In the clinic

Not every physio wants to work outside a clinical setting. Fortunately, fantastic clinical leadership opportunities are available, as Denise Roberts finds out

Sometimes you can recognise leadership qualities in another person before they do themselves, says Sue Roberts, head of physiotherapy services at Eastern Birmingham primary care trust (PCT). 'It's in the way people handle different situations and interact with different patients. It's in their problem solving approach and other clinical skills that can be transferred. A lot of people don't realise they have the right personality and skills to do it [lead]. The trick is to bring it out in staff.'Ms Roberts speaks from both experience and practice. She has been head of the physio department since 2002, but her transition to the role did not begin with a desire to lead. It was her line manager who recognised something in her, which, at the time, came as a little bit of a surprise. 'I wasn't thinking about it. I had been qualified less than five years when I was offered a leadership role. My manager saw something in me I did not see myself, and I have since done the same with staff. For example, I have seen that quality in my deputy. At first she said no to taking on a leadership role but now she does it and loves it.' Ms Roberts began her career in what was then the East Birmingham hospital physio department. Here she gained experience working on rotation, first as a senior II and then as a senior I, before she was given a superintendent role in community care (which is now known as primary care). Her career followed a natural progression: from managing two members of staff through to managing a team. One of the ways in which she has been able to strengthen her leadership skills is by managing a team in a department undergoing various changes. Today Ms Roberts is responsible for managing a physio team in the primary care trust, as well as managing the orthopaedic triage staff, to whom she is physio advisor. Change brings opportunities Changes to the national health service over the last five years or so have given rise to a wealth of opportunities for leaders in clinical roles. This is particularly true since the grades of clinical specialists and more recently consultants have been created, says Sheric Ellum, who is a consultant physio working in respiratory care at Guy's and St Thomas' hospital, London. Commenting on these career structure changes, Ms Ellum notes: 'This has radically increased the opportunities for staff who want to remain clinically based to evolve their expert clinical skills, and ensure these skills are very much at the heart of patient-centered care,' As she observes: 'I became aware quite early in my career that my real interest was respiratory care. I really enjoyed ward-based care and experience of working with a diverse multidisciplinary team. 'I knew that I wanted to remain clinical and could see a role for the progression of research in the clinical setting within my field. I particularly enjoyed postgraduate teaching in the clinical environment. The role of the consultant incorporates these three key dimensions which form a basis on which to lead professionally. The role seemed a logical progression for me at that point in my career.' Ms Ellum has a varied role. She is responsible for provision of cardio-respiratory clinical expertise to the management of acutely unwell patients in the 'patient at risk' team, and clinically leading the acute non-invasive ventilation service alongside a medical lead. She lectures and trains under-graduate and post graduate students to all grades and disciplines within the trust (and in other higher education institutes), and also identifies and facilitates service improvement and progression across the trust within the confines of critical care. Her role is one of two funded through finance from the critical care modernisation agency. Her remit is to work with a multidisciplinary team of highly skilled nursing and medical staff to optimise and ensure critical care is provided seamlessly and appropriately throughout the trust. Looking at her career path to this point, Ms Ellum says: 'I gained my junior experience across a very wide range of clinical areas, but specialised after two and a half years at senior II level and subsequently senior I level in respiratory care.' She adds: 'I was fortunate to successfully undertake a two-year research post working with a highly recognised respiratory team and this gave me valuable research skills that I could utilise in the clinical environment, firstly as a clinical specialist, and now as a consultant physiotherapist.' Bridging the gap Continuing professional development is of particular importance for those in leadership roles, or considering them. Specific leadership courses or programmes can help bridge the gap as physios develop into their roles as leaders. This transition period can at first be daunting, says Ms Roberts, 'because you feel that you do not have the right skills'. She admits: 'I panicked for the first six months. I thought, I can't do this.' She built her confidence by watching her seniors, reacting calmly, interacting with patients, team playing and then finally she asked to go on a management course, which she completed via the Open University route. Since then she has also taken courses with both the Institute of health service management and the Institute of leadership & management. Both courses give leaders a grounding in managerial issues and support them throughout their continuing professional development. Programmes range from developing specific skills of first line managers/supervisors to senior management development programmes. Ms Roberts feels that over the years management theories have not changed radically - it is about putting what you know to work in the workplace and then testing how you put it in place - but there have been new tools, such as mentorship and risk assessment. She says: 'Many of the courses were offered as 'on the job' training to those in first line and intermediate managerial positions. They were useful because they helped to reinforce what I was learning on the job - they put the theory behind the practice in areas such as understanding teams, how they work and empowering staff.' The courses were also an opportunity for participants to self evaluate and to think about different ways in which to respond to different situations. By being around others in similar roles they benefited from a kind of 'mentorship' with one another, swapping scenarios and gaining further insight into what it means to be a leader.  Tips for success So what does it mean to be a leader, and can anyone become one? 'Communication skills are essential,' advises Ms Ellum. 'Dealing across all grades of staff, building relationships, selling ideas, and motivating others to take a vision forward. Listen to feedback from everyone. It is easy to have a goal in mind and feel you can see an achievable service vision in front of you, but no matter how great it seems it is so important to take others' views into consideration.' She adds: 'In fact the leadership aspect of this role is using your skills to bring out the best from everyone else to make the best changes and provide the best service for the patient.' Physio lead Pippa Hodgson also cites people skills as central to leadership. 'You need to understand what motivates staff,' she says. 'Understand that people respond differently. You need to be open and available, but firm and clear when needed. 'It is also important to be available for staff and to be approachable. It is important that you understand their job - it helps if you've done it. You should also have the time to listen and try to involve staff in decision making and empowering scenarios. Be credible and honest - don't make promises you can't keep. And don't be distant.' Care at the frontline Mrs Hodgson is allied health professions and healthcare scientists lead at Leicestershire, Northamptonshire and Rutland strategic health authority. She notes that, ultimately, being a good leader must be seen at the other end of the care experience, where patients are, and she has been involved in creating a programme to help bring this about. The clinical leadership programme supports the strategic health authority and workforce development functions in delivering the NHS plan (2000). It has influenced the way these functions are able to raise funding, and led to a number of leadership events. These include: a political awareness programme for senior clinicians; learning sets for lead PCT nurses; and training in leading empowering organisations for nurses and allied health professionals (AHPs). The objectives have been to deliver leadership at the point of care to enable frontline staff the opportunity to develop their personal skills putting patients central to the services. Around 18 courses have been completed to date. 'The aim was to improve effectiveness in patient care and experience, says Mrs Hodgson. 'When thinking about leadership, personally I think the most important thing is spending time getting to know people, know where they are coming from even if you disagree. It is about being heard.' Mrs Hodgson qualified as a remedial gymnast, before qualifying as a physio in 1983. She specialised in treating acute stroke patients and moved through the ranks by taking managerial development training, which included an AHP national leadership programme study and a spell at the business school Insead, which she describes as excellent. She says those thinking about leadership roles need to be proactive as part of the department as a whole. Her advice is clear and direct. 'Get involved with your own department or organisation. Don't stand there as an observer or complaining. Get involved.'
Denise Roberts

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