicate a vision - they have good communication skills.'

She concludes: 'It's about the feeling of being inspirational and being an example to others... it's about someone's personal attributes: they say what they think and are able to take people with them.' Such personal characteristics are important for Ms Middleton. She believes a good leader is 'someone with vision who can communicate that and turn it into a reality. They have to have charisma too'.

For Ms Edwards a leader needs to be willing to 'take on challenges knowing they might not always succeed, but understanding this will not stop them and that they will learn from any less than successful outcomes'. Leaders also, she believes, need strong commitment and motivation to improve health services and the ability to motivate others. What is essential is possessing a vision for the future and being prepared to act to achieve this vision.

Ms Brown raises the issue of a leader's relationship with other staff. She notes a leader needs to be 'someone who communicates well, is approachable and ready to respond to the needs of staff and patients... Leaders have to be good at delegation. Leading a service ensures that all staff feel that they can put forward ideas and that their views will be respected.'

The leadership ladder

So how do physios develop the skills they already possess to become more effective leaders? Today there are a variety of courses for leadership available to help you on your way (see page 5). But one thing physios seem to agree on are the advantages of experiencing good leaders in action, as well as having a mentor they can turn to for advice and support.

Ms Middleton honed her leadership skills through a variety of courses. These included the King's Fund senior management programme 'which had a significant effect on me and my leadership ability' and a LEO (leading an empowered organisation) course. However, she says: 'The greatest help of all have been the various mentors and coaches I have had, and really simply watching and learning from managers I admire - and don't admire.'

'Invaluable', is how Ms Nicklin describes her mentor. Indeed, her advice for anyone moving into leadership and management for the first time is 'get a mentor - it has made a big difference for me. I have a chief executive [as my mentor] at the moment and she has been so helpful in helping me think things through and looking at them from a different perspective.' She also singles out learning from peers and superiors, as well as various leadership courses, as influential in her career development.

Although leadership programmes have played a central role for Ms Edwards, she stresses: 'More formal training is only part of developing leadership skills... Opportunities for shadowing others, peer supervision, mentorship, appraisal, experience, reflection and learning from mistakes and success form a major part of continual development.'

Ms Brown also comments on the value of learning from peers: 'Courses give you the tools to work with, but I have found that having good mentors, role models and managers has taught me and developed my skills more than courses.' She feels her work in sports physiotherapy, which includes managing provision of physio to national teams in a variety of sports, has helped her develop skills with different people in different and challenging environments.

The internal view

Finally, and perhaps the most tricky question: 'How do leaders see themselves?' Ms Middleton's philosophy for being a good leader centres around the principles 'practice what I preach, or try to. Behave in a way I expect others to behave in. Be happy to ask for help and to recognise when I don't know, yet also to take control and the lead when required.'

Ms Brown says: 'I think I am enthusiastic, about the NHS and particularly about physiotherapy and the role physiotherapy can play in healthcare. I love managing and leading staff and developing the services to patients. I have also been quite ambitious in many ways and taken on roles within the trust [St George's], which have helped me see the wider picture and to work closely with other senior trust colleagues.'

For Ms Nicklin the answer lies in: 'Being passionate about my work and really believing in the allied health professions. Being prepared to listen to all points of view, but also being prepared to take a reasoned stance as necessary.' It seems the recipe for leadership success is to be able to mix passion, flexibility and ambition.


How did these physios make it to where they are today? We take a look at their career paths

Karen Middleton has been a professional advisor at the Department of Health (DH) since March 2003. Her role is to provide professional advice to ministers and executives of the department and the NHS on all matters relating to the 12 allied health professions (AHPs).

'I have a particular lead on children, LTC [long-term conditions] and primary care and liaise particularly closely with the physiotherapy, SLT [speech and language therapy] and orthoptic professions,' explains Ms Middleton.

After 10 years of clinical work as a physio, Ms Middleton moved into service management with a six-month secondment to manage a project reviewing services for people with severe physical disabilities in Tower Hamlets. This was followed by time working with social services and the voluntary sector setting up a service for people with severe physical disabilities; a stint as associate director in primary care managing community nursing and allied services; and then just over a year working at the then London regional office in primary care development.

Jane Nicklin is allied health professions lead for Essex workforce development confederation (WDC). This means representing AHPs and acting as a point of reference for both clinicians and managers in the workplace, and individuals working in the strategic health authority and WDC. 'I may be asked to get involved in strategy that links to development of services or the workforce. In reality that means I may find myself advising about new commissions for training of any of the AHPs, or I may be involved in workshops to look at how AHPs can contribute to modernising services and the workforce that we provide in Essex. I also work to facilitate leadership and development of consultant posts.'

Ms Nicklin qualified in 1980 and has worked in both community and training hospitals, specialising in neurology. After 14 years at the National Hospital for Neurology, she undertook a project looking at neurorehabilitation services in Essex. 'From there I found myself highlighting work that needed to be undertaken by the Education Consortium, as it was then, that involved AHPs and basically built the case for an AHP lead [at the WDC], with support from the AHP leadership network led by Fran Woodard.'

Jenny Brown is general manager for the therapies clinical directorate at St George's healthcare trust, London. This involves managing dietetics, physiotherapy, occupational therapy, speech and language therapy and chaplaincy services. Ms Brown is also a member of the trust executive group. 'The role is fairly new and changes constantly,' she explains. 'I represent the therapy viewpoint on many trust-wide committees and working parties.'

After qualifying as an orthopaedic nurse, Ms Brown went on to train as a physiotherapist at Guy's Hospital. A stint at Nuffield Orthopaedic Centre, was followed by five years working in Canada. On returning to the UK, Ms Brown worked in London in neurorehab and musculoskeletal outpatients. After doing her Diploma of Teaching Practice she joined St George's as acute unit manager. She moved into a district role and then became physiotherapy manager at the trust. She was clinical director for clinical support for seven years before accepting her current post.

Janet Edwards is assistant director, adult services, at Bolton primary care trust (PCT) and her primary task is to lead the development of services for adults across the organisation. Her remit includes provision of multiprofessional services for learning disabilities, cardiovascular services, cancer and palliative care, smoking cessation and specialised community mental health services.

Ms Edwards qualified as a remedial gymnast and extended her skills to include electrical and thermal techniques and soft tissue manipulation. She has worked both in hospitals and domiciliary therapy teams. In the late 1980s she became superintendent physio for a domiciliary therapy team and in the mid-1990s was appointed physio manager for community healthcare, Bolton trust, and subsequently Bolton PCT. In summer 2003 she became assistant director, allied health professions, at the trust and took up her current post in 2004.


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