A General Medical Council (GMC) commission study found that senior healthcare staff are unprepared and unsupported for the challenges of leadership during the early stages of their management careers.

Participants revealed that the most demanding, but often unsupported, step into senior leadership was the first one beyond the level of consultant.

The research undertaken by medical ethics consultant Suzanne Shale entitled “How doctors in senior leadership roles establish and maintain a positive patient-centred culture” identified five ‘notable clinical subcultures’, that could be harmful if allowed to develop:

• Diva subcultures – powerful and successful professionals are not held to account for inappropriate behaviour. Left unchecked, divas become viewed as untouchable, and colleagues accommodate them and work around them.
• Factional subcultures – arise when disagreement becomes endemic, and the team starts to organise itself around continuing conflict. Those in dispute look for support and loyalty from colleagues, and staff may seek to avoid working with those on the ‘other side’.
• Patronage subcultures – arise around influential leaders who have social capital in the form of specialist knowledge, professional connections, high status, respect and access to resources.
• Embattled subcultures – where resource has been inadequate, and unequal to demand, practitioners eventually become overwhelmed. They feel besieged by the unmet need they see in patients, and may show signs of chronic stress such as short temper, anxiety and burnout.
• Insular subcultures – some units become isolated from the cultural mainstream of a larger organisation, resulting in professional practice or standards of care that deviate from what is expected. The isolation can be geographical or psychological.

The GMC recognised in its response to the research that: “We cannot just assume that doctors in senior leadership roles will automatically be good leaders. Leading in healthcare isn’t easy. Leaders are developed, not born, and doctors who choose to take on these roles deserve to have all the necessary support and resources to help them succeed.

“This research is a really valuable contribution to an important issue, and should be required reading for people right across healthcare in the UK. There are many of us with roles to play assisting those in leadership positions, and I would encourage people to read and digest this report. This is the start, and there are more conversations to be had about the lessons we can all take from this work.”

How doctors in leadership roles establish and maintain a positive patient-centred culture, is available on the GMC’s website.