As society, and our economy, gradually returns to some sort of ‘normality’, occupational health will be in more demand than ever. Leadership is going to be a key way that providers meet the challenges, as well as maximise the opportunities, posed by the pandemic. But what makes for a ‘good leader’ in the context of a commercial OH provider? A recent SOM webinar attempted to find out, as Nic Paton heard.
After the scouring year we’ve just had from Covid-19 and the myriad post-pandemic workplace health and wellbeing challenges that now lie ahead, arguably there has never been a more important time for occupational health to be stepping up, to be providing leadership and effecting positive change at all levels.
But what makes for a good leader in the context of occupational health and wellbeing, especially commercial OH? What clinical and managerial attributes does an OH professional – whether physician, nurse, adviser or practitioner – need to be bringing to the table? What do commercial OH organisations even look for in a leader? And how can practitioners develop and acquire the leadership skills they need to progress in this context?
These critical questions were at the heart of a recent SOM (Society of Occupational Medicine) webinar, part of a series of ‘future leaders’ online events looking at various facets of leadership within OH.
The event was led by Dr Paul Williams, OH physician and chief executive officer Maximus UK, who gave an initial presentation which then fed into a Q&A-led panel discussion between Alex Goldsmith, chief executive officer at OH provider Medigold Health, Alasdair Emslie, chief medical officer at provider Health Partners, and Caroline Pearson, customer services director at provider RPS.
Understanding ‘what is leadership?’
Dr Williams opened the discussion by posing the question: ‘what is leadership?’. As he pointed out, if you Google this question you come up many thousands of definitions, some more useful and relevant than others. Leadership and leadership development has become something of an industry, and an academic focus, in recent years and so it is all too easy to end up chasing yourself down a rabbit hole.
Nevertheless, he argued that, for him, two definitions stood out as being valuable. These were: ‘leadership is a process whereby an individual influences a group to achieve a common goal’ and leadership is ‘a process of influencing whereby those who are exposed to it are inspired, motivated or become willing to undertake the tasks necessary to achieve an agreed goal.’
But what did this mean in reality? To try and get a handle on this, you need to begin to understand some of the common differences between ‘leadership’ and ‘management’, Dr Williams suggested. Often thought of as being synonymous – after all, a manager in an organisation is also often a leader – they are in fact very different, and require different skill-sets and competencies. He suggested the following table could be useful to understand some of the distinctions:
Articulate vision Planning
Motivate Direct resources
Empower Problem solving
As Dr Williams then put it: “At least in theory, leadership is primarily around articulating and communicating a vision; influencing people; and motivating and empowering people. That is why it is often thought of as somewhat more than management, which is more of a transactional activity to do with things such as planning, budgeting, organising, deploying resources, and solving day-to-day problems.
“Another concept to put alongside this is that, under leadership, many of those activities and attributes are really about transforming a business or an enterprise and adapting to new circumstances and challenges. Whereas the management activities are really primarily about a technical set of skills, attributes and activities that help you hit a target, and to run things as they are.”
“In reality, for those of us who hold relatively senior positions in organisations, we spend a lot of time flipping between those two, often in the same conversation. And so I encourage people just to think about your own job and where you are at the moment. Where do you operate now? How much time do you spend on the left or the right of that chart?
“If you were seeking to be a senior leader in – in this context – a commercial organisation (but it could be anywhere), how much time should you spend in each of those sectors, and where might you like to operate in the future?” he asked.
So, for anyone aspiring to a leadership role, how do you make this transition? “This is about thinking not where should we be, but where could we be?” said Dr Williams. “What does the future look like? How will people interact with clinicians for example? One of the things I am fond of saying to my team is that there are more smartphones in the world than there are lavatories. What does that mean for how people will access clinical advice and services five years from now?”
Leadership, he suggested, is about trying to think about what is the opportunity for the future, how will things be different, and what do we need to do in order to deliver those different services and outlooks? How would you consider those contexts and apply them in terms of where you’re at today but also where you might aspire to be in the future?
Leaders within commercial OH organisations needed to be thinking about organisational leadership and direction alongside clinical, commercial and financial imperatives (including how the organisation is owned), national versus international (if relevant or appropriate), and the different legislative or regulatory frameworks. There also needs to be consideration given to the types of sector, clients or services you wanted to target, whether there were specific or different cultural issues to be factoring, and issues such as diversity and inclusion around recruitment, retention and day-to-day management, Dr Williams pointed out.
How to develop the skills you need as a leader
The event then moved on to the panel discussion, with the panellists responding to questions from the audience. The panellists were first asked to consider how, as a leader, should you go about developing the skills you’re looking for?
Alex Goldsmith highlighted the importance within this sector of having, and maintaining, a “compassionate and empathetic” style of leadership. Alasdair Emslie, as a former GP, occupational physician and past president of SOM, added: “From my perspective, the most important thing is to be yourself. I admit to having never read anything about leadership in the entirety of my medical career. But I think the key thing is enthusiasm and understanding of what makes a good clinician a good clinician and being yourself.”
What about specific management or leadership qualifications, such as an MBA (Masters of Business Administration)? These are notoriously expensive to gain as qualifications and require a very intensive commitment. But can having an MBA give you an edge, an advantage, as leader within a profession such as OH, and potentially open doors that might otherwise have remained closed?
“Yes, very much so,” suggested Caroline Pearson. “I don’t think it [an MBA] is a pre-requisite but I do think having commercial integrity and strong commercial acumen as well as a client-centred approach is very, very important. I think in occupational health, what we’re looking for is inspirational leaders. We want people who lead from the front.
“I think it is very important for them [leaders] to walk the walk. The hands-on experience of delivering occupational health services from a clinical perspective does, I think, equip people to be leaders. But I think they need to take it to the next level and certainly have that understanding of planning, budgeting, resource management and so on. An MBA would be a really good way to do that.
The hands-on experience of delivering occupational health services from a clinical perspective does, I think, equip people to be leaders. But I think they need to take it to the next level and certainly have that understanding of planning, budgeting, resource management and so on. An MBA would be a really good way to do that.” – Caroline Pearson, customer services director at OH provider RPS.
“At RPS, what we do with our senior leaders, a lot of our leaders, is we take them through all of the detail of financial management, budgeting and operational service delivery if they don’t have a formal qualification,” she added.
“I wouldn’t necessarily insist on it or say it is vital that you have an MBA,” agreed Goldsmith. “One of the things, if we’re talking about clinical leaders, I think there is a general mistake I’ve seen across various businesses industries, which is that if people are good at their job they then immediately get promoted to a leader or to be a more important person, with absolutely zero evidence at all that they are going to be a good leader.
“You see if often in sales roles but I have also seen it with doctors, where we see doctors getting promoted to senior leadership roles in OH companies and clients sometimes, because they are very good at being doctors. And that doesn’t necessarily mean they are going to be good leaders.
“Whether or not it is an MBA, I certainly think businesses should give people more tools in terms of how to manage people, how to follow a vision, how to look at different angles of a problem rather than just the thing that interests you or your specialty. So, whether or not it is a formal MBA or just some form on internal training, it is important to make people understand what leadership is rather than just saying, ‘you’re good at your job, go and be a leader’,” he said.
“I do think, if you’re going to be involved in the business development side, it is quite important that you do have some commerciality,” echoed Alasdair Emslie. “Again, enthusiasm for what you’re doing and understanding of what you’re selling. And you’ve got to make a profit at the end of the day.”
How to maximise opportunities as a leader
The next question from the audience was: “what is more likely to optimise outcomes, leadership skills or management skills?”.
“I honestly think it’s both,” said Goldsmith. “If you’re talking in terms of outcomes, the end result of a project, you have got to have the vision and give the management team the tools to achieve the outcome. But you have got to have competent management to deliver on a vision. Plenty of businesses have failed because they had a really evangelistic leader who had a great idea but then didn’t actually equip the management or even had the management team in place to deliver on that outcome.
“No leader is going to be able to deliver on his own. But, vice versa, if you have really good managers, who are fantastically efficient, but don’t have a leader with the vision or ability to give the tools to that manager to deliver what is asked from them, then, again, it doesn’t work. So I would argue that those two things are hand in glove,” he said.
“I think Alex is absolutely right,” agreed Pearson. “It is the two, in equal measure. But the ability to know where you need to focus at any particular time. Because I think in leadership you are always leading and then you bring in your management skills to evidence and support and inspire others, and to get people to follow you. But it is following you down the right path that is really, really important.”
How to manage non-clinical risk as a clinician
How can clinicians manage risk outside of a clinical environment, the panel was then asked? And how does that skill-set translate into commercial leadership?
“From my perspective, the clinical governance is absolutely fundamental to everything that we do,” said Emslie. “That clinical governance piece has to be well led; it needs good data; it needs a culture of audit and people need to be involved in that; we need to see evidence that people are keeping up to date. Essentially, these are all the things that I have always regarded, being a professional person, as the duties of a professional person and, of course as a doctor.
“But they need to be put together into, essentially, a programmatic approach to quality. Without that there are so many potential pitfalls for disaster in occupational health that you constantly have to have your eye on it. I probably spend half of my time dealing with quality, improving it, and thinking about how we can reduce risk in this area. It is almost the most important thing that I do I would suggest,” he added.
“It is pretty much the nail on the head of what many leaders in the occupational health industry have wrestled with,” said Goldsmith. “It is bluntly true that the natural instinct of many clinicians – nurses and doctors – is of a very caring, risk-averse approach, just naturally, because that is how they are taught, clinically, to be.
“Commercial and very entrepreneurial clinicians are, I would say, on the rarer side but certainly do exist. Any successful organisation, clinically and commercially, would need to have various people who are both clinically trained and commercially savvy in their industry. I don’t think you can force people to think in a different way. But I have had success with some doctors who have now become managers and directors.
“For example, people have been worried in the past by cashflow and P&L [profit and loss] numbers, and have seen some numbers they, as clinicians, would be brought up to see as scary or negative. But, actually, you need to take on debt, you need to do certain things to grow a business. I have trained those doctors over time to become much more happy with those types of things and much more understanding of them.
“Once the nature of risk versus reward is explained, they tend to catch on. But I think it is a very interesting topic because, bluntly, the natural nature of many clinicians is not to be incredibly commercial. Sometimes managing customer expectations with the number of appointments we are asked to do in a day, with some of the very real constraints you have with running a business, with clinical excellence and efficacy and doing things ‘properly’. Sometimes those two things can be slightly at odds with each other,” he said.
“I think the skill of a really strong and powerful leader is knowing when to take the risk, particularly if they are a clinician,” argued Pearson. “It is deciding when is the right time to take a risk. I understand that, obviously, it is also about following evidence, but you are quite right that, without taking a commercial risk, organisations will fail. It is all about balance and, sometimes, pushing the boundaries, but always within the constraints of clinical governance.”
Can ‘great’ leadership be taught?
As the event drew to a conclusion, the panel was asked what non-clinical attributes did they feel defined a ‘great’ leader, and could these be taught?
“I would say that, of the three I would choose, the first would be empathy,” said Goldsmith. “As a leader I have had probably my most effective work done through trying to understand the feelings of my people and my customers; really showing and making an extra effort to appreciate that not everyone is the same personality type as you, and trying to be very inclusive in that regard and empathising with certain situations.
“Vision would be the second. What I mean by that is really just working out where you are going. Leadership is a lot like looking at a chess board and sometimes decisions seem obvious – you take the piece in front of you because that seems to be right thing to do. But five moves down the line, that one move causes you disaster. So being able to visualise the business as a chessboard and being able to see – because sometimes to your staff when you make a decision it seems very strange but, actually, when you can explain to them very transparently, the reason you have done that is to stop something worse happening or to cause something better to happen in the future, that is good.
“The final one would be conviction. I think we have seen that in the pandemic. You’ve got to stay true to your convictions and have courage in them. Have a vision and stick to it. If you see things coming down the road; the best example I can give is that poor leaders see a problem emerging over the horizon and often do a 180degree turn and run back where they have come from. I’ve seen that time and again,” said Goldsmith.
“I think if you can have the courage to keep looking forward and maybe try and take a bit of a swerve in the road but still be heading roughly in the same direction and stay head up, that is a very, very important attribute.
“For me, [in terms of tools to get there] it is very simple – people, good people,” Goldsmith continued. “Good people to support you is most important thing. You can talk about IT, you can talk about courses you can go on, you can talk about training. But if you have got the right calibre of team underneath you, who you trust and who trust you in return, you can’t really go wrong,” he added.