Healthy Leadership (672) 'Technical Skills Matter But You Use Them Differently When Promoted'
As doctors go through their student years knowledge and technical skills are a key component of learning. There are sessions on compassion, communication and teamwork but the focus is getting to know things and being able to do things. The trainee years add further to their knowledge and experiences build over the years. The doctor reaches a senior level (eg Consultant) and then more responsibility is piled on that has little to do with the early knowledge or those first skills and competencies. They must lead teams, deal with conflict, recruit staff, manage finances, improve performance, develop services, partner with other organisations etc. In the years that pass from student to consultant is it possible to hold onto all the knowledge and skills that have been acquired? Knowledge – Skill – Experience – Expectation – Responsibility – Role… balance and effectiveness are tricky for those in a senior position.
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The ‘Pick of the Week’ (see below) suggests that at an early stage in our careers we focus on technical skills and that means we could struggle as non technical skills become a requirement of promotion. The development at all stages of both technical and non technical skills might help with understanding of roles and responsibilities and diminish the tension between ‘junior’ and ‘senior’ in many areas of our work. Is that right? Is that possible? Convincing the student doctor that they should be as interested in the important skills of leadership, cross system collaboration and budget management is a tough ask when the urgent requirement to pass the next assessment looms large. How to balance when you learn and what you learn is tricky.
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A newly qualified nurse has spent 3 years developing a clinical skill set. They begin their career usually at a grade called ‘band 5’ and they build their experience. Let’s say for arguments sake that 90% of their time is clinical – point of care. There maybe some management/leadership as they supervise students, co-ordinate shifts etc. They are the clinical point of care powerhouse. They are really good at this and they prove to be competent and so are encouraged to go for promotion.
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A newly promoted nurse has spent the last few years further developing a clinical skill set. They are now a band 6 and they are excited and proud of the position. Let’s say for arguments sake that 80% of their time is clinical – point of care. There will be more management/leadership expectations as they coordinate shifts, plan rota’s and manage band 5’s. They remain a clinical point of care powerhouse. Something is changing in their role. They are really good at this and they prove to be competent and so are encouraged to go for promotion.
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A newly promoted nurse has spent the last few years further developing a clinical, managerial and leadership skill set. They are now a band 7 and they are excited and proud of the position. Let’s say for arguments sake that 60% of their time is clinical – point of care. There will be more management/leadership as they coordinate shifts, plan rota’s, manage band 6’s, undertake audits, resolve complaints, improve performance, recruit new staff, manage budgets and more. They remain a clinical point of care resource and expert but the powerhouse of clinical care is with others. Something is changing in their role. They are really good at this and they prove to be competent and so are encouraged to go for promotion.
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A newly promoted nurse has spent the last few years further developing a clinical, managerial and leadership skill set. They are now a band 8 and they are excited and proud of the position. Let’s say for arguments sake that 20% of their time is clinical – point of care. There will be more management/leadership as they coordinate shifts, plan rota’s, manage band 7’s, undertake audits, resolve complaints, improve performance, recruit new staff, manage budgets, lead more than one unit, engage at senior organisational levels, respond to national expectations, meet in expert groups at regional level, plan for future, build on the present and respond to staffing emergencies and more. They remain a clinical point of care resource and have experience of being an expert but the powerhouse of clinical care is with others. Something is changing in their role. They are really good at this they prove to be competent and so are encouraged to go for promotion….
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That’s promotion… it is how the world works. But is it working? Is this how it must be?
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This experience of promotion focuses on an upward trajectory. This risk in this model of promotion is going the other way and it becoming a downward trajectory! Up and down are the directions of travel in hierarchies. Some of this movement is planned, some is because of the urgent moment and some unconscious. It is what hierarchies do.
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Promotion is tricky. A band 7 is not a band 6 with a few more pennies but a different job. If we fail to recognise the difference in roles we risk success in those roles. Are we clear on roles and responsibilities?
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The band 5 is busy and over stretched with point of care activity and looks to help from the band 6. The band 6 remembers what it was like when the unit became busy and so stops what they are doing and helps. What did they stop… was it cancelling the 1:1 with the student? was it rescheduling the audit? whatever it is there is now a gap emerging. One gap is closed and another opens.
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The band 6 is busy and over stretched with point of care activity and is struggling with the management expectations and looks to help from the band 7. The band 7 remembers what it was like when this situation arises and so stops what they are doing and helps. What did they stop… was it cancelling the rota planning, writing the response to the complaint, checking the budget? whatever it is there is now a gap emerging. One gap is closed and another opens.
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The band 7 is busy and over stretched and is struggling with the management expectations and looks to help from the band 8. The band 8 remembers what it was like when this situation arises and so stops what they are doing and helps. What did they stop… was it cancelling the safety debrief, someone’s performance review, writing a business case for more resources, preparing for an inspection by regulators, attending the regional specialist groups? whatever it is there is now a gap emerging. One gap is closed and another opens.
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Mind the gap…
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Senior staff find it hard to say no when junior staff are struggling and the reasons make perfect (common) sense – or do they?
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The common sense answer is of course the urgent requirement to respond to point of care needs. Although is every ‘yes’ to the request for help the right response. It might be that with a little rethinking the urgent request for point of care help could be managed differently – does it have to be you? It may also be that the senior nurse is struggling with the management tasks they lack training and competence in and so prefers the clinical competency and the immediate difference they can make. Rescuing the present is rewarding in a way that auditing for the future just isn’t.
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It might be a form of reputation management… accept that you have experience of being a junior member of the team but that junior members of the team have no experience of being a senior member of the team. They will talk about you… it is the way of the world. They will make assumptions that might go like this… ‘what are they doing all day sat in that office’, ‘they are at yet another meeting’, ‘they have no idea what it’s like in the real world’. The senior might agree to the request from the junior for help in order to manage this moment. To be seen as competent, stop the ‘gossip’ and gain respect… reputation.
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But the gap continues to widen. The reports are not being prepared, the budgets are not being signed off, the performance reviews are being delayed, team meetings are cancelled, improvement plans for the future seem ridiculous in a present that is so overwhelming. There is huge pressure to close those gaps and so people work longer hours, stay late, work in the evenings, at the weekends. Just in the nick of time and by the skin of your teeth the gap seems to be closed. But it can’t go on…
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At some point this strain will show. Sickness raises, resentment grows, people leave, toxic cultures emerges, blame? is the game and the story spreads… it is an undoable job.
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This is the reality many in healthcare are facing the focus here was on doctors and nurses (it often is, it’s an easy known reference point) but in other areas of work a similar pattern emerges.
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When you are newly qualified you have a high level of technical competencies and as promotions come you also start to gain a high level of non technical competencies. Knowing how to maintain and deploy your technical skills as promotion applies pressure on them is an important consideration of moving roles. Making sure you become as competent in those non technical skills is as vital for success as any other element of your work. Then finding technical and non technical balance in each role is one of the challenges of promotion – getting this right might require letting go of somethings… that can be tough.
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Some considerations to help you influence this dynamic…
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If you are a band 5 do you think your minute is as valuable as a minute that the band 7 has?
If you are a band 5 you are doing vital work, thank you, is the band 7 doing vital work?
If you are a band 7 how are you helping the band 5 understand your role?
If you delay important leadership/management for urgent point of care tasks do the team understand the consequence?
As a senior are you working out how to let go of being a junior?
As a junior do you appreciate the work of the seniors?
When does the team come together to discuss such tensions and agree how to respond?
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Your context is different and the examples are not wholly accurate of where you find yourself. Yet the tension of promotion, success and gap management is common and real. In your role, at whatever level, how you move, make choices with your time, respond to the urgent, build confidence in the team, talk openly and transparently about consequences is part of the process of creating success. You will be drawn to the past where you were competent and confident. Staying in the reality of the present in which you are anxious about your ability is difficult and acknowledging that this dimension to your decision making is also part of this process is helpful.
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In whatever industry and whatever rank you are at there is always some looking up the hierarchy and questioning the competence, experience, relevance of those in charge. It is real and perhaps useful sometimes. How it is managed and responded to is part of your leadership practice.
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Working in hierarchies, working in professional groups, looking for technical skilled staff to learn the non technical skills required for success – this is complex, dynamic and true of many organisations. Are there better ways to achive success?
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We often promote people because they have become expert in their current role. The moment we do they become a novice in their new role – expert to novice is the promotion pathway. The humility you show as a novice will help you become the expert as time, training, feedback and experience weave their magic on you. Then as your expertise settles in, your confidence grows, someone might suggest….. ‘have you thought about your next promotion!!!!!’
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Do your team know what you spend your time doing?
Do you know what your team spend their time doing?
Are their clear objectives for you and the team – shared and understood?
Is their a mentoring / shadowing process to help people understand people?
Have you team discussed how they want to respond to overwhelming workload?
Does everyone understand that gaps are created as a response to choices?
Do juniors appreciate the value of the work of the seniors?
Do the seniors appreciate the value of the work of the junior?
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Notice and be Curious
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Pick of the Week - Technical Skills Matter… for how long
Early in our careers the focus is on technical skill as these help current success & future promotion... but a shift happens at some point & other competencies matter in an ever increasing amount.
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