JMos as funCtional leaders

By Dr Lloyd McCann
Director of Clinical Strategy (EMEA) Carefx

There is ample available literature on leadership frameworks, leadership styles and leadership theories. In recent years, the concept of clinical leadership has come to the forefront within healthcare systems and healthcare delivery.
Whilst the notion and concept of clinical leadership remains relatively vague, it is heartening to see that there has been a return to increasing managerial responsibility for clinicians. There is also increasing recognition that clinicians benefit from leadership and managerial training and cannot simply fulfil leadership roles and management positions based on clinical credibility alone. However, a gap remains between clinician managers, management and leadership training and the everyday shop-floor leadership required by clinicians and particularly JMOs. JMOs will all be thrust into a position of leadership or coordination at early stages in their careers. Registrars are expected to competently lead ward rounds, organise radiology conferences, run tutorials, chair MDT meetings and lead small teams. Most learning in these aspects of the JMO role is learned through osmosis JMOs observe more senior doctors and other colleagues, including JMOs, in these roles.

Some medical students and JMOs have the distinct benefit of being involved in student and committee leadership positions as well as wider positions of leadership or management through external activities. This brief article aims to outline some practical frameworks that JMOs can use in their everyday work to manage and lead their teams. The concepts outlined here are all related and based on Functional Leadership theory.
Functional Dynamics

There are 3 basic components that makeup the functional leadership framework. Whilst this is a framework, it provides a realistic view of the factors anyone in leadership position must attempt to balance in order to lead successfully (see functional dynamics diagram).
FUNCTIONAL DYNAMICS

The Zone Task

Team

Individual

Adapted from: http://en.wikipedia.org/wiki/Functional_leadership_model

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This framework focuses on how leadership occurs rather than who is leading. Translated, this speaks to anyone being able to focus on and exhibit these behaviours when necessary.
Task Dynamics

basic to more specialised (e.g. basic needs such as food/water/rest versus the need for development and education). In many group situations, individual needs are often pushed aside for the benefit of the group and task achievement. Within the medical setting, basic and more advanced needs are important. For example, House Officer teaching is something that is mandated and clearly necessary for personal and professional development, but this is often in direct tension with team and task requirements. Again, it falls to the JMO leader to ensure that balance is maintained, but also that, where necessary, needs continue to be prioritised. When a leader is able to balance task, group and individual requirements, they can consider themselves to be in the zone!
A Practical Tool

Medical work is largely task orientated. The functional leader must never lose sight of the task/s to be achieved this has a direct impact on patient outcomes. This is why many teams will sit down after a ward-round to confirm the list of jobs for completion. In many instances, task needs must be placed first in the medical setting as the health outcomes of our patients rely on investigations being organised, treatments and procedures being performed and administrative tasks being completed. As functional leaders, JMOs must always have task needs in hand.
Group Dynamics

JMOs are usually thrust into a leadership position. This may be as the day-to-day leader of a small medical team, or the chair of an MDT group. Group dynamics are an important factor in the functional leadership model. Every group has specific requirements examples of these are: cohesion, leadership, principles, education, a defined role and success. The role of the leader is to recognise these needs and ensure that they are met. This is where the first issue arises often group needs may be in direct conflict with task needs. Ultimately it falls to the JMO leader to attempt to balance these needs.
Individual Dynamics

Now that we are aware of the potential competing needs JMO leaders must balance, we can focus on applying a practical tool to lead in our environment. The tool is based on a New Zealand Army model PICSIE:

Planning initiating Controlling Supporting informing evaluating

These are general steps and provide a process to follow when approaching a workday/set of tasks etc. Naturally, we already do plenty of these things (perhaps subconsciously), but what this does provide is something to refer back

Individuals form the basis of any group or team - without individuals the achievement of any task becomes impossible. Individual needs vary from

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to, in terms of practical steps that can be applied in a number of situations.

\Planning

It is imperative that the leader provides information and feedback to their team in a timely manner.
Evaluating

This first step is often overlooked or rushed and many pay the price later on. Involving your team in planning and taking time to plan is a great investment. When your team is involved in planning there is a higher level of engagement and ownership the task becomes shared and is therefore more likely to be achieved. It is imperative during this step that the leader is clear about the tasks and that these are expressed with great clarity to ensure group understanding.
Initiating

This step is critical and is often overlooked. The leader must evaluate individual and team performance to allow for improvement and the identification of strengths and weaknesses. This step allows for individual and team development and ultimately contributes to a teams overall effectiveness. Here, both real-time and retrospective evaluations have a place within this cycle. So, in a nutshell, there you have it. The more you think about the functional dynamics and apply the steps to situations, there more natural it becomes. Remember that this approach focuses on how to lead and does not rely on integral qualities or styles of a leader. Yes, it is important that we are authentic and apply appropriate styles and behaviours, but this outline provides a good basis whereby JMOs can function as leaders in everyday situations.

Frequently, this involves delegating or assigning people to perform tasks or components of a larger task. Never forget that you are part of the team and can complete tasks yourself!
Controlling

This sounds counter-intuitive - especially in circles where we tend to operate as independent practitioners. However, the leader must maintain control of the task or situation and ultimately ensure that the group is moving towards achieving their task. This relies on communication, seeking feedback on understanding and progress, and monitoring. This step is closely linked to supporting.
Supporting

Whilst maintaining control, the leader must make certain that team members feel supported and are comfortable with what they must achieve.
Informing

This involves ensuring that the team is aware of any potential changes in the situation or actual changes in the task.

December 2011