My life as a Medical Director: Peter Lees

Today… we hear from an up and coming area of medicine that more and more people are interested in: Medical Leadership and Management. We speak to the leader, and founder, Mr Peter Lees.

A graduate of Manchester and Southampton Universities, Mr Peter Lees is the Chief Executive and Medical Director of the UK intercollegiate Faculty of Medical Leadership and Management. Over 20 years, he combined a career in neurosurgery with senior roles in operational management and leadership development and is now the spearhead of the field in the UK. We managed to catch up with him and get his insights into the state of medical leadership, and how he sees it changing in the future.

Thank you very much for speaking to me! Could you tell me a little bit about your journey to leading the FMLM?

I was an academic neurosurgeon when medical leadership and management came very much to the fore in the early 90s. I made the choice to go into management, but obviously kept my clinical work on. I quickly recognised that doctors in leadership roles needed help with their development – there was none at that time. That led me to becoming increasingly involved in leadership development through a variety of national, regional and local roles including the first NHS Leadership Centre. I ended up with three strands to my career before ultimately giving up clinical work for very positive reasons – I’d done 25 years as a consultant which is a fair ‘innings’ I think!

My last NHS role was as SHA Medical Director and Director of Leadership. The demise of SHAs coincided with the decision by the Academy of Medical Royal Colleges with the UK medical royal colleges to establish a Faculty of Medical Leadership and Management, the establishment of which, I was very privileged to be asked to lead.

So the management interest you have – is that something you had before you started medical school, or is that something that you developed?

No, not at all – I suppose when I look back over my early clinical career, I had always tried to make things more efficient – in fact I was driven mad by inefficiency so I got involved in many initiatives over those years, but we would never have known then that you called it management or leadership.

Okay. And do you think going forward maybe medical leadership and management will be seen as a specialty in its own right?

I hope not.

Why is that?

I think there is something inherent in a medical leader having reached a certain level of experience in the system that then actually makes you better equipped in making decisions – otherwise, you become a manager who happens to have a medical degree. If, as has recently been suggested, we get more doctors into chief executive positions, we may ( I only say may) have to rethink. I still think there is a lot to be gained from having a significant clinical career. There is also research evidence from Cass Business School to back that up. In a variety of settings, they have shown that ‘experts ’ have the edge on non – experts. For example, they showed that card-holding academics make more successful vice-chancellors . They also showed that there is a 25% quality premium associated with medical chief executives – food for thought.

Do you think that there is an optimal level of or a minimal level of training to have?

I don’t think anybody knows the answer to that, but we are making progress. Firstly, we have to recognise that leadership takes place at all levels of a clinical career – it is then self – evident (unless you are deluded into thinking that leaders are born) that individual doctors at every level need help to develop their skills commensurate with the level they are operating at.

Okay. From your point of view, you’ve obviously been involved with FMLM for quite a few years, what’s been your  a) most challenging and b) most rewarding thing you achieved during your time there?

The answer to both is setting it up and setting it up! So, to try to set up a membership organisation in a deep recession, where a predecessor organisation went bust, and with little support, has been a major challenge. The fact that it now stands on its own two feet feels quite an achievement… or do I mean relief! I think the second thing is that we have professionalized medical leadership, but without going down the route of making it a specialty . We now have standards of medical leadership and management which no other professional group has done despite the fact that Francis and Kirk up both called for it. On top of that, we now award fellowships! And I guess the third thing is the work with the junior doctor community and the clinical fellowships, which we have run with Sir Bruce Keogh over the last 6 years. That scheme now has 150 alumni and what an amazing group of people. Pharmacy and dentistry now have their own scheme sponsored by their chief officers which we are helping to manage.

So, my next question is related to that, you had an article published in a BMJ about advocating for a flatter hierarchy, how can junior doctors and medical students interested in leadership and management, or who are interested in this field, take on a leadership position? I’ve often seen in my background that people might have great ideas, so how can you empower people in sort of the junior positions to take on these roles?

I think it depends on which roles you mean, if you think ask a medical student to take on the medical director role, the answer is you can’t. But what I think we should be doing, which is starting to happen, is I think we should be giving medical students and junior doctors training and development to help them with their leadership skills and leadership development. I think the second thing I’d say is that you don’t need to have some sort of formal title of leader to actually be doing it, so medical students to a lesser extent, but all junior doctors are leaders in their own right. Finally, as part of development, we need to be much more creative in allowing students and trainees, opportunities to lead.

Importantly, we need to be much more aware of the leadership already undertaken by more junior colleagues who lead when they interact with patients, who lead if they are the most senior member of a team – for example, on a daily basis the first person at a cardiac arrest leads. I think it’s important to help everyone understand that if they get the leadership bit wrong, the patients will suffer, as well as that they will suffer if they get the clinical bit wrong. So, I think we need to be offering opportunities to develop earlier on, and in direct answer to the question, we should then be creating opportunities, which we do through the fellowships scheme for example, for people earlier in their career to take leadership responsibility and experience. We’ve got to get away from this rather outdated and for me, simply wrong notion that you’ve got to be old and grey before you do anything around leadership. And we’re wasting masses of talent by that approach.