After five to six years of medical school and eight to ten years of postgraduate training, you are a consultant. Something to be genuinely proud of.
Congratulations on getting the job. You have earned the right to attend court to advise the judge. They will ask you to do lots of things, flattering you with the word leadership. You can lead a ward round. You run clinics. You know what to do in theatre. You are an expert.
At some point someone will ask you to speak to a colleague who shouts, throws instruments, and undermines nurses. He is probably clinically brilliant. He has never been spoken to seriously. The culture lets him. Nobody will have trained you for that conversation.
At some point someone will ask you to lead a change: moving a clinic, reducing waiting times, starting a new service. Nobody will have trained you for that either.
At some point you will begin to believe, because you have been flattered by the word leadership, that you can lead. Being a leader is a whole other thing.
Bob's story
Colonel Bob Pearce MBE is a military man from his travel iron to his DNA. He is also brilliantly thoughtful and reflective, which is rare in all walks of life, and in the military perhaps unusual.
The Daily Telegraph shared his story: I thought the NHS would be like the Army. I could not have been more wrong.
The highlights are worth reading.
The military selects for leadership potential from age 16. Candidates are assessed continuously on how well they manage the people under their command. In the NHS, the equivalent doesn't happen until a hospital is in trouble, at which point someone brings in new leadership.
In the Army, the whole team has to succeed. There is a collective drive. In the NHS, people turn up and look after their individual patient rather than the collective outcome for the whole patient population. The failings, Bob argues, are in part because employees are taught to look after their own section, their own budget, their own patients, rather than the whole.
On the consultant asked to lead change: he had not been trained what to do. He could look after an individual patient, but being in charge of a department or a ward, you learn that on the job.
Selection, not just development
The General Sir Gordon Messenger 2022 report on NHS leadership recommended reform, and the Faculty of Medical Leadership and Management has absorbed some of its recommendations. Self-selection into programmes and degrees helps. Post-nominals help. But the military model does something fundamentally different: it selects for leadership potential, not just clinical excellence. It assesses continuously, not at crisis point.
At STRASYS, the Decision Intelligence engine for healthcare, Board Operating System evaluates board-level leadership capability: whether boards have the composition, challenge dynamics, and decision intelligence to lead effectively. The Board Operating System provides the decision framework that connects leadership capability to organisational performance.
The NHS takes the idea of leadership seriously in rhetoric. NHS England is especially serious because the default explanation for a failing hospital is leadership. The only solution is to change the leadership. But this assumes that the replacement will be better, without any systematic process for identifying who has the capability to lead before they are thrown into it.
Bob wrote a book: How to Climb a 12-Foot Wall. Forever curious, he is working on a PhD focused on how board-level healthcare leadership can be developed and measured.
Naeem Younis, STRASYS CEO, argues that the NHS shares one thing with the military: it is a matter of life and death. If that is true, then selecting for leadership potential should be as rigorous in the NHS as it is in the armed forces. Self-selection and post-nominals are not enough. The NHS needs a system for identifying, developing, and measuring leadership capability from the earliest stages of a clinical career.